Kei Fukami1, Ryo Shibata1, Hitomi Nakayama2, Kentaro Yamada2, Seiya Okuda1, Masafumi Koga3. 1. Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan. 2. Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan. 3. Department of Internal Medicine, Kawanishi City Hospital, Hyogo 666-0915, Japan. Electronic address: m-koga@kawanishi-city-hospital.com.
Abstract
OBJECTIVE: Diabetic patients with severe chronic kidney disease (CKD) not treated with dialysis falsely show low levels of HbA1c and GA due to renal anemia and proteinuria, respectively. Recently, we reported that serum albumin-adjusted GA (adjGA) accurately reflects mean plasma glucose (PG) in these patients. It is considered that GA reflects not only mean PG but also glycemic excursion; therefore, in the present study we investigated whether adjGA reflects glycemic excursion in these patients. METHODS: Thirty type 2 diabetic patients with severe CKD not treated with dialysis were enrolled in the present study. PG was monitored by seven times a day, and indicators of glycemic excursion [SD, max PG, ΔPG, M value, J index, and mean amplitude of glucose excursion (MAGE)] were calculated. The correlations between HbA1c, GA or adjGA and indicators of glycemic excursion were investigated. RESULTS: HbA1c showed no significant correlation with indicators of glycemic excursion. GA was significantly correlated with them except for ΔPG. adjGA was significantly and strongly associated with them except for MAGE. GA, but not adjGA, showed a significant positive correlation with serum albumin. CONCLUSION: adjGA was not influenced by serum albumin and showed a significant correlation with indicators of glycemic excursion in diabetic patients with severe CKD not treated with dialysis. These results suggest that adjGA could be useful for indicating glycemic control in diabetic patients with severe CKD not treated with dialysis.
OBJECTIVE:Diabeticpatients with severe chronic kidney disease (CKD) not treated with dialysis falsely show low levels of HbA1c and GA due to renal anemia and proteinuria, respectively. Recently, we reported that serum albumin-adjusted GA (adjGA) accurately reflects mean plasma glucose (PG) in these patients. It is considered that GA reflects not only mean PG but also glycemic excursion; therefore, in the present study we investigated whether adjGA reflects glycemic excursion in these patients. METHODS: Thirty type 2 diabeticpatients with severe CKD not treated with dialysis were enrolled in the present study. PG was monitored by seven times a day, and indicators of glycemic excursion [SD, max PG, ΔPG, M value, J index, and mean amplitude of glucose excursion (MAGE)] were calculated. The correlations between HbA1c, GA or adjGA and indicators of glycemic excursion were investigated. RESULTS: HbA1c showed no significant correlation with indicators of glycemic excursion. GA was significantly correlated with them except for ΔPG. adjGA was significantly and strongly associated with them except for MAGE. GA, but not adjGA, showed a significant positive correlation with serum albumin. CONCLUSION: adjGA was not influenced by serum albumin and showed a significant correlation with indicators of glycemic excursion in diabeticpatients with severe CKD not treated with dialysis. These results suggest that adjGA could be useful for indicating glycemic control in diabeticpatients with severe CKD not treated with dialysis.
Authors: Rodolfo J Galindo; Roy W Beck; Maria F Scioscia; Guillermo E Umpierrez; Katherine R Tuttle Journal: Endocr Rev Date: 2020-10-01 Impact factor: 19.871