Associations of Acute and Chronic Glycemic Measures with Contrast-Induced Nephropathy in Type 2 Diabetes Mellitus Undergoing Coronary Angiography

Abstract

Contrast-induced nephropathy (CIN) remains an important complication of coronary angiography, particularly in patients with type 2 diabetes mellitus (T2DM), yet the relative associations of chronic and acute glycemic measures with CIN remain incompletely understood. The present study compared the associations of glycated hemoglobin (HbA1c), admission blood glucose and pre-procedural blood glucose with CIN in patients with T2DM undergoing coronary angiography. A total of 200 participants were included, of whom 98 (49.0%) met the CIN definition. Higher HbA1c, admission glucose and pre-procedural glucose were observed in participants with CIN. In mutually adjusted logistic regression models adjusting for cardiorenal and procedural covariates, HbA1c remained associated with CIN per 1% increase (odds ratio [OR], 1.338; 95% confidence interval [CI], 1.023–1.750; P=0.034), as did admission glucose per 50 mg/dl increase (OR, 1.750; 95% CI, 1.113–2.753; P=0.015), whereas the linear association for pre-procedural glucose was attenuated (OR, 1.175; 95% CI, 0.772–1.788; P=0.453). Restricted cubic spline analysis identified significant nonlinear components for HbA1c and pre-procedural glucose. In the final flexible model, likelihood-ratio testing demonstrated independent global contributions from HbA1c (P<0.001), admission glucose (P=0.008) and pre-procedural glucose (P=0.029). These findings indicate that chronic and acute glycemic measures provide complementary information regarding CIN, with distinct exposure-response patterns that may be obscured by conventional linear modeling.