Clement Lo1, Michelle Lui2, Sanjeeva Ranasinha3, Helena J Teede1, Peter G Kerr4, Kevan R Polkinghorne4, David M Nathan5, Hui Zheng6, Sophia Zoungas7. 1. Monash Applied Research Stream, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia. 2. Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia. 3. Monash Applied Research Stream, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. 4. Department of Nephrology, Monash Medical Centre and Monash University, Clayton, Australia. 5. Diabetes Centre, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA. 6. Biostatistics Centre, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA. 7. Monash Applied Research Stream, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia; The George Institute for Global Health, Sydney, Australia. Electronic address: sophia.zoungas@monash.edu.
Abstract
AIMS: To examine the relationship between average glucose (AG) and HbA1c in patients with and without chronic kidney disease (CKD) and type 2 diabetes. MATERIALS AND METHODS: 43 patients with diabetes and CKD (stages 3-5) with stable glycaemic control, and glucose-lowering and erythropoiesis stimulating agent (ESA) doses, were prospectively studied for 3 months and compared to 104 age-matched controls with diabetes, without CKD from the ADAG study. Over 3 months, AG was calculated from 7 to 8 point self-monitored blood glucose measurements (SMBG) and from continuous glucose monitoring (CGMS), and mean HbA1c was calculated from 4 measurements. AG and HbA1c relationships were determined using multivariable linear regression analyses. RESULTS: The CKD and non-CKD groups were well matched for age and gender. Mean AG tended to be higher (p=0.08) but HbA1c levels were similar (p=0.68) in the CKD compared with non-CKD groups. A linear relationship between AG and HbA1c was observed irrespective of the presence and stage of CKD. The relationship was weaker in patients with stage 4-5 CKD (non-CKD R2=0.75, stage 3 CKD R2=0.79 and stage 4-5 CKD R2=0.34, all p<0.01). The inclusion of ESA use in the model rendered the effect of CKD stage insignificant (R2=0.67, p<0.01). CONCLUSIONS: In patients with type 2 diabetes and CKD there is a linear relationship between HbA1c and AG that is attenuated by ESA use, suggesting that ESA results in a systematic underestimation of AG derived from HbA1c.
AIMS: To examine the relationship between average glucose (AG) and HbA1c in patients with and without chronic kidney disease (CKD) and type 2 diabetes. MATERIALS AND METHODS: 43 patients with diabetes and CKD (stages 3-5) with stable glycaemic control, and glucose-lowering and erythropoiesis stimulating agent (ESA) doses, were prospectively studied for 3 months and compared to 104 age-matched controls with diabetes, without CKD from the ADAG study. Over 3 months, AG was calculated from 7 to 8 point self-monitored blood glucose measurements (SMBG) and from continuous glucose monitoring (CGMS), and mean HbA1c was calculated from 4 measurements. AG and HbA1c relationships were determined using multivariable linear regression analyses. RESULTS: The CKD and non-CKD groups were well matched for age and gender. Mean AG tended to be higher (p=0.08) but HbA1c levels were similar (p=0.68) in the CKD compared with non-CKD groups. A linear relationship between AG and HbA1c was observed irrespective of the presence and stage of CKD. The relationship was weaker in patients with stage 4-5 CKD (non-CKD R2=0.75, stage 3 CKD R2=0.79 and stage 4-5 CKD R2=0.34, all p<0.01). The inclusion of ESA use in the model rendered the effect of CKD stage insignificant (R2=0.67, p<0.01). CONCLUSIONS: In patients with type 2 diabetes and CKD there is a linear relationship between HbA1c and AG that is attenuated by ESA use, suggesting that ESA results in a systematic underestimation of AG derived from HbA1c.
Authors: James Ling; Jack K C Chung Ng; Eric S H Lau; Ronald C W Ma; Alice P S Kong; Andrea O Y Luk; Jeffrey S S Kwok; Cheuk-Chun Szeto; Juliana C N Chan; Elaine Chow Journal: Kidney Int Rep Date: 2022-04-06
Authors: Leila R Zelnick; Zona O Batacchi; Iram Ahmad; Ashveena Dighe; Randie R Little; Dace L Trence; Irl B Hirsch; Ian H de Boer Journal: Diabetes Care Date: 2020-08-11 Impact factor: 19.112
Authors: Hector E Sanchez-Ibarra; Luisa M Reyes-Cortes; Xian-Li Jiang; Claudia M Luna-Aguirre; Dionicio Aguirre-Trevino; Ivan A Morales-Alvarado; Rafael B Leon-Cachon; Fernando Lavalle-Gonzalez; Faruck Morcos; Hugo A Barrera-Saldaña Journal: Front Pharmacol Date: 2018-04-06 Impact factor: 5.810