IS HBA1C A TRUE MARKER OF GLYCAEMIC CONTROL IN DIABETIC PATIENTS ON HAEMODIALYSIS?
Abstract
Background: HbA1c is generally conducted to check blood glucose control in diabetic patients. As reported by several recent studies, HbA1c may not be considered as a reliable assay for monitoring glycaemic status in haemodialysis patients. Multiple factors may result in artificially low HbA1c. We sought to confirm this observation by performing a study in which we saw the agreement between expected HbA1c values as indicated by the mean plasma glucose level and the measured HbA1c values of haemodialysis dependent Diabetic patients. Methods: This cross-sectional study was conducted on 45 patients. Daily three readings of capillary blood glucose were taken for three consecutive days in a week, every two weeks in a month for up to three months. Total 54 capillary blood glucose levels were checked in the duration of three months. Mean blood glucose level was calculated at the end of the study and it is used to calculate the '˜expected HbA1c' levels using a formula. At the offset, HbA1c was measured (at 12 weeks) and was compared with the expected HbA1c. Results: On comparing the expected and measured HbA1c levels in 45 patients on haemodialysis. There is a significant difference between the two levels, with reduced levels of measured HbA1c in majority of patients as compared to expected ones. Conclusion: HbA1c is not a true marker of glucose control in diabetic patients on regular haemodialysis.
Keywords: HbA1c; Haemodialysis; glycaemic control; capillary blood glucose; Diabetes MellitusReferences
Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin dependent diabetes mellitus. N Engl J Med 1993;329(14):977-86.
Oomichi T, Emoto M, Tabata T, Morioka T, Tsujimoto Y, Tahara H, et al. Impact of glycemic control on survival of diabetic patients on chronic regular hemodialysis: a 7-year observational study. Diabetes Care 2006;29(7):1496-1500.
Inaba M, Okuno S, Kumeda Y, Yamada S, Imanishi Y, Tabata T, et al. Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol 2007;18(3):896-903.
Fukuoka K, Nakaao K, Morimoto H, Nakao A, Takatori Y, Arimoto K, et al. Glycated albumin levels predict long-term survival in diabetic patients undergoing haemodialysis. Nephrology (Carlton) 2008;13(4):278-83.
Nakao T, Matsumoto H, Okada T, Han M, Hidaka H, Yoshino M, et al. Influence of erythropoietin treatment on hemoglobinA1c levels in patients with chronic renal failure on hemodialysis. Intern Med 1998;37(10):826-30.
Uzu T, Hatta T, Deji N, Izumiya T, Ueda H, Miyazawa I, et al. Target for glycemic control in type 2 diabetic patients on hemodialysis: effects of anemia and erythropoietin injection on hemoglobin A1c. Ther Apher Dial 2009;13(2):89-94.
Sany D, Elshahawy Y, Anwar W. Glycated albumin versus glycated hemoglobin as glycemic indicator in hemodialysis patients with diabetes mellitus: variables that influence. Saudi J Kidney Dis Transpl 2013;24(2):260-73.
Hoshino J, Molnar MZ, Yamagata K, Unara Y, Takaichi K, Kovesdy CP, et al. Developing an HbA1c-Based Equation to Estimate Blood Glucose in Maintenance Hemodialysis Patients. Diabetes Care 2013;36(4):922-7.
Williams ME, Lacson E Jr, Teng M, Ofsthun N, Lazarus JM. Hemodialyzed type I and type II diabetic patients in the US: Characteristics, glycemic control, and survival. Kidney Int 2006;70(8):1503-9.
Ryan TP. Sample Size Determination and Power. New Jersey: John Wiley & Sons; 2013.
Abe M, Matsumoto K. Glycated hemoglobin or glycated albumin for assessment of glycemic control in hemodialysis patients with diabetes? Nat Clinc Pract Nephrol 2008;4(9):482-3.
Chujo K, Shima K, Tada H, Oohashi T, Minakuchi J, Kawashima S. Indicators with blood glucose control in diabetics with End-stage chronic renal disease: GHb vs. Glyvated albumin (GA). J Med Invest 2006;53(3-4):223-8.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
