Indicators for blood glucose control in diabetics with end-stage chronic renal disease : GHb vs. glycated albumin (GA)

Diabetics with end-stage renal disease (ESRD) exhibit abnormal life span of erythrocytes, and thus, HbAlc is not necessarily a good indicator for blood glucose control. The present study was conducted to reaffirm this point and determine whether glycated albumin (GA) can be used instead of HbAlc. The following three groups of patients with diabetes served as subjects : 49 predialysis patients with ESRD (predialysis group), 37 patients with ESRD on dialysis (dialysis group), and 40 patients without nephropathy (non-dialysis group). The profile set mean blood glucose was calculated by measuring blood glucose levels seven times a day. The relationship of profile set mean blood glucose with HbAlc and GA levels was then investigated. Corrected HbAlc levels were calculated by applying the profile set mean blood glucose of each ESRD patient to the regression formula for the HbAlc of non-dialysis patients. The actual and corrected HbAlc levels for the predialysis patients were 5.4±1.1 and 7.9±1.1%, respectively, while those for the dialysis patients were 5.6±1.0 and 7.5±0.9%, respectively (plt0.0001). The changes in GA levels in relation to the blood glucose control in the dialysis patients matched those in non-dialysis patients. HbAlc levels for diabetics with ESRD were lower than indicated by their blood glucose control. When assessing blood glucose control based solely on HbAlc, erroneous results may be obtained. In such cases, GA may be used instead of HbAlc

マッキ ジンフゼン トウニョウビョウ カンジャ ニオケル ケットウ カンリ シヒョウ : HbA1c ノ モンダイテン

We have investigated the validity of HbA1c values measured as the index of glycemic controls in diabetics with end-stage renal disease（ESRD）. HbA1c levels for diabetics with ESRD undergoing haemodialysis were lower than indicated by their blood glucose control. However, the changes in glycated albumin in relation to the blood glucose control in the dialysis patients matched those in diabetics without renal dysfunction. Diabetics with stage４or５chronic kidney disease（CKD）not on haemodialysis had significantly lower values of HbA1c and shorter RBC lifespan compared with patients without renal dysfunction. When assessing blood glucose control based solely on HbA1c, erroneous result may be obtained in diabetics with ESRD