Fasting glucose variability as a risk indicator for end‐stage kidney disease in patients with diabetes: A nationwide population‐based study

Da Young Lee, Jaeyoung Kim, Sanghyun Park, So Young Park, Ji Hee Yu, Ji A Seo, Nam Hoon Kim, Hye Jin Yoo, Sin Gon Kim, Kyung Mook Choi, Sei-Hyun Baik, Kyungdo Han, Nan Hee Kim

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3 Citations (Scopus)


Given the fact that diabetes remains a leading cause of end‐stage kidney disease (ESKD), multi‐aspect approaches anticipating the risk for ESKD and timely correction are crucial. We inves-tigated whether fasting glucose variability (FGV) could anticipate the development of ESKD and identify the population prone to the harmful effects of GV. We included 777,192 Koreans with diabetes who had undergone health examinations more than three times in 2005–2010. We evaluated the risk of the first diagnosis of ESKD until 2017, according to the quartile of variability independent of the mean (VIM) of FG using multivariate‐adjusted Cox proportional hazards analyses. During the 8‐year follow‐up, a total of 7290 incidents of ESKD were found. Subjects in the FG VIM quartile 4 had a 27% higher risk for ESKD compared to quartile 1, with adjustment for cardiovascular risk factors and the characteristics of diabetes. This effect was more distinct in patients aged <65 years; those with a long duration of diabetes; the presence of hypertension or dyslipidemia; and prescribed angiotensin‐converting enzyme inhibitors, metformin, sulfonylurea, α‐glucosidase inhibitors, and insulin. In contrast, the relationship between baseline FG status and ESKD risk showed a U‐shaped association. FGV is an independent risk factor for kidney failure regardless of FG.

Original languageEnglish
Article number5948
JournalJournal of Clinical Medicine
Issue number24
Publication statusPublished - 2021 Dec 2

Bibliographical note

Funding Information:
Funding: This research was supported Visit‐to‐Visit Glucose Variability Predicts the Development of End‐Stage Renal Disease in Type 2 Diabetes by the Bio and Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (NRF‐2019M3E5D3073102 and NRF‐2019R1H1A2039682), a Korea University Grant (K1810951), and the Basic Science Research Program through NRF funded by the Ministry of Education (NRF‐ 2020R1I1A1A0107166512).

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzer-.


  • Diabetes mellitus
  • End‐stage kidney disease
  • Glucose variability
  • Korean National Health Insurance Corporation

ASJC Scopus subject areas

  • General Medicine


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