Premium
Use of complementary markers in assessing glycaemic control in people with diabetic kidney disease undergoing iron or erythropoietin treatment
Author(s) -
Konya J.,
Ng J. M.,
Cox H.,
Cooke M.,
Lewis N.,
Bhandari S.,
Atkin S. L.,
Kilpatrick E. S.
Publication year - 2013
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12249
Subject(s) - fructosamine , medicine , interquartile range , kidney disease , diabetes mellitus , erythropoiesis , endocrinology , gastroenterology , albumin , glycated hemoglobin , glycated haemoglobin , type 2 diabetes , anemia
Aims HbA 1c values are unreliable in patients with diabetes who have chronic kidney disease who receive iron and/or erythropoiesis stimulating agents. The study aimed to evaluate the utility of the complementary glycaemic markers glycated albumin, fructosamine and 1,5 anhydroglucitol in this group of patients. Methods A prospective study of patients with Type 2 diabetes and chronic kidney disease stage IIIB / IV undergoing intravenous iron or erythropoiesis‐stimulating agent therapy. Glycaemic control was monitored using HbA 1c , seven‐point daily glucose thrice weekly, continuous glucose monitoring, glycated albumin, fructosamine and 1,5 anhydroglucitol. Results Fifteen patients [9 men; median age 72 years (interquartile range 68–74), follow‐up period (16.4 ± 3.7 weeks)] received parenteral iron; 15 patients [11 men; 70 years (interquartile range 62–75), (17.3 ± 3.3 weeks)] received erythropoiesis‐stimulating agent. HbA 1c fell following treatment with both iron [57 mmol/mol (7.4%) to 53 mmol/mol (7.0%), P < 0.001] and erythropoiesis‐stimulating agent [56 mmol/mol (7.3%) to 49 mmol/mol (6.6%), P = 0.01] despite mean blood glucose remaining unchanged (iron: 9.55 to 9.71 mmol/l, P = 0.07; erythropoiesis‐stimulating agent: 8.72 to 8.78 mmol/l, P = 0.89). Unlike HbA 1c , the glycated albumin, fructosamine and 1,5 anhydroglucitol levels did not change following iron [glycated albumin (16.8 to 16.3%, P = 0.10); fructosamine (259.5 to 256 μmol/l, P = 0.89); 1,5 anhydroglucitol (54.2 to 50.9 μmol/l, P = 0.89)] or erythropoiesis‐stimulating agent [glycated albumin (17.9 to 17.5%, P = 0.29), fructosamine (324.3 to 306.0 μmol/l, P = 0.52), 1,5 anhydroglucitol (58.2 to 46.7 μmol/l, P = 0.35)]. Despite this, HbA 1c was consistently the marker most closely related to mean blood glucose before and after each treatment ( R range 0.7–0.88). Conclusions These data indicate that HbA 1c was statistically most closely related to mean blood glucose, but clinical trends in glycaemia in patients undergoing iron or erythropoiesis‐stimulating agent therapy are likely best assessed by including one of these additional glycaemic markers.