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Defining the relationship between average glucose and HbA1c in patients with type 2 diabetes and chronic kidney

Clement Lo1, Michelle Lui2, Sanjeeva Ranasinha3

  • 1Monash Applied Research Stream, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia.

Diabetes Research and Clinical Practice
|February 28, 2014
PubMed

Insights

In type 2 diabetes patients, erythropoiesis stimulating agents (ESAs) can cause hemoglobin A1c (HbA1c) to underestimate average glucose (AG), especially in chronic kidney disease (CKD). This impacts diabetes management and CKD patient care.

Area of Science:

  • Endocrinology
  • Nephrology
  • Clinical Chemistry

Background:

  • Type 2 diabetes management relies on monitoring average glucose (AG) and hemoglobin A1c (HbA1c).
  • Chronic kidney disease (CKD) is a common complication of type 2 diabetes.
  • Erythropoiesis-stimulating agents (ESAs) are frequently used in diabetic patients with CKD.

Purpose of the Study:

  • To investigate the relationship between AG and HbA1c in patients with type 2 diabetes and CKD.
  • To compare this relationship in patients with and without CKD.
  • To assess the influence of CKD stage and ESA use on the AG-HbA1c correlation.

Main Methods:

  • Prospective study of 43 patients with type 2 diabetes and CKD (stages 3-5).
  • Comparison with 104 age-matched controls with type 2 diabetes but without CKD.
  • AG measured via self-monitored blood glucose and continuous glucose monitoring; HbA1c measured from blood samples.
  • Multivariable linear regression analyses used to determine relationships.

Main Results:

  • Mean AG was higher in the CKD group, while HbA1c levels were similar between groups.
  • A linear relationship between AG and HbA1c was observed across all CKD stages.
  • The AG-HbA1c relationship was weaker in advanced CKD (stage 4-5) but became insignificant when ESA use was factored in.

Conclusions:

  • A linear correlation exists between AG and HbA1c in type 2 diabetes patients with CKD.
  • ESA use attenuates this relationship, leading to potential underestimation of AG by HbA1c.
  • Findings suggest careful interpretation of HbA1c in diabetic CKD patients on ESA therapy.
Abstract

Keywords:
Chronic kidney diseaseDiabetes mellitusErythropoietin stimulating agentGlycated haemoglobin

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