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Glycated Hemoglobin Levels in Patients with Decompensated Cirrhosis

Jeffrey Nadelson1, Sanjaya K Satapathy2, Satheesh Nair2

  • 1Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center, Memphis, TN, USA.

International Journal of Endocrinology
|November 25, 2016
PubMed

Insights

Glycated hemoglobin (HbA1c) is unreliable for monitoring glycemic control in decompensated cirrhosis patients. Significant discordance between measured and calculated HbA1c indicates its limitations, particularly with anemia.

Area of Science:

  • Hepatology
  • Endocrinology
  • Clinical Chemistry

Background:

  • Decompensated cirrhosis poses challenges for managing glycemic control.
  • Hemoglobin A1c (HbA1c) is a standard marker for long-term blood glucose levels.
  • The accuracy of HbA1c in cirrhotic patients with altered red blood cell turnover is questionable.

Purpose of the Study:

  • To assess the reliability of HbA1c as a predictor of glycemic control in patients with decompensated cirrhosis.
  • To evaluate the discordance between measured HbA1c and calculated HbA1c based on contemporaneous glucose levels.

Main Methods:

  • A cohort of 200 patients with decompensated cirrhosis awaiting liver transplantation was analyzed.
  • Measured HbA1c (MA1c) was compared with calculated HbA1c (CA1c) derived from three preceding glucose measurements.
  • Patients were stratified into groups based on the magnitude of MA1c-CA1c difference.

Main Results:

  • Nearly half of the patients (49%) had HbA1c levels below 5%.
  • Significant discordance (>0.5%) between MA1c and CA1c was observed in 47% of patients.
  • Severe anemia was identified as an independent predictor of higher HbA1c discordance (OR 0.77).
  • HbA1c independently predicted hepatocellular carcinoma (HCC) occurrence (OR 2.69).

Conclusions:

  • HbA1c is not a reliable indicator of glycemic control in patients with decompensated cirrhosis.
  • The reliability of HbA1c is particularly compromised in patients with severe anemia.
  • Clinical interpretation of HbA1c in this population requires caution due to potential inaccuracies.

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