ABSTRACT
Background: In conditions that may change red blood cell survival, such as hemodialysis, the accuracy of A1c glycosylated hemoglobin (HbA1c) to assess metabolic control can be hampered. Other glycosylated proteins such as fructosamine, could accomplish the role of HbA1c. Aim: To assess if HbA1c is a good metabolic control parameter in diabetic patients on chronic hemodialysis. To compare fructosamine, HbA1c and serial capillary glucose levels in the same patients. Material and Methods: Patients on hemodialysis three times per week were studied. Twenty one subjects with diabetes mellitus and 10 non-diabetic patients were included (70 percent were male). During a period of 14 days, fasting and post prandial capillary glucose levels were measured. Venous glucose, HbA1c and fructosamine were measured at the onset and completion of the monitoring period. Results: Diabetic patients were older than their non-diabetic counterparts (65 and 47 years respectively, p < 0.04). In diabetic and non-diabetic patients respectively, capillary blood glucose levels were 161 +/- 22 and 104 +/- 51 mg/dl, HbA1c levels were 6.8 +/- 1.2 and 5.4 +/- 0.4 percent and fructosamine levels were 282.0 +/- 126.6 and 154.6 +/- 73 umol/L. In all patients there was a positive correlation between blood glucose, HbA1c (r = 0.78 p < 0.01) and fructosamine (r = 0.52, p 0.02). There was a positive correlation between mean capillary glucose, HbA1c (r = 0.77, p < 0.01) and fructosamine (r = 0.69, p < 0.02). Among diabetic patients, the correlation coefficients between mean capillary glucose levels, HbA1c and fructosamine levels were 0.67 (p < 0.01) and 0.51 (NS), respectively. Conclusions: Among diabetic patients on hemodialysis fructosamine levels are not a better indicator of metabolic control than HbA1c.
Subject(s)
Humans , Male , Female , Middle Aged , Diabetes Mellitus/blood , Fructosamine/analysis , Glycated Hemoglobin/analysis , Renal Dialysis , Blood Glucose , Body Mass Index , Diabetes Mellitus/diagnosis , Kidney Failure, Chronic/blood , Prospective StudiesABSTRACT
The clinical usefulness of A1c glycosylated hemoglobin (A1c), in the metabolic control of diabetic patients is well known and the goal is to achieve values below 7 percent to prevent the appearance of microangiopathic complications. Standardized measurement methods are required to obtain trustful values. The proposal of the American Diabetes Association to accept A1c as a diagnostic criterion for diabetes and as a means to identify subjects at risk of developing the disease is currently being discussed. The establishment of universal cutoff points has been hindered by the fact that factors such as ethnic influence on glycosylation may modify values of A1c. The use of A1c as an alternative to blood glucose measured during fasting ad after a 75 g glucose load, will not be possible without standardizing measurement methods and performing studies to validate it as a diagnostic method in different populations, including Chileans.