medwireNews: A post-hoc analysis of a prospective study indicates that increased time in range (TIR) is linked to a reduction in albuminuria in people with type 1 diabetes.
Ajenthen Ranjan (Steno Diabetes Center Copenhagen, Gentofte, Denmark) and co-researchers studied 26 people who had been randomly assigned to receive sensor-augmented insulin pump therapy as part of an open-label trial.
During the 12-month trial, glycated hemoglobin (HbA1c) reduced from an average of 76.0 to 61.8 mmol/mol (9.1 to 7.8%) and average TIR (blood glucose 3.9–10.0 mmol/L; 70 to 180 mg/dL) improved from 46.9% to 64.3%. The average urinary albumin-to-creatinine ratio (UACR) fell from 95.8 to 76.3 mg/g.
The changes in albuminuria significantly and inversely correlated with TIR, such that the UACR fell by 18.6% with each 10% increase in TIR. This remained statistically significant after accounting for BMI, mean arterial pressure, and HbA1c.
UACR also fell by 22.1% with each 10 mmHg reduction in mean arterial pressure, although this measure did not itself change during the trial, the team notes in Diabetes Care.
In addition to its association with TIR, albuminuria also fell with decreasing mean glucose level and glucose management indicator after accounting for confounders, but not with glucose variability.
“Thus, we can speculate that albuminuria may be determined by the overall glucose load rather than by the glucose fluctuations,” say Ranjan and team. “However, more studies are needed to confirm these findings.”
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