Disease Epidemiology / Clinical Course / Diabetes

3E-01 - Real-world Evidence on the Legacy Effect of Early versus Late Glycaemic Reduction with Kidney Failure in Newly-Diagnosed Patients with Type 2 Diabetes without Chronic Kidney Disease

Monday, August 25, 2025

8:15 AM - 8:30 AM ET

Presenting Author(s)

Aimin Yang

The Chinese University of Hong Kong, Hong Kong

Co-Author(s)

XZ

Xinge Zhang

The Chinese University of Hong Kong, Hong Kong
HW

Hongjiang Wu

The Chinese University of Hong Kong, Hong Kong
MS

Mai Shi

The Chinese University of Hong Kong, Hong Kong
EL

Eric Lau

The Chinese University of Hong Kong, Hong Kong
JY

Jiazhou Yu

The Chinese University of Hong Kong, Hong Kong
BF

Baoqi Fan

The Chinese University of Hong Kong, Hong Kong
JL

Juliana Lui

The Chinese University of Hong Kong, Hong Kong
AK

Alice Kong

The Chinese University of Hong Kong, Hong Kong
AL

Andrea Luk

The Chinese University of Hong Kong, Hong Kong
RM

Ronald Ma

The Chinese University of Hong Kong, Hong Kong
JC

Juliana Chan

The Chinese University of Hong Kong, Hong Kong
EC

Elaine Chow

The Chinese University of Hong Kong, Hong Kong

Background: While clinical trials have established the legacy effects of hyperglycaemia on macrovascular complications in people with diabetes, real-world evidence on how historical glycaemic exposures affect microvascular complications such as kidney failure and the critical time window for achieving glycemic control is limited.

Objectives: To evaluate the legacy effect of glycaemic exposure on kidney failure among newly-diagnosed patients with type 2 diabetes (T2D) without chronic kidney disease (CKD).

Methods: : In a retrospective cohort of 99,593 newly-diagnosed T2D patients without CKD using data from the Hong Kong Electronic Health Records (EHR) in 2000-2019, we assessed the 10-year risk of kidney failure and estimated the time-varying impact of historical HbA1c exposures using a weighted cumulative exposure model, adjusting for confounders including glucose-lowering drugs.

Results: Among 99,596 patients (mean age: 57±11 years; 47% female; mean HbA1c at diagnosis: 7.9%±2.1%, mean eGFR 91.8±15.7 ml/min/1.73 m2 at baseline), 2,534 (2.5%) developed kidney failure over a median follow-up of 5.6 years. Over a hypothetical 10-year period, a sustained mean 1% reduction in HbA1c was associated with a 22% lower risk of kidney failure (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]: 0.75-0.81). When analysed by time frame of achieving glycemic control, the first 3 years post-diagnosis were critical. The risk reductions for achieving 1% HbA1c reduction during years 1–3, 4–6, and 7–9 after diagnosis, were 9% (HR=0.91, 0.87-0.94), 7% (HR=0.93, 0.89-0.96), and 5% (HR=0.95, 0.92–0.98) respectively. The maximal effect size was observed within the first 6 years post-diagnosis among patients with low 10-year atherosclerotic cardiovascular disease (ASCVD) risk but not in those with intermediate or high risk.

Conclusions: Early HbA1c exposure was associated with reduced long-term risk of kidney failure in newly-diagnosed T2D patients without CKD and at low risk of ASCVD. These findings highlight the importance of early diagnosis to optimize and maintain glycaemic control to reduce long term cardiovascular-renal complications.