| Objective:A retrospective cohort study was conducted to investigate the relationship between islet function indicators and the progression of renal function in patients with T2DM,and to evaluate its value in predicting renal outcome events in patients with T2DM,so as to provide a new strategy for monitoring and clinical treatment of diabetic kidney disease.Methods:Patients with T2DM who were hospitalized for 2 or more times from January 2011 to September 2021 at the Third Xiangya Hospital of Central South University with an interval of 5±0.5 years were included.The data included basic information(age,sex,duration of diabetes,waist circumference and so on)and laboratory indicator(fasting glucose,fasting insulin,serum creatinine,hemoglobin A1c,lipids and so on).Homeostatic model assessment for insulin resistance,homeostatic model assessment ofβ-cell function and estimated glucose disposal rate index were used to assess islet function.Multiple interpolation of missing values was performed using chain equations.Renal outcome events included e GFR<60 ml/min/1.73 m~2,e GFR decline rate≥50%,doubling of blood creatinine,end stage renal disease and renal composite endpoints(e GFR decline rate≥50%,doubling of blood creatinine or end-stage renal disease).Restricted cubic spline and generalized linear models were used to analyze the correlation between islet function indicators and renal outcome events.Stratified analysis was performed by gender,age,and duration of diabetes mellitus.Results:1.A total of 956 patients with T2DM with baseline e GFR≥60 ml/min/1.73 m~2 were finally included.After a mean follow-up of4.9±0.6 years.747(78.14%)patients experienced a decline in renal function,229(23.95%)patients experienced a rapid e GFR decline,210(21.97%)patients had e GFR<60 m L/min/1.73 m~2.109(11.4%)patients had a decrease in e GFR≥50%,94(9.83%)patients experienced doubling of blood creatinine,47(4.92%)patients entered end-stage renal disease,116(12.13%)patients had renal composite endpoint events.2.Patients in the e GFR<60ml/min/1.73m~2 group had higher baseline age,duration of diabetes,blood pressure,Hb A1c levels and lower e GDR compared to the e GFR≥60ml/min/1.73m~2 group,all with statistically significant differences(P<0.05).HOMA-IR and HOMA-B levels were not statistically different between the two groups(P>0.05).3.The results of the restricted cubic spline based on linear regression showed that after controlling for age,duration of diabetes,uric acid,LDL,triglycerides,and BMI confounders,baseline e GDR was significantly and non-linearly correlated with the rate of decline in e GFR and follow-up e GFR(P<0.001),but neither HOMA-IR nor HOMA-B was associated with the rate of decline in e GFR and follow-up e GFR(P>0.05).4.The results of the restricted cubic spline based on logistic regression showed that after controlling for age,duration of diabetes,uric acid,LDL,triglycerides,lipid-lowering drugs,anticoagulant drugs,and medication history of insulin confounders,e GDR<6.39 mg/kg/min was an independent risk factor for the occurrence of rapid e GFR decline,renal outcome events,and renal composite endpoints in patients with T2DM,with all differences were statistically significant(P<0.05).However,HOMA-IR and HOMA-B were not correlated with rapid e GFR decline and renal outcome events.5.Generalized linear model analysis showed that after controlling for age,duration of diabetes,uric acid,urea,LDL,medication history(lipid-lowering drugs,antidiabetic,anticoagulant),compared with e GDR controls(5.65-6.91 mg/kg/min),patients with e GDR>8.33 mg/kg/min had 76%,62%,62%,63%,42%,and 63%lower risk of rapid e GFR decline,e GFR<60 m L/min/1.73m~2,>50%decline in e GFR,doubling of blood creatinine,end-stage renal disease,and renal composite endpoints,respectively.e GDR≤4.2 mg/kg/min was an independent risk factor for the development of rapid e GFR decline(OR=1.60,P=0.041),doubling of blood creatinine(OR=2.29,P=0.011)and end-stage renal disease(OR=6.50,P<0.001)in patients with T2DM.The predictive value of e GDR for the occurrence of e GFR<60 m L/min/1.73m~2and renal composite endpoint events in patients with T2DM was superior to that of Hb A1c,waist circumference,and hypertension.6.Stratified analysis showed that e GDR was associated with rapid e GFR decline and ESRD regardless of whether the patient was male or female,age<65 or≥65 years,and duration of diabetes<10 or≥10 years.Higher cut-off points for e GDR exert renoprotective effects in T2DM patients with age<65 years,diabetes mellitus<10 years,and men.Conclusion:The islet function index e GDR was strongly associated with the occurrence of rapid e GFR decline and renal outcome events in patients with T2DM.T2DM patients with age<65 years,diabetes mellitus<10 years,and men need to pay more attention to improve insulin resistance.However,HOMA-IR and HOMA-B were not correlated with the progression of renal function in T2DM. |
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