Original Articles Vol. 3 No. 3 (2026): Bioscience Insights Published 2026-10-23

ASSOCIATION BETWEEN GLYCEMIC VARIABILITY AND RAPID DECLINE OF KIDNEY FUNCTION IN TYPE 2 DIABETES MELLITUS PATIENTS

Authors

  • Dr Tanzeela Khalil Dar MBBS, Azad Jammu Kashmir Medical College, Muzaffarabad, Pakistan Pakistan Author
  • Ismail Mansoor Doctor, MBBS, CMH Lahore Medical College, Pakistan Pakistan Author
  • Hassan Mujtaba Student, Minhaj University, Lahore, Pakistan Pakistan Author
  • Dr. Munawar Ali Awan Assistant Professor, ICU, Ayub Medical College, Abbottabad, Pakistan Pakistan Author
  • Bisma Irshad PGT Medicine, POF Hospital Wah Cantt, Pakistan Pakistan Author
  • Prof. Shaikh Khalid Muhammad MBBS, FCPS (Medicine), Professor of Medicine, CMC Teaching Hospital, Shaheed Mohtarma Benazir Bhutto Medical College, Larkana, Pakistan Pakistan Author
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Abstract

Background: Glycated hemoglobin (HbA1c) is widely used to assess long-term glycemic control in patients with type 2 diabetes mellitus. However, average HbA1c may not fully reflect fluctuations in glucose control over time. Increasing evidence suggests that visit-to-visit glycemic variability may contribute to diabetic kidney disease and faster loss of renal function.

Objective: To examine the association between long-term HbA1c variability and rapid decline in kidney function among patients with type 2 diabetes mellitus.

Methods: A longitudinal cohort framework was used to assess 412 adults with type 2 diabetes. Glycemic variability was estimated using the coefficient of variation of serial HbA1c measurements. Patients were categorized into low, moderate, and high variability groups. Kidney function was assessed using estimated glomerular filtration rate (eGFR), and annual change in eGFR was calculated during follow-up. Multivariable logistic regression was used to determine whether HbA1c variability was independently associated with rapid renal decline after adjustment for relevant clinical factors.

Results: The mean age of participants was 58.5 ± 10.0 years, and 53.9% were male. Mean baseline HbA1c was 8.13 ± 1.20%, while mean baseline eGFR was 73.0 ± 18.8 mL/min/1.73 m². Annual eGFR decline increased across low, moderate, and high glycemic variability groups from −0.84 to −1.41 and −1.74 mL/min/1.73 m²/year, respectively (p < .001). Rapid renal decline occurred in 0.7%, 4.4%, and 9.5% of these groups (p = .003). HbA1c variability showed a moderate negative correlation with annual eGFR change (r = −0.431, p < .001). After adjustment, higher HbA1c variability remained independently associated with rapid renal decline (adjusted OR = 1.31, 95% CI 1.14–1.51).

Conclusion: Greater visit-to-visit HbA1c variability was associated with faster kidney function decline. Monitoring glycemic stability, in addition to average HbA1c, may help identify patients at greater risk of diabetic kidney disease progression.

Keywords

  • Precision nutrition, functional foods, artificial intelligence, nanoencapsulation, nutrigenomics, microbiome modulation, food technology.

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