Impact of diabetes duration and hyperglycemia on the progression of diabetic kidney disease: Insights from the KNHANES 2019-2021

doi:10.4239/wjd.v16.i5.102094

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May 15, 2025 (publication date) through Apr 25, 2025

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Diabetes. May 15, 2025; 16(5): 102094
Published online May 15, 2025. doi: 10.4239/wjd.v16.i5.102094

Table 1 Baseline characteristics of the study participants, KNHANES 2019 to 2021

Characteristics	No diabetic kidney disease	Diabetic kidney disease	P value
Unweighted number	1688	615
Weighed number	3479066	1193443
Age, years	59.13 ± 0.37	64.09 ± 0.67	< 0.001
20-39	6.79 (0.87)	2.83 (0.82)	< 0.001
40-64	59.39 (1.36)	44.06 (2.52)
≥ 65	33.83 (1.27)	53.11 (2.53)
Sex (male)	57.73 (1.43)	59.52 (2.26)	0.5045
Smoking			0.3969
Never	48.70 (1.48)	49.24 (2.30)
Former	30.38 (1.37)	27.37 (2.09)
Current	20.92 (1.30)	23.39 (2.08)
Alcohol consumption			0.2791
Never	33.46 (1.31)	37.59 (2.34)
Mild	54.50 (1.40)	50.61 (2.40)
Heavy	12.04 (0.95)	11.80 (1.59)
Duration of diabetes mellitus, years			< 0.0001
New onset	36.80 (1.41)	24.51 (2.10)
< 5	25.06 (1.18)	17.89 (1.80)
5-10	15.41 (1.11)	15.69 (1.75)
10-15	11.15 (0.92)	15.56 (1.75)
15-20	6.25 (0.67)	8.04 (1.26)
≥ 20	5.34 (0.55)	18.30 (1.70)
Hemoglobin A1C (%)	7.09 ± 0.04	7.62 ± 0.08	< 0.0001
< 6.5	24.42 (1.2)	22.92 (2.06)
6.5-7	35.38 (1.32)	19.48 (1.76)
7-8	25.74 (1.29)	26.21 (2.17)
8-9	7.67 (0.80)	13.31 (1.62)
9-10	2.52 (0.45)	7.07 (1.12)
≥ 10	4.27 (0.66)	11.01 (1.69)
eGFR (mL/min/1.73 m²)	91.89 ± 0.41	76.94 ± 1.17	< 0.0001
UACR (mg/g)	9.35 ± 0.16	201.98 ± 19.42	< 0.0001
Regular physical activity	39.11 (1.44)	31.96 (2.18)	0.0056
Cardiovascular disease	10.23 (0.83)	13.78 (1.52)	0.0358
Hypertension	53.07 (1.54)	71.67 (2.30)	< 0.0001
Dyslipidemia	47.81 (1.42)	50.12 (2.54)	0.4134
WC (cm)	90.86 ± 0.29	91.35 ± 0.47	0.3835
Height (cm)	163.85 ± 0.28	163.06 ± 0.46	0.1502
Weight (cm)	69.89 ± 0.42	68.51 ± 0.72	0.1013
BMI (kg/m²)	25.9 ± 0.12	25.6 ± 0.19	0.1753
Fasting glucose (mg/dL)	134.66 ± 1.08	146.82 ± 2.66	< 0.0001
Total cholesterol (mg/dL)	176.62 ± 1.21	173.27 ± 2.23	0.1726

Values are presented as mean ± SE, percentage (SE), or geometric mean (95% confidence interval). KNHANES: Korea National Health and Nutrition Examination Survey; eGFR: Estimated glomerular filtration rate; UACR: Urinary albumin creatinine ratio; BMI: Body mass index; WC: Waist circumference.

Table 2 Odds ratio of diabetic kidney disease according to duration or severity of diabetes mellitus

Group	Percentage (SE)	Unadjusted, OR (95%CI)	Model 1, OR (95%CI)¹	Model 2, OR (95%CI)²
Duration of diabetes mellitus (years)
New onset	18.60 (1.71)	1 (reference)	1 (reference)	1 (reference)
< 5	19.68 (1.96)	1.072 (0.766, 1.501)	0.975 (0.699, 1.361)	0.958 (0.684, 1.342)
5-10	25.89 (2.83)	1.529 (1.068, 2.189)	1.412 (0.983, 2.028)	1.398 (0.963, 2.031)
10-15	32.38 (3.36)	2.096 (1.461, 3.006)	1.865 (1.286, 2.704)	1.849 (1.272, 2.688)
15-20	30.64 (4.09)	1.933 (1.247, 2.998)	1.497 (0.958, 2.340)	1.489 (0.959, 2.312)
≥ 20	54.03 (3.73)	5.144 (3.621, 7.306)	3.759 (2.609, 5.416)	3.765 (2.602, 5.449)
P for trend		< 0.001	< 0.001	< 0.001
Hemoglobin A1C (%)
< 6.5	24.36 (2.12)	1 (reference)	1 (reference)	1 (reference)
6.5-7	15.88 (1.61)	0.586 (0.429, 0.802)	0.587 (0.429, 0.803)	0.598 (0.436, 0.82)
7-8	25.89 (2.12)	1.085 (0.782, 1.505)	1.142 (0.822, 1.586)	1.193 (0.854, 1.666)
8-9	37.33 (4.01)	1.850 (1.233, 2.775)	2.141 (1.404, 3.263)	2.307 (1.493, 3.567)
9-10	49.03 (6.03)	2.988 (1.771, 5.040)	3.873 (2.282, 6.573)	4.588 (2.661, 7.911)
≥ 10	46.95 (5.91)	2.749 (1.639, 4.611)	4.588 (2.633, 7.994)	4.911 (2.795, 8.630)
P for trend		< 0.001	< 0.001	< 0.001

¹Model 1 was adjusted for age and sex.

²Model 2 was adjusted for age, sex, regular exercise, and history of cardiovascular disease, hypertension and dyslipidemia.

OR: Odds ratio; 95%CI: 95% confidential interval.

Table 3 Odds ratio of kidney outcomes according to duration or severity of diabetes mellitus

Group	eGFR < 60 mL/min/1.73 m²		UACR ≥ 30 mg/g Cr
Group	Percentage (SE)	Adjusted, OR (95%CI)	Percentage (SE)	Adjusted, OR (95%CI)
Duration of diabetes mellitus (years)
New onset	3.22 (0.68)	1 (reference)	16.11 (1.67)	1 (reference)
< 5	5.76 (1.03)	1.349 (0.740, 2.459)	15.57 (1.85)	0.917 (0.627, 1.343)
5-10	6.46 (1.35)	1.578 (0.826, 3.014)	22.28 (2.62)	1.456 (0.987, 2.148)
10-15	8.04 (1.88)	1.877 (0.950, 3.711)	29.19 (3.25)	2.057 (1.394, 3.034)
15-20	7.21 (1.91)	1.112 (0.538, 2.297)	27.02 (3.98)	1.729 (1.080, 2.767)
≥ 20	28.46 (3.68)	4.875 (2.626, 9.050)	41.93 (3.73)	3.351 (2.243, 5.009)
P for trend		< 0.001		< 0.001
Hemoglobin A1C (%)
< 6.5	9.28 (1.33)	1 (reference)	18.47 (1.97)	1 (reference)
6.5-7	6.19 (0.96)	0.693 (0.423, 1.134)	11.85 (1.37)	0.606 (0.423, 0.869)
7-8	6.49 (1.13)	0.808 (0.482, 1.352)	22.50 (1.96)	1.377 (0.966, 1.964)
8-9	8.90 (2.35)	1.387 (0.688, 2.797)	35.20 (3.96)	2.793 (1.792, 4.353)
9-10	8.47 (3.38)	1.487 (0.529, 4.178)	47.09 (5.99)	5.288 (3.078, 9.085)
≥ 10	6.42 (2.62)	1.788 (0.679, 4.711)	43.46 (5.91)	4.945 (2.832, 8.635)
P for trend		0.1786		< 0.001

Adjusted for age, sex, regular exercise, and history of cardiovascular disease, hypertension and dyslipidemia. eGFR: Estimated glomerular filtration rate; UACR: Urinary albumin creatinine ratio; OR: Odds ratio; 95%CI: 95% confidential interval.

Table 4 Subgroup analysis of odds ratio for diabetic kidney disease according to age, sex and hypertension

Group	Subgroup	Percentage (SE)	Adjusted, OR (95%CI)	Subgroup	Percentage (SE)	Adjusted, OR (95%CI)	P for interaction
Duration of DM (years)	< 65 years			≥ 65 years			0.1113
New onset		16.51 (2.04)	1 (reference)		24.26 (3.06)	1 (reference)
< 5		13.51 (2.28)	0.772 (0.472, 1.260)		31.96 (3.53)	1.312 (0.849, 2.029)
5-10		20.21 (3.65)	1.281 (0.739, 2.219)		35.31 (4.15)	1.680 (1.040, 2.713)
10-15		32.41 (4.99)	2.317 (1.349, 3.980)		32.33 (4.23)	1.576 (0.951, 2.612)
15-20		21.08 (6.25)	1.311 (0.572, 3.005)		36.70 (5.18)	1.785 (1.011, 3.152)
≥ 20		55.29 (8.71)	5.694 (2.708, 11.974)		53.68 (4.21)	3.644 (2.293, 5.792)
Hemoglobin A1C (%)							0.1732
< 6.5		16.88 (2.62)	1 (reference)		33.95 (3.18)	1 (reference)
6.5-7		7.98 (1.64)	0.419 (0.238, 0.735)		27.12 (2.9)	0.761 (0.510, 1.137)
7-8		19.03 (2.63)	1.117 (0.659, 1.893)		36.79 (3.32)	1.306 (0.873, 1.954)
8-9		30.67 (5.11)	2.193 (1.155, 4.165)		49.57 (5.88)	2.527 (1.501, 4.256)
9-10		41.61 (7.35)	4.166 (2.065, 8.404)		66.52 (8.15)	4.587 (1.914, 10.993)
≥ 10		46.55 (6.63)	4.911 (2.567, 9.394)		48.96 (11.36)	2.417 (0.947, 6.170)
Duration of DM (years)	Male			Female			0.2914
New onset		20.86 (2.34)	1 (reference)		15.14 (2.18)	1 (reference)
< 5		19.70 (2.64)	0.827 (0.536, 1.277)		19.64 (2.88)	1.218 (0.738, 2.01)
5-10		24.70 (3.96)	1.116 (0.668, 1.865)		27.24 (3.80)	1.964 (1.155, 3.338)
10-15		34.57 (4.75)	1.754 (1.061, 2.900)		29.24 (4.35)	1.996 (1.183, 3.366)
15-20		26.28 (5.12)	1.015 (0.563, 1.828)		36.23 (6.40)	2.543 (1.325, 4.882)
≥ 20		59.20 (5.08)	3.970 (2.338, 6.739)		48.47 (5.35)	3.783 (2.235, 6.402)
Hemoglobin A1C (%)							0.7956
< 6.5		27.10 (3.07)	1 (reference)		20.68 (2.73)	1 (reference)
6.5-7		15.65 (2.15)	0.501 (0.326, 0.769)		16.17 (2.19)	0.750 (0.467, 1.207)
7-8		24.22 (2.77)	0.962 (0.611, 1.516)		28.29 (3.14)	1.574 (0.997, 2.486)
8-9		35.79 (5.23)	1.992 (1.090, 3.643)		39.67 (5.91)	3.047 (1.651, 5.625)
9-10		51.09 (8.14)	4.135 (2.040, 8.382)		45.17 (8.34)	5.387 (2.278, 12.741)
≥ 10		47.75 (7.58)	4.482 (2.210, 9.089)		45.48 (8.99)	5.662 (2.099, 15.276)
Duration of DM (years)	No hypertension			Hypertension			0.6858
New onset		13.17 (2.10)	1 (reference)		23.73 (2.74)	1 (reference)
< 5		11.39 (2.83)	0.827 (0.425, 1.608)		25.48 (2.74)	0.987 (0.66, 1.477)
5-10		22.03 (4.45)	1.941 (1.031, 3.655)		28.72 (3.55)	1.169 (0.748, 1.827)
10-15		19.92 (4.61)	1.689 (0.855, 3.334)		40.21 (4.56)	1.938 (1.206, 3.114)
15-20		19.78 (5.81)	1.601 (0.732, 3.501)		36.28 (5.53)	1.448 (0.82, 2.558)
≥ 20		42.89 (7.31)	4.648 (2.269, 9.518)		59.05 (4.16)	3.338 (2.127, 5.238)
Hemoglobin A1C (%)							0.7324
< 6.5		16.55 (3.08)	1 (reference)		29.14 (2.88)	1 (reference)
6.5-7		8.00 (1.78)	0.426 (0.233, 0.782)		21.3 (2.24)	0.686 (0.481, 0.978)
7-8		15.05 (2.59)	0.872 (0.475, 1.601)		33.67 (2.98)	1.421 (0.962, 2.098)
8-9		27.97 (5.87)	1.98 (0.961, 4.078)		45.71 (5.38)	2.553 (1.551, 4.201)
9-10		36.83 (8.11)	3.323 (1.44, 7.669)		65.61 (7.89)	5.473 (2.588, 11.574)
≥ 10		35.68 (7.52)	3.381 (1.469, 7.782)		58.71 (8.69)	6.784 (3.019, 15.246)

Adjusted for age, sex, regular exercise, and history of cardiovascular disease, hypertension and dyslipidemia. DM: Diabetes mellitus; OR: Odds ratio; 95%CI: 95% confidential interval.

Citation: Kim CS, Suh SH, Choi HS, Bae EH, Ma SK, Kim B, Han KD, Kim SW. Impact of diabetes duration and hyperglycemia on the progression of diabetic kidney disease: Insights from the KNHANES 2019-2021. World J Diabetes 2025; 16(5): 102094
URL: https://www.wjgnet.com/1948-9358/full/v16/i5/102094.htm
DOI: https://dx.doi.org/10.4239/wjd.v16.i5.102094