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Glycemic variability predicts all-cause mortality among adults with diabetes on hemodialysis
Adults with diabetes undergoing hemodialysis who had the most glycemic variability had a greater all-cause mortality risk than those with less variability, according to findings published in the Journal of Diabetes and its Complications.
“Glycemic variability has emerged as a measure that could more accurately capture the pathological processes of the occurrence of adverse outcomes,” Chao Shi, of the department of nephrology at the First Affiliated Hospital of Jiaxing University in China, and colleagues wrote. “Up to now, no studies have explored the association between glycemic variability and mortality among patients with diabetes on maintenance dialysis.”
Shi and colleagues used continuous glucose monitoring to assess baseline glycemic variability during 2 consecutive days — one with dialysis and one without — among 1,240 adults with diabetes who were treated with hemodialysis (mean age, 64.3 years; 39.2% women). According to the researchers, a biosensor in the CGM device takes glucose measurements at 3-minute intervals. The researchers established coefficients of variation for each participant with these data. Participants with a coefficient of variation of more than 52% had the most glycemic variability whereas participants with a coefficient of variation of 31% or less had the least glycemic variability. The researchers examined patients records during 2.4 years of median follow-up to assess mortality.
The researchers identified 340 deaths in the entire cohort and found that participants with the most glycemic variability were twice as likely to die during follow-up as participants with the least glycemic variability (OR = 2; 95% CI, 1.2-3.2). The researchers also noted that “the highest coefficient of variation quartile remained a statistically significant predictor of all-cause mortality” in fully adjusted models, with those with the most glycemic variability more likely to die during follow-up than those with a coefficient of variation of between 31% and 40% (OR = 2.2; 95% CI, 1.3-3.7) and between 40% and 52% (OR = 1.7; 95% CI, 1-2.7).
“We found that high glycemic variability was independently associated with an increased risk of all-cause mortality among this patient population regardless of hemoglobin, albumin, C-reactive protein, prior cardiovascular disease history, medication or hypoglycemia, adding to the growing body of evidence on the prognostic value of glycemic variability,” the researchers wrote. “The association of glycemic variability with mortality could be related to an important influence of glycemic variability on the development of various complications, especially diabetes macrovascular and microvascular complications.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.