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Assessment of markers of glycaemic control in diabetic patients with chronic kidney disease using continuous glucose monitoring.
Nephrology (Carlton). 2012 Feb; 17(2):182-8.N

Abstract

AIM

Due to altered red blood cell survival and erythropoietin therapy glycated haemoglobin (HbA1c) may not accurately reflect long-term glycaemic control in patients with diabetes and chronic kidney disease (CKD). Glycated albumin (GA) and fructosamine are alternative markers of glycaemia. The aim of this study was to investigate the accuracy of HbA1c, GA and fructosamine as indicators of glycaemic control using continuous glucose monitoring.

METHODS

HbA1c, GA and fructosamine concentrations were measured in 25 subjects with diabetic nephropathy (CKD stages 4 and 5 (estimated glomerular filtration rate <30 mL/min per 1.73 m(2))) matched with 25 subjects with diabetes and no evidence of nephropathy. Simultaneous real-time glucose concentrations were monitored by continuous glucose monitoring over 48 h.

RESULTS

GA correlated significantly to mean glucose concentrations in patients with and without CKD (r = 0.54 vs 0.49, P < 0.05). A similar relationship was observed with fructosamine relative to glucose. A poor correlation between HbA1c and glucose was observed with CKD (r = 0.38, P = ns) but was significant in the non-CKD group (r = 0.66, P < 0.001). The GA/HbA1c ratio was significantly higher in diabetic patients with CKD compared with controls (2.5 ± 0.4 vs 2.2 ± 0.4, P < 0.05). HbA1c values were significantly lower in CKD patients, relative to non-CKD patients at comparable mean glucose concentrations.

CONCLUSION

HbA1c significantly underestimates glycaemic control in patients with diabetes and CKD stages 4 and 5. In severe CKD, GA more accurately reflects glycaemic control compared with fructosamine and HbA1c and should be the preferred marker of glycaemic control.

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Authors+Show Affiliations

Vos FE
Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin 9001, New Zealand. frederiek.vos@southerndhb.govt.nz
Schollum JB
No affiliation info available
Coulter CV
No affiliation info available
Manning PJ
No affiliation info available
Duffull SB
No affiliation info available
Walker RJ
No affiliation info available

MeSH

AdultAgedBiomarkersBlood GlucoseCase-Control StudiesChronic DiseaseDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2Diabetic NephropathiesFemaleFructosamineGlycated Hemoglobin AHumansHypoglycemic AgentsMaleMiddle AgedMonitoring, PhysiologicNew ZealandPeritoneal DialysisRegression AnalysisRenal DialysisSerum AlbuminSeverity of Illness IndexTime FactorsTreatment Outcome

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21883672

Clinical Trial Links

Pilot Study of Glycemic Control in Diabetic Hemodialyzed Patients

Citation

Vos, Frederiek E., et al. "Assessment of Markers of Glycaemic Control in Diabetic Patients With Chronic Kidney Disease Using Continuous Glucose Monitoring." Nephrology (Carlton, Vic.), vol. 17, no. 2, 2012, pp. 182-8.
Vos FE, Schollum JB, Coulter CV, et al. Assessment of markers of glycaemic control in diabetic patients with chronic kidney disease using continuous glucose monitoring. Nephrology (Carlton). 2012;17(2):182-8.
Vos, F. E., Schollum, J. B., Coulter, C. V., Manning, P. J., Duffull, S. B., & Walker, R. J. (2012). Assessment of markers of glycaemic control in diabetic patients with chronic kidney disease using continuous glucose monitoring. Nephrology (Carlton, Vic.), 17(2), 182-8. https://doi.org/10.1111/j.1440-1797.2011.01517.x
Vos FE, et al. Assessment of Markers of Glycaemic Control in Diabetic Patients With Chronic Kidney Disease Using Continuous Glucose Monitoring. Nephrology (Carlton). 2012;17(2):182-8. PubMed PMID: 21883672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of markers of glycaemic control in diabetic patients with chronic kidney disease using continuous glucose monitoring. AU - Vos,Frederiek E, AU - Schollum,John B, AU - Coulter,Carolyn V, AU - Manning,Patrick J, AU - Duffull,Stephen B, AU - Walker,Robert J, PY - 2011/9/3/entrez PY - 2011/9/3/pubmed PY - 2012/5/16/medline SP - 182 EP - 8 JF - Nephrology (Carlton, Vic.) JO - Nephrology (Carlton) VL - 17 IS - 2 N2 - AIM: Due to altered red blood cell survival and erythropoietin therapy glycated haemoglobin (HbA1c) may not accurately reflect long-term glycaemic control in patients with diabetes and chronic kidney disease (CKD). Glycated albumin (GA) and fructosamine are alternative markers of glycaemia. The aim of this study was to investigate the accuracy of HbA1c, GA and fructosamine as indicators of glycaemic control using continuous glucose monitoring. METHODS: HbA1c, GA and fructosamine concentrations were measured in 25 subjects with diabetic nephropathy (CKD stages 4 and 5 (estimated glomerular filtration rate <30 mL/min per 1.73 m(2))) matched with 25 subjects with diabetes and no evidence of nephropathy. Simultaneous real-time glucose concentrations were monitored by continuous glucose monitoring over 48 h. RESULTS: GA correlated significantly to mean glucose concentrations in patients with and without CKD (r = 0.54 vs 0.49, P < 0.05). A similar relationship was observed with fructosamine relative to glucose. A poor correlation between HbA1c and glucose was observed with CKD (r = 0.38, P = ns) but was significant in the non-CKD group (r = 0.66, P < 0.001). The GA/HbA1c ratio was significantly higher in diabetic patients with CKD compared with controls (2.5 ± 0.4 vs 2.2 ± 0.4, P < 0.05). HbA1c values were significantly lower in CKD patients, relative to non-CKD patients at comparable mean glucose concentrations. CONCLUSION: HbA1c significantly underestimates glycaemic control in patients with diabetes and CKD stages 4 and 5. In severe CKD, GA more accurately reflects glycaemic control compared with fructosamine and HbA1c and should be the preferred marker of glycaemic control. SN - 1440-1797 UR - https://www.unboundmedicine.com/medline/citation/21883672/Assessment_of_markers_of_glycaemic_control_in_diabetic_patients_with_chronic_kidney_disease_using_continuous_glucose_monitoring_ L2 - https://doi.org/10.1111/j.1440-1797.2011.01517.x DB - PRIME DP - Unbound Medicine ER -