ArticleNan fang yi ke da xue xue bao = Journal of Southern Medical University2026
[Buffering effect of intensive lipid lowering on mortality risk in type 2 diabetic patients with chronic kidney disease and challenging glycemic management: a cohort study based on dual metabolic trajectories].
Article in Nan fang yi ke da xue xue bao = Journal of Southern Medical University, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo investigate the longitudinal synergistic evolution of low-density lipoprotein cholesterol (LDL-C) and glycated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), and analyze the interaction effects and risk-modifying effect of dual metabolic trajectories on all-cause mortality.
methodsThis study included 7991 patients with T2DM and CKD based on the Tianjin medical insurance data platform. Group-based trajectory modeling (GBTM) was employed to identify longitudinal trajectory patterns of LDL-C and HbA1c, and dual metabolic trajectory groups were constructed to evaluate their synergistic effects. LASSO regression was applied for feature selection. Multivariable Cox proportional hazards regression with a dual-reference group strategy was utilized to systematically quantify the combined risks of dual trajectories and specifically assess the risk modification value of intensive lipid lowering across different glycemic backgrounds.
resultsDuring a median follow-up of 5.10 (3.15-7.52) years, 405 deaths (5.1%) were recorded. Three LDL-C trajectories (Intensive Control, Standard Control, and High-Regression) and 3 HbA1c trajectories (Well-Controlled, Moderate Improvement, and Poorly Controlled) were identified. Dual metabolic disturbances demonstrated a significant dose-response gradient, with the "Lipid-Poor/Glucose-Poor" group exhibiting the highest mortality risk (HR=5.550, 95%
conclusionsThis study reveals for the first time the longitudinal synergistic evolution of glucose and lipid metabolic trajectories in patients with T2DM and CKD and their superimposed impact on prognosis. Intensive lipid lowering (LDL-C<1.8 mmol/L) confers a significant protective effect in patients with difficulty in glycemic management and serves as an effective compensatory strategy to improve patient prognosis.
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