BACKGROUND: Glycated hemoglobin A1c (HbA1c) among diabetic hemodialysis patients continues to be the standard of care, although its limitations are well recognized. This study evaluated glycated albumin (GA) and glycated serum protein (GSP) as alternatives to HbA1c in detecting glycemic control among diabetic hemodialysis patients using continuous-glucose-monitoring (CGM)-derived glucose as reference standard. METHODS: A CGM system (iPRO) was applied for 7 days in 37 diabetic hemodialysis patients to determine glycemic control. The accuracy of GA and GSP versus HbA1c in detecting a 7-day average glucose ≥184 mg/dL was evaluated via receiver-operating-characteristic (ROC) analysis. RESULTS: CGM-derived glucose exhibited strong correlation (r = 0.970, p < 0.001) and acceptable agreement with corresponding capillary glucose measurements obtained by the patients themselves in 1,169 time-points over the 7-day-long CGM. The area under ROC curve (AUC) for GA, GSP, and HbA1c to detect poor glycemic control was 0.976 (0.862-1.000), 0.682 (0.502-0.862), and 0.776 (0.629-0.923) respectively. GA levels >20.3% had 90.9% sensitivity and 96.1% specificity in detecting a 7-day average glucose ≥184 mg/dL. The AUC for GA was significantly higher than the AUC for GSP (difference between areas: 0.294, p < 0.001) and the AUC for HbA1c (difference between areas: 0.199, p < 0.01). CONCLUSION: Among diabetic hemodialysis patients, GA is a stronger indicator of poor glycemic control assessed with 7-day-long CGM when compared to GSP and HbA1c.
BACKGROUND: Glycated hemoglobin A1c (HbA1c) among diabetic hemodialysispatients continues to be the standard of care, although its limitations are well recognized. This study evaluated glycated albumin (GA) and glycated serum protein (GSP) as alternatives to HbA1c in detecting glycemic control among diabetic hemodialysispatients using continuous-glucose-monitoring (CGM)-derived glucose as reference standard. METHODS: A CGM system (iPRO) was applied for 7 days in 37 diabetic hemodialysispatients to determine glycemic control. The accuracy of GA and GSP versus HbA1c in detecting a 7-day average glucose ≥184 mg/dL was evaluated via receiver-operating-characteristic (ROC) analysis. RESULTS: CGM-derived glucose exhibited strong correlation (r = 0.970, p < 0.001) and acceptable agreement with corresponding capillary glucose measurements obtained by the patients themselves in 1,169 time-points over the 7-day-long CGM. The area under ROC curve (AUC) for GA, GSP, and HbA1c to detect poor glycemic control was 0.976 (0.862-1.000), 0.682 (0.502-0.862), and 0.776 (0.629-0.923) respectively. GA levels >20.3% had 90.9% sensitivity and 96.1% specificity in detecting a 7-day average glucose ≥184 mg/dL. The AUC for GA was significantly higher than the AUC for GSP (difference between areas: 0.294, p < 0.001) and the AUC for HbA1c (difference between areas: 0.199, p < 0.01). CONCLUSION: Among diabetic hemodialysispatients, GA is a stronger indicator of poor glycemic control assessed with 7-day-long CGM when compared to GSP and HbA1c.
Authors: Hyunju Kim; Olive Tang; Casey M Rebholz; Morgan E Grams; Josef Coresh; Robert H Christenson; Elizabeth Selvin Journal: J Appl Lab Med Date: 2022-06-30
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Authors: Michael Bergman; Muhammad Abdul-Ghani; Ralph A DeFronzo; Melania Manco; Giorgio Sesti; Teresa Vanessa Fiorentino; Antonio Ceriello; Mary Rhee; Lawrence S Phillips; Stephanie Chung; Celeste Cravalho; Ram Jagannathan; Louis Monnier; Claude Colette; David Owens; Cristina Bianchi; Stefano Del Prato; Mariana P Monteiro; João Sérgio Neves; Jose Luiz Medina; Maria Paula Macedo; Rogério Tavares Ribeiro; João Filipe Raposo; Brenda Dorcely; Nouran Ibrahim; Martin Buysschaert Journal: Diabetes Res Clin Pract Date: 2020-06-01 Impact factor: 5.602
Authors: Maurizio Gallieni; Cristina De Salvo; Maria Elena Lunati; Antonio Rossi; Francesca D'Addio; Ida Pastore; Gianmarco Sabiu; Roberta Miglio; Gian Vincenzo Zuccotti; Paolo Fiorina Journal: Acta Diabetol Date: 2021-03-20 Impact factor: 4.280