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Bomholt T, Rix M, Almdal T, et al. The Accuracy of Hemoglobin A1c and Fructosamine Evaluated by Long-Term Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Hemodialysis. Blood Purif. 2021;1-9doi: 10.1159/000519050.
Bomholt, T., Rix, M., Almdal, T., Knop, F. K., Rosthøj, S., Heinrich, N. S., Jørgensen, M. B., Larsson, A., Hilsted, L., Feldt-Rasmussen, B., & Hornum, M. (2021). The Accuracy of Hemoglobin A1c and Fructosamine Evaluated by Long-Term Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Hemodialysis. Blood purification, 1-9. https://doi.org/10.1159/000519050
Bomholt, Tobias, et al. "The Accuracy of Hemoglobin A1c and Fructosamine Evaluated by Long-Term Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Hemodialysis." Blood purification vol. (2021): 1-9. doi: https://doi.org/10.1159/000519050
Bomholt T, Rix M, Almdal T, Knop FK, Rosthøj S, Heinrich NS, Jørgensen MB, Larsson A, Hilsted L, Feldt-Rasmussen B, Hornum M. The Accuracy of Hemoglobin A1c and Fructosamine Evaluated by Long-Term Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Hemodialysis. Blood Purif. 2021 Sep 28;1-9. doi: 10.1159/000519050. Epub 2021 Sep 28. PMID: 34583354.
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Blood Purif. 2021 Sep 28;1-9. doi: 10.1159/000519050. Epub 2021 Sep 28.

The Accuracy of Hemoglobin A1c and Fructosamine Evaluated by Long-Term Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Hemodialysis.

Blood purification

Tobias Bomholt, Marianne Rix, Thomas Almdal, Filip K Knop, Susanne Rosthøj, Niels Søndergaard Heinrich, Morten B Jørgensen, Anders Larsson, Linda Hilsted, Bo Feldt-Rasmussen, Mads Hornum

Affiliations

  1. Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  2. Department of Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  3. Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
  4. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
  5. Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
  6. Steno Diabetes Center Copenhagen, Gentofte, Denmark.
  7. Section of Biostatistics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
  8. Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.
  9. Department of Clinical Biochemistry Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

PMID: 34583354 DOI: 10.1159/000519050

Abstract

INTRODUCTION: The accuracy of hemoglobin A1c (HbA1c) as a glycemic marker in patients with type 2 diabetes (T2D) receiving hemodialysis (HD) remains unknown. To assess accuracy, we compared HbA1c and fructosamine levels with interstitial glucose measured by continuous glucose monitoring (CGM) in patients with T2D receiving HD.

METHODS: Thirty patients in the HD group and 36 patients in the control group (T2D and an estimated glomerular filtration rate >60 mL/min/1.73 m2) completed the study period of 17 weeks. CGM (Ipro2®, Medtronic) was performed 5 times for periods of up to 7 days (with 4-week intervals) during a 16-week period. HbA1c (mmol/mol), the estimated mean plasma glucose from HbA1c (eMPGA1c [mmol/L]) and fructosamine (μmol/L) was measured at week 17 and compared with mean sensor glucose levels from CGM.

FINDINGS: In the HD group, mean sensor glucose was 1.4 mmol/L (95% confidence interval [CI]: 1.0-1.8) higher than the eMPGA1c, whereas the difference for controls was 0.1 mmol/L (95% CI: -0.1-[0.4]; p < 0.001). Adjusted for mean sensor glucose, HbA1c was lower in the HD group (-7.3 mmol/mol, 95% CI: -10.0-[-4.7]) than in the control group (p < 0.001), with no difference detected for fructosamine (p = 0.64).

DISCUSSION: HbA1c evaluated by CGM underestimates plasma glucose levels in patients receiving HD. The underestimation represents a clinical challenge in optimizing glycemic control in the HD population. Fructosamine is unaffected by the factors affecting HbA1c and appears to be more accurate for glycemic monitoring. CGM or fructosamine could thus complement HbA1c in obtaining more accurate glycemic control in this patient group.

© 2021 S. Karger AG, Basel.

Keywords: Continuous glucose monitoring; Diabetic nephropathy; Fructosamine; Hemodialysis; Hemoglobin A1c

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