The Glycemic Indices in Dialysis Evaluation (GIDE) study: Comparative measures of glycemic control in diabetic
Mark E Williams1, Neal Mittman2, Lin Ma3
1Renal Unit, Joslin Diabetes Center, Boston, Massachusetts, USA.
Insights
Hemoglobin A1c (HgbA1c) may be unreliable for managing diabetes in advanced kidney disease patients on dialysis. Anemia and treatments like erythropoiesis-stimulating agents (ESA) can affect HgbA1c accuracy.
Area of Science:
- Nephrology
- Endocrinology
- Clinical Chemistry
Background:
- Hemoglobin A1c (HgbA1c) validity is questioned in advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients.
- HgbA1c often shows discordance with other glycemic indices in this population.
Purpose of the Study:
- To assess the correlation of HgbA1c with casual glucose, glycated albumin, and serum fructosamine.
- To evaluate glycemic index reliability in diabetic patients undergoing dialysis.
Main Methods:
- The Glycemic Indices in Dialysis Evaluation (GIDE) Study enrolled 1758 diabetic patients from 26 US dialysis facilities.
- Analyzed HgbA1c, casual glucose, glycated albumin, and serum fructosamine distributions, variability, and correlations.
- Examined patient factors including anemia and erythropoiesis-stimulating agent (ESA) doses.
Main Results:
- Serum glucose had the highest intra-patient variability; HgbA1c showed the least.
- Modest to strong correlations were found among the four glycemic indices.
- HgbA1c was more frequently in target range than glycated albumin or fructosamine, influenced by anemia and ESA therapy.
Conclusions:
- Anemia, ESA management, and iron administration impact HgbA1c interpretation in dialysis patients.
- Reliance on HgbA1c alone for glycemic control in advanced CKD/ESRD may be problematic.
- Clarified laboratory correlations among glycemic indices, highlighting concerns for HgbA1c in this cohort.
Abstract:
The validity of hemoglobin A1c (HgbA1c) is undergoing increasing scrutiny in the advanced CKD/ESRD (chronic kidney disease/end-stage renal disease) population, where it appears to be discordant from other glycemic indices. In the Glycemic Indices in Dialysis Evaluation (GIDE) Study, we sought to assess correlation of HgbA1c with casual glucose, glycated albumin, and serum fructosamine in a large group of diabetic patients on dialysis. From 26 dialysis facilities in the United States, 1758 diabetic patients (hemodialysis = 1476, peritoneal dialysis = 282) were enrolled in the first quarter of 2013. The distributions of HgbA1c and the other glycemic indices were analyzed. Intra-patient coefficients of variation and correlations among the four glycemic indices were determined. Patients with low HgbA1c values were both on higher erythropoietin (ESA) doses and more anemic. Serum glucose exhibited the highest intra-patient variability over a 3-month period; variability was modest among the other glycemic indices, and least with HgbA1c. Statistical analyses inclusive of all glycemic markers indicated modest to strong correlations. HgbA1c was more likely to be in the target range than glycated albumin or serum fructosamine, suggesting factors which may or may not be directly related to glycemic control, including anemia, ESA management, and iron administration, in interpreting HgbA1c values. These initial results from the GIDE Study clarify laboratory correlations among glycemic indices and add to concerns about reliance on HgbA1c in patients with diabetes and advanced kidney disease.
Related Concept Videos
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:25Drug Dosing in Renal Diseases: Measurement of Glomerular Filtration Rate
01:28Chronic Kidney Disease III: Interprofessional Care
01:23Dipeptidyl Peptidase 4 Inhibitors
01:25Hemodialysis III: Nursing Management
01:06Oral Hypoglycemic Agents: Glinides