The retinopathy-derived HbA1c threshold of 6.5% for type 2 diabetes also captures the risk of diabetic nephropathy in NHANES.
As per the recommendation of the International Expert Committee (IEC), individuals with HbA1c levels of 6.5% or more have a markedly increased risk of retinopathy. This definition didn’t take into account other diabetic microvascular complications of nephropathy and neuropathy, for which the HbA1c level of 6.5% might be too high. Stephen L. Atkin and colleagues conducted research under the title “The retinopathy-derived HbA1c threshold of 6.5% for type 2 diabetes also captures the risk of diabetic nephropathy in NHANES” published in the Diabetes, Obesity and Metabolism journal. The summary of this study is given below:
Objective:
To investigate whether an HbA1c diagnostic threshold of less than 6.5% could be identified based on a urinary albumin-creatinine ratio (UACR) of 30 mg/g or higher in subjects without diabetes.
Methods:
In 2011-2018 nationally representative cross-sectional National Health and Nutrition Examination Surveys, a UACR was measured for 20,158 participants.
Findings:
The study reports that the percentage of elevated UACR is only significantly increased in those subjects with an HbA1c of 7.0% or higher compared with those individuals with HbA1c levels of less than 5.0%. Additionally, the study suggests aggressive management of prediabetes due to the increased risk of chronic kidney disease in these subjects. Investigators add that the retinopathy-derived HbA1c threshold of 6.5% also considers the risk for diabetic nephropathy in NHANES.
Limitations:
InvestiCgators highlight several limitations of the study such as small sample size with elevated HbA1c, only a single record of UACR with no data for any seasonal variations in values. Additionally, the database unable to exclude those subjects with microalbuminuria and a low HbA1c because of kidney disease other than diabetic nephropathy. Lastly, the findings can’t be generalized.
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