Incident Type 2 Diabetes in Individuals With CKD: The REGARDS Study.

RATIONALE &

OBJECTIVE

Chronic kidney disease (CKD) and diabetes are comorbid metabolic diseases that share common factors such as insulin resistance. Few studies have examined the association between CKD and incident diabetes, with limited consensus and associated risk factors. We conducted an analysis of participants in the Reasons for Geographic and Racial Differences in stroke study to investigate incident diabetes among participants with CKD compared with non-CKD participants.

STUDY

DESIGN

A prospective cohort study.

SETTING &

PARTICIPANTS

Total of 7,511 participants who completed 10 years of follow-up were included in the analysis, of whom 994 had CKD (an estimated glomerular filtration rate <60 mL/min/1.73m2 or albumin-to-creatinine ratio >30mg/g) at baseline.

EXPOSURE: CKD.

OUTCOME: Incident diabetes.

ANALYTICAL APPROACH: Logistic regression analysis was performed to estimate the odds of incident diabetes among CKD participants, with odds ratio (OR) and 95% CI. Risk factors for incident diabetes among CKD participants were also examined.

RESULTS

After 10 years of follow-up, 11.0% (717) of non-CKD participants and 15.8% (157) of CKD participants developed diabetes. Incident diabetes was higher among CKD participants than in non-CKD participants using creatinine-based equations, which was not seen when using a creatinine-based and cystatin C-based equation for CKD. Several risk factors such as race, prediabetes, age, body mass index, hypertension, current smoking, and exercise ≥ 4 times/week increased the odds of incident diabetes, whereas current alcohol use had a lower risk of incident diabetes. Prediabetes had the highest risk of incident diabetes (OR = 4.94, 95% Cl: 4.22-5.78; P < 0.01).

LIMITATIONS: Attrition bias, limited generalizability, and limited diagnostic classification.

CONCLUSIONS

The association between CKD and incident diabetes depends on how CKD is defined. These findings highlight the need for future studies to explore how renal function is assessed when determining adverse outcomes related to CKD.