ASSOCIATION OF GLYCEMIC CONTROL (HBA1C) WITH SEVERITY OF DIABETIC NEPHROPATHY AND CARDIOVASCULAR RISK IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CROSS-SECTIONAL STUDY

Abstract

Type 2 diabetes mellitus remains a major public health challenge, frequently complicated by microvascular and macrovascular pathologies, including diabetic nephropathy and cardiovascular disease. This cross-sectional study investigated the association between glycemic control, measured by glycated hemoglobin (HbA1c), and the severity of diabetic nephropathy and cardiovascular risk among adult patients with type 2 diabetes mellitus at Niazi Medical College & Teaching Hospital, Sargodha. A total of 300 patients were evaluated and categorized into three glycemic tiers: optimal control (HbA1c < 7.0%, n = 90), moderate control (HbA1c 7.0%–8.5%, n = 120), and poor control (HbA1c > 8.5%, n = 90). Patients were assessed for renal parameters, including estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR), along with multi-factorial cardiovascular risk stratification. HbA1c showed a strong, statistically significant negative correlation with eGFR (r = −0.584, p < 0.001) and a strong positive correlation with log-transformed ACR (r = 0.612, p < 0.001). Multivariable logistic regression, adjusted for age, sex, diabetes duration, and systolic blood pressure, showed that patients in the poor control tier had substantially higher odds of advanced nephropathy staging (adjusted odds ratio [OR] = 4.28, 95% confidence interval [CI]: 2.45–7.52, p < 0.001) and of high-to-very-high cardiovascular risk classification (adjusted OR = 5.12, 95% CI: 2.89–9.08, p < 0.001) compared with those with optimal glycemic control. Sustained hyperglycemia is strongly associated with severe diabetic nephropathy and elevated cardiovascular risk, underscoring the need for strict glycemic optimization in routine clinical practice.