Optimal Target Level of Glycosylated Hemoglobin (HbA1c) for Reducing Cardiovascular Mortality in Patients with Diabetic Nephropathy: A Systematic Review
DOI:
https://doi.org/10.54536/ajmsi.v5i1.6467Keywords:
Cardiovascular Diseases, Chronic Kidney Failure, Diabetic Nephropathies, Glycated Haemoglobin, Glycemic ControlAbstract
Adverse cardiovascular (CVD) complications drive increased mortality in diabetic nephropathy (DN) patients. Glycemic control is the primary management approach in patients with diabetes. However, no specific thresholds have been reported for reducing CVD in DN patients. A systematic literature review was conducted in adherence with the PRISMA guidelines to synthesise evidence published from January 1990 to June 2024. The objective of this systematic literature review was to explore optimal glycemic control levels to reduce CVD complications in patients with diabetic nephropathy. A pre-defined study selection criterion was employed to conduct a targeted search of academic databases to yield relevant literature. Ten studies that met the eligibility criteria were synthesised to generate evidence-based findings. Findings revealed a linear correlation between glycosylated haemoglobin (HbA1c) levels and both cardiovascular mortality and the progression of nephropathy to end-stage renal disease (ESRD) and renal-related death. As the renal disease progressed, lower HbA1c values lost their predictive abilities and were associated with increased CVD risk. New glycemic controls, such as Glycated Albumin or the Haemoglobin Glycation Index, have shown potential to reflect glycemic levels accurately but require further validation to predict CVD mortality in DN patients. Our study identified a lack of research on CVD-specific mortality in DN patients, while accounting for heterogeneity in exposure and outcome domains. Future research should focus on long-term monitoring of HbA1c levels in DN and their influence on CVD mortality.
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