Abstract: TH-PO743

Burnt-Out Diabetes Phenomenon and Association between Glycemic Control and Cardiovascular Comorbidity Rate in Hemodialysis Patients

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Abe, Masanori, Nihon University School of Medicine, Tokyo, Japan
  • Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, Osaka-fu, Japan
  • Hoshino, Junichi, Toranomon Hospital, Tokyo, Japan
  • Nakai, Shigeru, Fujita Health University School of Health Scieneces, Toyoake, Aichi, Japan
  • Masakane, Ikuto, Honcho-Yabuki Clinic, Yamagata, Japan

Group or Team Name

  • Committee of Japanese Renal Data Registry, Japanese Society for Dialysis Therapy
Background

In patients with diabetes on hemodialysis (HD), glycemic control improves spontaneously, leading to normal glycated hemoglobin (HbA1c) levels; this phenomenon is known as “burnt-out diabetes.” However, glycated albumin (GA) might be a better indicator of glycemic control than HbA1c in HD patients. Therefore, the aim of this study was to identify how many patients experience “burnt-out diabetes” using HbA1c and GA levels and to examine the association between glycemic control and cardiovascular comorbidity risk in patients on HD.

Methods

The data were obtained from the annual nationwide surveys of dialysis patients conducted by the Japanese Society for Dialysis Therapy (JSDT) in 2013. Patients with diabetes on HD whose HbA1c and GA levels were measured and whose antidiabetic therapy was recorded were included. The “burnt-out diabetes” phenomenon was investigated in patients who were assessed for both HbA1c and GA levels. The association between cardiovascular comorbidity risk and HbA1c and GA levels were assessed using multivariable logistic regression models.

Results

In this cohort study, 23,668 patients were included. When “burnt-out diabetes” was defined as HbA1c <6.0% without treatment with antidiabetic medication, it was noted in 4,899 patients (20.7%). However, when “burnt-out diabetes” was defined as HbA1c <6.0% and GA <16.0% without treatment with antidiabetic medication, it was found in 1,286 patients (5.4%). Higher HbA1c levels were associated with the comorbidity rate of all cardiovascular diseases. However, higher GA levels were associated with comorbidities of all cardiovascular diseases except cerebral hemorrhage.
The odds ratio (OR) of the cardiovascular comorbidity rate based on the GA category, with GA 16.0 to <18.0% treated as the reference group. The OR of cardiovascular comorbidity risk were significantly associated with GA >18%. After adjustment for confounders, the OR of the GA <16.0% group was significantly decreased as compared to the reference group.

Conclusion

Although the “burnt-out diabetes” phenomenon might be present in 20.7% of patients with diabetes on HD in terms of HbA1c, the rate was significantly decreased to 5.4% in terms of GA. The risk of cardiovascular comorbidity was higher in patients with GA > 18%.