Background
Methods
Study population and design
Definition of diabetes mellitus
Laboratory analysis
Statistical methods
Results
Baseline characteristics
HbA1C ≤ 7.0 % (53 mmol/mol) n = 897 | HbA1C > 7.0 % (53 mmol/mol) n = 945 | |
---|---|---|
Epidemiological data | ||
Age (years) | 65 ± 8 | 64 ± 8 |
Male, number (%) | 591 (65.9) | 637 (67.4) |
Systolic blood pressure (mm Hg) | 141 ± 22 | 143 ± 21 |
Diastolic blood pressure (mm Hg) | 76 ± 12 | 76 ± 12 |
BMI (kg/m2) | 32 ± 6 | 33 ± 6 |
Current smokers, number (%) | 127 (14.2) | 142 (15.0) |
Duration of CKD | ||
≥ 5 years | 369 (41.2) | 413 (43.7) |
3 – < 5 years | 133 (14.8) | 162 (17.1) |
1 – < 3 years | 207 (23.1) | 198 (21.0) |
< 1 year | 154 (17.2) | 130 (13.8) |
Physical activity | ||
Less than once a week | 173 (19.3) | 201 (21.3) |
1–2 times a week | 202 (22.6) | 221 (23.4) |
3–5 times a week | 256 (28.6) | 236 (25.0) |
More than 5 times a week | 251 (28.0) | 278 (29.5) |
CV disease, number (%) a
| 403 (44.9) | 463 (49.0) |
Laboratory data | ||
Creatinine (mg/dL) | 1.47 (1.23, 1.80) | 1.50 (1.27, 1.83) |
eGFR (mL/min/1.73 m2) | 44 (35, 55) | 44 (35, 54) |
eGFR 0–29 | 126 (14.1) | 125 (13.6) |
eGFR 30–44 | 322 (36.1) | 346 (37.6) |
eGFR 45–59 | 296 (33.2) | 301 (32.7) |
eGFR ≥ 60 | 148 (16.6) | 149 (16.2) |
Urinary albumin/creatinine-ratio (mg/gCrea) | 34 (7, 330) | 59 (10, 412) |
< 30 | 420 (48.4) | 356 (38.7) |
30–300 | 216 (24.9) | 298 (32.4) |
> 300 | 231 (26.6) | 266 (28.9) |
Hemoglobin (g/dL) a
| 13.4 (12.1, 14.5) | 13.6 (12.5, 14.5) |
HbA1C (%) | 6.6 (6.3, 6.8) | 7.9 (7.4, 8.6) |
HbA1C (mmol/mol) | 49 (45, 51) | 63 (57, 70) |
Serum albumin (g/L) | 38.6 (35.9, 40.6) | 38.1 (35.6, 40.5) |
CRP (mg/L) | 2.50 (1.24, 5.78) | 3.13 (1.47, 6.73) |
Calcium (mmol/L) | 2.27 (2.18, 2.35) | 2.28 (2.19, 2.36) |
Phosphate (mmol/L) | 1.11 (0.97, 1.25) | 1.09 (0.96, 1.23) |
Ca/Ph-Produkt (mmol2/L2) | 2.03 (1.79, 2.33) | 2.06 (1.79, 2.33) |
Total cholesterol (mg/dL) b
| 194.9 (167.4, 228.8) | 192.2 (161.2, 223.7) |
HDL (mg/dL) b
| 45.1 (37.4, 55.7) | 43.2 (35.8, 53.4) |
LDL (mg/dL) b
| 103.1 (82.9, 131.8) | 99.4 (75.3, 124.3) |
TG (mg/dl) c
| 180.9 (125.5, 259.8) | 197.1 (134.8, 279.4) |
Antidiabetic treatment strategies | ||
Dietary treatment alone | 292 (35.1) | 113 (13.5) |
Oral anti-diabetic drugs alone, any
| 277 (33.3) | 149 (17.8) |
Oral anti-diabetic drugs plus insulin | 49 (5.9) | 92 (10.9) |
Insulin alone | 214 (25.7) | 485 (57.8) |
Antidiabetic treatment
Dietary treatment | Oral anti-diabetic drugs alone, any
| Oral anti-diabetic drugs plus insulin | Insulin alone |
P-value a
| Classes of oral antidiabetic drugs, alone or in combination | ||||
---|---|---|---|---|---|---|---|---|---|
Metformin | Sulfonyl-ureas | Glinides | DPP-4-inhibitors | ||||||
Number | 405 | 426 | 141 | 699 | 346 | 265 | 119 | 191 | |
Percent | 24.2 | 25.5 | 8.4 | 41.8 | 18.8 | 14.4 | 6.5 | 10.4 | |
Age, years
| 65 ± 8 | 65 ± 7 | 65 ± 7 | 64 ± 9 | 0.0377 | 64 ± 8 | 67 ± 6 | 66 ± 6 | 65 ± 7 |
Male, n (%)
| 270 (66.7) | 282 (66.2) | 89 (63.1) | 478 (68.4) | 0.64 | 213 (61.6) | 175 (66.0) | 92 (77.3) | 129 (67.5) |
BMI, kg/m
2
| 31 ± 6 | 32 ± 6 | 35 ± 6 | 32 ± 6 | <0.0001 | 33 ± 6 | 33 ± 6 | 32 ± 6 | 34 ± 6 |
Hemoglobin, g/dL
c
| 13.6 (12.5, 14.8) | 13.5 (12.2, 14.5) | 13.6 (12.6, 14.5) | 13.3 (12.2, 14.4) | 0.0833 | 13.6 (12.3, 14.7) | 13.4 (12.5, 14.5) | 13.5 (12.5, 14.6) | 13.6 (12.5, 14.6) |
HbA1c, %
| 6.7 (6.5, 7.1) | 6.7 (6.3, 7.3) | 7.5 (6.8, 8.4) | 7.5 (6.8, 8.4) | <0.0001 | 6.9 (6.4, 7.6) | 7.1 (6.5, 7.9) | 6.8 (6.5, 7.6) | 6.9 (6.4, 7.7) |
HbA1c, mmol/mol
| 50 (48, 54) | 50 (45, 56) | 58 (51, 68) | 58 (51, 68) | 52 (46, 60) | 54 (48, 63) | 51 (48, 60) | 52 (46, 61) | |
eGFR, mL/min/1.73 m
2
| 44 (35, 55) | 48 (38, 58) | 46 (37, 56) | 41 (33, 51) | <0.0001 | 53 (43, 62) | 45 (36, 55) | 42 (33, 50) | 47 (36,56) |
UACR, mg/gCrea
| 34 (8, 253) | 31 (8, 322) | 52 (9, 333) | 71 (11, 512) | 0.0011 | 38 (7, 369) | 50 (9, 329) | 45 (9, 371) | 29 (6, 202) |
CV disease, n(%)
b
| 176 (43.5) | 169 (39.7) | 72 (51.1) | 382 (54.7) | <0.0001 | 141 (40.7) | 120 (45.3) | 46 (38.7) | 88 (46.1) |
Duration of CKD | |||||||||
≥ 5 years | 183 (45.3) | 152 (35.7) | 56 (39.7) | 324 (46.4) | 0.0021 | 121 (34.9) | 99 (37.4) | 50 (42.0) | 68 (35.6) |
3 – < 5 years | 65 (16.1) | 63 (14.8) | 23 (16.3) | 115 (16.5) | 50 (14.5) | 35 (13.2) | 20 (16.8) | 28 (14.7) | |
1 – < 3 years | 80 (19.8) | 108 (25.3) | 25 (17.7) | 152 (21.8) | 81 (23.4) | 69 (26.0) | 30 (25.2) | 47 (24.6) | |
< 1 year | 63 (15.6) | 84 (19.7) | 22 (15.6) | 84 (12) | 66 (19.1) | 50 (18.9) | 17 (14.3) | 41 (21.4) |
Insulin | Dietary treatment | Metformin | Sulfonyl-ureas | Metformin + Insulin | Glinides | DPP-4 inhibitors | Metformin + Sulfonyl-ureas | Sulfonyl-ureas + Insulin | Metformin + DPP-4 inhibitors | DPP-4 inhibitors + Insulin | |
---|---|---|---|---|---|---|---|---|---|---|---|
N | 699 | 405 | 123 | 123 | 76 | 59 | 46 | 38 | 38 | 37 | 27 |
Percent | 41.8 | 24.2 | 7.4 | 7.4 | 4.6 | 3.5 | 2.8 | 2.3 | 2.3 | 2.2 | 1.6 |
Age, years
| 64 ± 9 | 65 ± 8 | 64 ± 9 | 67 ± 6 | 64 ± 7 | 66 ± 6 | 65 ± 7 | 66 ± 5 | 66 ± 6 | 64 ± 8 | 65 ± 7 |
Male gender, n (%)
| 478 (68.4) | 270 (66.7) | 70 (56.9) | 80 (65.0) | 46 (60.5) | 45 (76.3) | 36 (78.3) | 29 (76.3) | 27 (71.1) | 22 (59.5) | 16 (59.3) |
BMI, kg/m
2
| 32 ± 6 | 31 ± 6 | 33 ± 6 | 32 ± 5 | 35 ± 5 | 31 ± 5 | 34 ± 5 | 33 ± 6 | 34 ± 8 | 32 ± 5 | 36 ± 6 |
Hemoglobin, g/dL
b
| 13.2 (12.2, 14.4) | 13.6 (12.5, 14.8) | 13.7 (12.2, 5.0) | 13.4 (12.3, 14.5) | 13.7 (12.4, 14.4) | 13.5 (12.4, 14.5) | 13.1 (12.1, 14.3) | 13.1 (12.1, 14.4) | 13.7 (12.7, 14.7) | 14.1 (12.5, 15.1) | 13.5 (12.8, 14.1) |
HbA1c, %
c
| 7.5 (6.8, 8.4) | 6.7 (6.5, 7.1) | 6.6 (6.3, 7.1) | 6.8 (6.3, 7.5) | 7.3 (6.8, 8.1) | 6.7 (6.3, 7.0) | 6.7 (6.3, 7.1) | 7.3 (6.6, 7.9) | 7.8 (7.0, 8.6) | 6.7 (6.4, 7.2) | 7.6 (6.6, 8.7) |
eGFR, mL/min/1.73 m
2
| 43 ± 15 | 46 ± 17 | 56 ± 18 | 45 ± 12 | 55 ± 17 | 42 ± 10 | 45 ± 13 | 52 ± 16 | 42 ± 12 | 53 ± 17 | 41 ± 12 |
UACR, mg/gCrea
| 71 (11, 512) | 34 (8, 253) | 22 (7, 322) | 45 (8, 319) | 59 (7, 353) | 51 (8, 245) | 22 (5, 247) | 56 (14, 408) | 81 (12, 357) | 29 (6, 441) | 29 (14, 102) |
Duration of CKD, n (%)
| |||||||||||
≥ 5 years | 324 (46.4) | 183 (45.3) | 38 (30.9) | 47 (38.2) | 32 (42.1) | 27 (45.8) | 16 (34.8) | 10 (26.3) | 14 (36.8) | 14 (37.8) | 10 (37) |
3 – < 5 years | 115 (16.5) | 65 (16.1) | 19 (15.5) | 17 (13.8) | 13 (17.1) | 10 (17) | 9 (19.6) | 6 (15.8) | 4 (10.5) | 2 (5.4) | 6 (22.2) |
1 – < 3 years | 152 (21.8) | 80 (19.8) | 29 (23.6) | 33 (26.8) | 11 (14.5) | 15 (25.4) | 9 (19.6) | 11 (29) | 10 (26.3) | 11 (29.7) | 4 (14.8) |
< 1 year | 84 (12) | 63 (15.6) | 27 (22) | 25 (20.3) | 11 (14.5) | 6 (10.2) | 11 (23.9) | 7 (18.4) | 5 (13.2) | 8 (21.6) | 6 (22.2) |
CV disease, number (%)
a
| 382 (54.7) | 176 (43.5) | 38 (30.9) | 58 (47.2) | 38 (50) | 17 (28.8) | 17 (37) | 23 (60.5) | 16 (42.1) | 16 (43.2) | 18 (66.7) |
Glycaemic control and hemoglobin
Factors associated with HbA1C
Indicators a, b
| Regression coefficient a
| Standard error a
| Odds ratio a
| 95 % confidence interval a
|
P-value a
|
---|---|---|---|---|---|
Body mass index (per 1 kg/m2 increase) | 0.0374 | 0.0091 | 1.038 | 1.020–1.057 | <0.0001 |
Hemoglobin (per 1 g/dL increase) c
| 0.1060 | 0.0323 | 1.112 | 1.044–1.184 | 0.0010 |
Antidiabetic treatment strategies b
| |||||
Oral anti-diabetic drugs alone, any (n = 426) | 0.2177 | 0.1566 | 1.243 | 0.915–1.690 | 0.16 |
Oral anti-diabetic drugs plus insulin (n = 141) | 1.4428 | 0.2159 | 4.233 | 2.772–6.462 | <0.0001 |
Insulin alone (n = 699) | 1.7288 | 0.1427 | 5.634 | 4.260–7.452 | <0.0001 |