Kidney Week

Abstract: FR-PO0528

Glycemic Markers and Kidney Function Decline in Type 2 Diabetes

Session Information

• CKM: Clinical - Trials, Epidemiology, and Biomarkers
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Tang, Mengyao, Massachusetts General Hospital, Boston, Massachusetts, United States

Mengyao Tang, MD, MPH, FASN

• Wexler, Deborah J., Massachusetts General Hospital, Boston, Massachusetts, United States

Deborah J. Wexler, MD, MS

• Nathan, David M., Massachusetts General Hospital, Boston, Massachusetts, United States

David M. Nathan, MD

• Rhee, Eugene P., Massachusetts General Hospital, Boston, Massachusetts, United States

Eugene P. Rhee, MD, FASN

• de Boer, Ian, University of Washington, Seattle, Washington, United States

Ian de Boer, MD, MS

• Kalim, Sahir, Massachusetts General Hospital, Boston, Massachusetts, United States

Sahir Kalim, MD, MS, MSc, FASN

Background

HbA1c is the standard measure of glycemia in type 2 diabetes (T2D), yet residual kidney risk persists even with target HbA1c. Whether other glycemic markers such as glycated albumin (GA), continuous glucose monitoring (CGM)-derived metrics, and oral glucose tolerance test (OGTT) measures capture additional information about kidney decline beyond HbA1c is unclear.

Methods

Among 1,362 participants with T2D in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) trial who underwent 10-day CGM, we evaluated 9 glycemic markers measured concurrently: HbA1c; GA; CGM-derived glucose management indicator (GMI), time in range 70–180 mg/dL (TIR), coefficient of variation (CV), and SD; and OGTT-derived fasting plasma glucose (FPG), 2-hr glucose, and total glucose area under the curve (AUC_0-120). eGFR (CKD-EPI) was measured annually. Linear mixed-effects models with random intercept and slope estimated each marker's association with annual eGFR slope, adjusted for age, sex, race/ethnicity, treatment group, baseline eGFR, and diabetes duration (Model 1); Model 2 added HbA1c (main effect and HbA1c × time interaction).

Results

Mean participant age was 57±10 years, 39% were female, and 27% Black, 24% Hispanic. Baseline eGFR was 91.7±18.6 mL/min/1.73m², HbA1c 7.0±1.0%, and diabetes duration 4.1±2.8 years. Over a median 2-year follow-up, mean eGFR slope was −2.26 mL/min/1.73m²/year. In Model 1, higher HbA1c, GMI, GA, and FPG were each associated with faster eGFR decline (Table). After adjustment for HbA1c (Model 2), none of these associations remained significant. TIR, CV, SD, 2-hr glucose, and AUC_0-120 were not associated with eGFR slope in either model.

Conclusion

In T2D with preserved eGFR, average glucose (GMI, GA) and fasting glucose (FPG) markers were associated with faster eGFR decline but not independently of HbA1c, suggesting these markers capture overlapping kidney-relevant glycemic signal. Glycemic variability (TIR, CV, SD) and postprandial measures (2-hr glucose, AUC_0-120) were not associated with eGFR decline.

Table 1.

Funding

• NIDDK Support