Masanori Abe1, Takayuki Hamano2, Junichi Hoshino3, Atsushi Wada4, Masaaki Inaba5, Shigeru Nakai6, Ikuto Masakane7. 1. The Renal Data Registry Committee, The Japanese Society for Dialysis Therapy, Tokyo, Japan; Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan. Electronic address: abe.masanori@nihon-u.ac.jp. 2. The Renal Data Registry Committee, The Japanese Society for Dialysis Therapy, Tokyo, Japan; Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: hamatea@kid.med.osaka-u.ac.jp. 3. The Renal Data Registry Committee, The Japanese Society for Dialysis Therapy, Tokyo, Japan; Nephrology Center, Toranomon Hospital, Tokyo, Japan. Electronic address: jhoshino-ind@umin.ac.jp. 4. The Renal Data Registry Committee, The Japanese Society for Dialysis Therapy, Tokyo, Japan; Department of Nephrology, Kitasaito Hospital, Asahikawa, Japan. Electronic address: atsushi.wada@jinyukai.jp. 5. Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University, Osaka, Japan. Electronic address: m1356849@med.osaka-cu.ac.jp. 6. The Renal Data Registry Committee, The Japanese Society for Dialysis Therapy, Tokyo, Japan; Department of Clinical Engineering, Fujita Health University, Aichi, Japan. Electronic address: s-nakai@fujita-hu.ac.jp. 7. The Renal Data Registry Committee, The Japanese Society for Dialysis Therapy, Tokyo, Japan; Department of Nephrology, Yabuki Hospital, Yamagata, Japan. Electronic address: imasakan.aipod@seieig.or.jp.
Abstract
AIMS: In patients with diabetes on hemodialysis (HD), glycemic control improves spontaneously, leading to normal glycated hemoglobin (HbA1c) levels; this phenomenon is known as "burnt-out diabetes." However, glycated albumin (GA) might be a better indicator of glycemic control than HbA1c in HD patients. Therefore, the aim of this study was to identify how many patients experience "burnt-out diabetes" using HbA1c and GA levels and to examine the association between cardiovascular comorbidity risk and GA levels. METHODS: Patients with diabetes on HD whose HbA1c levels were measured and whose antidiabetic therapy was recorded were included. First, the "burnt-out diabetes" phenomenon was investigated in patients whose HbA1c levels were measured (HbA1c cohort). Then, it was investigated in patients who were assessed for both HbA1c and GA levels (GA cohort). Risk of cardiovascular comorbidity was assessed using multivariable logistic regression models. RESULTS: In the HbA1c cohort, 60,019 patients were included. When "burnt-out diabetes" was defined as HbA1c<6.0% without treatment with antidiabetic medication, it was noted in 11,159 patients (18.6%). In the GA cohort, 23,668 patients were included, and it was found in 4899 patients (20.7%). However, when "burnt-out diabetes" was defined as HbA1c<6.0% and GA<16.0% without treatment with antidiabetic medication, it was found in 1286 patients (5.4%). Patients with GA>18% had a higher risk of cardiovascular comorbidity. CONCLUSIONS: Although the "burnt-out diabetes" phenomenon might be present in 20.7% of patients with diabetes on HD in terms of HbA1c, the rate was significantly decreased to 5.4% in terms of GA. CLINICAL TRIAL REGISTRATION NUMBER: UMIN000018641.
AIMS: In patients with diabetes on hemodialysis (HD), glycemic control improves spontaneously, leading to normal glycated hemoglobin (HbA1c) levels; this phenomenon is known as "burnt-out diabetes." However, glycated albumin (GA) might be a better indicator of glycemic control than HbA1c in HDpatients. Therefore, the aim of this study was to identify how many patients experience "burnt-out diabetes" using HbA1c and GA levels and to examine the association between cardiovascular comorbidity risk and GA levels. METHODS:Patients with diabetes on HD whose HbA1c levels were measured and whose antidiabetic therapy was recorded were included. First, the "burnt-out diabetes" phenomenon was investigated in patients whose HbA1c levels were measured (HbA1c cohort). Then, it was investigated in patients who were assessed for both HbA1c and GA levels (GA cohort). Risk of cardiovascular comorbidity was assessed using multivariable logistic regression models. RESULTS: In the HbA1c cohort, 60,019 patients were included. When "burnt-out diabetes" was defined as HbA1c<6.0% without treatment with antidiabetic medication, it was noted in 11,159 patients (18.6%). In the GA cohort, 23,668 patients were included, and it was found in 4899 patients (20.7%). However, when "burnt-out diabetes" was defined as HbA1c<6.0% and GA<16.0% without treatment with antidiabetic medication, it was found in 1286 patients (5.4%). Patients with GA>18% had a higher risk of cardiovascular comorbidity. CONCLUSIONS: Although the "burnt-out diabetes" phenomenon might be present in 20.7% of patients with diabetes on HD in terms of HbA1c, the rate was significantly decreased to 5.4% in terms of GA. CLINICAL TRIAL REGISTRATION NUMBER: UMIN000018641.
Authors: Bayan Hassan Banimfreg; Hussam Alshraideh; Abdulrahim Shamayleh; Adnane Guella; Mohammad Harb Semreen; Mohammad Tahseen Al Bataineh; Nelson C Soares Journal: Biomolecules Date: 2022-07-08