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 Compared to individuals with normal blood sugar, people with
slightly abnormal glucose levels are more likely to have two
problems associated with kidney disease – abnormal blood filtration
and more of the protein albumin in the urine, the study found.
The questions, said Dr. Robert Cohen, an endocrinology researcher at
the University of Cincinnati College of Medicine who wasn’t involved
in the study, are, “What represents abnormal `enough’ blood sugar to
start causing problems in the kidneys that we see with full blown
diabetes, and what criteria should we be using if we want to get a
head start on preventing the complications of diabetes?”
Globally, about one in nine adults have diabetes, which is often
linked to obesity and aging and develops when the body can't
properly use or make enough of the hormone insulin to convert sugar
into energy.
While the link between full-blown diabetes and chronic kidney
disease is well known, doctors disagree about how much sugar in the
blood might pose a risk to people without the disease. They also
disagree on how to diagnose and treat patients with only mildly
abnormal blood glucose levels and whether it’s reasonable to call
this condition “prediabetes.”
For the current study, Dr. Toralf Melsom of the University of North
Norway and colleagues assessed blood sugar and indicators of kidney
damage in 1,261 people aged 50 to 62 who didn’t have diabetes.
Researchers looked for abnormal blood sugar by measuring blood
glucose in fasting patients, and by measuring blood levels of
hemoglobin A1c. This second test estimates average blood sugar over
several months based on the percentage of hemoglobin – the protein
in red blood cells that carries oxygen – that is coated with sugar.
At the start of the study, 595 people had slightly abnormal blood
sugar levels based on U.S. guidelines for interpreting these test
results, which are fairly stringent. Under guidelines favored
outside the U.S. that require more sugar in the blood before glucose
levels are considered elevated, only 169 people had abnormal
results.
After a typical follow-up period of around five years, people with
slightly abnormal blood sugar under either set of guidelines were
more likely to have kidneys that were working harder to filter the
blood. The condition, called hyperfiltration, is thought to
contribute to kidney damage in diabetes.
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Participants who had slightly abnormal baseline fasting glucose test
results were also more likely to have elevated levels of albumin in
the urine, indicating early kidney damage.
The subset of people with slightly abnormal blood sugar under the
more restrictive guidelines used outside the U.S. were 95 percent
more likely to have high blood filtration rates and 83 percent more
likely to have excess albumin in the urine.
The study only included middle-aged white people, so the results
might be different in other populations, the authors acknowledge in
the American Journal of Kidney Diseases. There also isn’t consensus
on the best way to define kidney filtration in studies of large
populations because nephrons, the functional waste-processing unit
in the kidney, vary by age and gender, the authors note.
While the study findings may not change clinical practice, the
results highlight the need for doctors to pay attention to people
with slightly elevated blood sugar, said Dr. Laura Rosella, a public
health researcher at the University of Toronto who wasn’t involved
in the study.
These people should focus on lifestyle changes such as eating
better, exercising more and losing weight, she said.
“If someone adopts the necessary changes that would prevent the
onset of diabetes, it is likely to protect against the progression
to kidney disease as well – just like it will prevent cardiovascular
disease and many cancers,” Rosella added.
SOURCE: http://bit.ly/1RPIBGN American Journal of Kidney Diseases,
online December 29, 2015.
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