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Hemoglobin A(1c) and fructosamine for assessing glycemic control in diabetic patients with CKD stages 3 and 4

Harn-Shen Chen1, Tzu-En Wu, Hong-Da Lin

  • 1Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. chenhs@vghtpe.gov.tw

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|March 6, 2010
PubMed

Insights

Glycemic control monitoring using Hemoglobin A1c (HbA1c) and fructosamine may underestimate blood glucose levels in type 2 diabetic patients with chronic kidney disease (CKD). Reference ranges may require adjustment for this population.

Area of Science:

  • Nephrology
  • Endocrinology
  • Clinical Chemistry

Background:

  • Hemoglobin A1c (HbA1c) and fructosamine are standard glycemic control markers.
  • Their accuracy in chronic kidney disease (CKD) patients is not well-established.
  • This study investigates their validity in type 2 diabetes with CKD stages 3-4.

Purpose of the Study:

  • To evaluate the correlation and accuracy of HbA1c and fructosamine.
  • To compare these markers against self-monitoring of blood glucose (SMBG).
  • To assess glycemic monitoring in type 2 diabetic patients with CKD stages 3-4.

Main Methods:

  • Diagnostic test study design.
  • Recruited 30 type 2 diabetic patients with normal kidney function and 30 with CKD stages 3-4.
  • Measured HbA1c, fructosamine, and performed SMBG over 12 weeks.

Main Results:

  • Strong correlation between HbA1c and mean blood glucose (MBG) in both groups (r=0.836, r=0.813).
  • Moderate correlation between fructosamine-albumin ratio and MBG (r=0.645, r=0.649).
  • Estimated Average Glucose (eAG) from HbA1c and fructosamine underestimated MBG in CKD patients.

Conclusions:

  • HbA1c and fructosamine may underestimate glycemic control in type 2 diabetes with CKD stages 3-4.
  • Current reference ranges may need modification for CKD patients.
  • Further research with larger sample sizes and more data is warranted.
Abstract

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