Estimating Average Glucose Levels from Glycated Albumin in Patients with End-Stage Renal Disease

PURPOSE: In patients with diabetic end stage renal disease (ESRD), glycated albumin (GA) reflects recent glycemic control more accurately than glycated hemoglobin (HbA1c). We evaluated the relationship between GA and average blood glucose (AG) level and developed an estimating equation for translating GA values into easier-to-understand AG levels. MATERIALS AND METHODS: A total of 185 ESRD patients, including 154 diabetic and 31 non-diabetic participants, were enrolled (108 hemodialysis, 77 peritoneal dialysis). Patients were asked to perform four-point daily self-monitoring of capillary blood glucose (SMBG) at least three consecutive days each week for four weeks. Serum levels of GA, HbA1c and other biochemical parameters were checked at baseline, as well as at 4 and 8 weeks. RESULTS: Approximately 74.3+/-7.0 SMBG readings were obtained from each participant and mean AG was 169.1+/-48.2 mg/dL. The correlation coefficient between serum GA and AG levels (r=0.70, p<0.001) was higher than that of HbA1c and AG (r=0.54, p<0.001). Linear regression analysis yielded the following equation: estimated AG (eAG) (mg/dL)=4.71xGA%+73.35, and with this formula, serum GA levels could be easily translated to eAG levels. Multivariate analysis revealed significant contributions of postprandial hyperglycemia (beta=0.25, p=0.03) and serum albumin (beta=0.17, p=0.04) in determining serum GA level, independent to other clinical parameters. CONCLUSION: Compared to HbA1c, serum GA levels were better correlated with AG levels. Using the estimating equation, an average blood glucose level of 155-160 mg/dL could be matched to a GA value of 18-19% in patients with ESRD.

Can average blood glucose is an alternative for glycosylated hemoglobin A1c / 中国实用内科杂志

Glycosylated hemoglobin A1c(HbA1c)is the products of slow,continuous non-enzymatic saccharification reaction,which can reflect the average blood glucose of 2~3 months of the patients,and it is the most important index for long-term monitoring of glucose.There are so many methods for detecting HbA1c that America,Japan and Swede proposed their own standardized detection methods to reduce the difference laboratories.However,these methods were non-specific.A new method for was developed by International Federation of Clinical Chemistry and laboratory medicine (IFCC) in 2007,which was of high specificity,but which resulted in relatively low glycosylated hemoglobin.To avoid the confusion in reference value of glycosylated hemoglobin,average blood glucose was recommended by American Diabetes Association (ADA),European Association for the Study of Diabetes (EASD),and International Diabetes Federation (IDF).This paper review the origin of average blood glucose substituting HbA1c,relationship of HbA1c with average blood glucose,and the international multiple-center research of ADAG and its enlightenment,and we also discuss the relevant development in future.