AUTHOR=An Lingwang , Yu Qiuzhi , Chen Linhui , Tang Hong , Liu Yanjun , Yuan Qun , Ji Yu , Lee Yaujiunn , Lu Juming 

TITLE=The Association Between the Decline of eGFR and a Reduction of Hemoglobin A1c in Type 2 Diabetic Patients

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 12 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2021.723720

DOI=10.3389/fendo.2021.723720

ISSN=1664-2392

ABSTRACT=Objective: This study aimed to explore the relationship between short-term (≤12 months) changes in the estimated glomerular filtration rate (eGFR) and haemoglobin A1c (HbA1c) in patients with type 2 diabetes (T2D).
Method: A total of 2,599 patients with T2D were enrolled if they were registered in the Diabetes Sharecare information system, were aged 18–75 years and had 2–3 HbA1c and eGFR measurements within the preceding 12 months. The studied patients were categorised into five groups based on eGFR, i.e. the relatively stable (RS), fast decline (FD), modest decline (MD), modest increase (MI) and fast increase (FI) groups. 
Results: The median eGFR changes from the baseline were −22.14, −6.44, 0.00, 6.32 and 20.00 mL/min per 1.73 m2 for patients in the FD, MD, RS, MI and FI groups, respectively. Up to 1,153 (44.4%) subjects experienced an eGFR decline of ≥3.5 mL/min per 1.73 m2, including 821 (31.6%) FD subjects and 332 (12.8%) MD subjects.A decrease trend was found between the eGFR change and HbA1c decrease category, even after multivariable adjustment. In general, an eGFR FD was frequently found in patients who had an HbA1c reduction of ≥3.00% and a baseline HbA1c ≥8.0%; alternatively, such a result was also observed for a urinary albumin-to-creatinine-ratio (UACR) of 30.0–300.0 mg/g, regardless of a diabetes duration of <10.0 or ≥10.0 years, or in patients who had an HbA1c reduction of ≥1.00% accompanied by hyperfiltration.
Conclusions:Some patients with T2D experienced an eGFR FD or MD during the ≤12 month follow-up period. A significant downward trend in eGFR change was demonstrated alongside an HbA1c reduction, independent of UACR stage, diabetes duration and hyperfiltration. Sustained monitoring and cautious interpretation of the HbA1c and eGFR changes will be needed in clinical practice.