Hemoglobin A1c Has Suboptimal Performance to Diagnose and Monitor Diabetes Mellitus in Patients with Cirrhosis

Addepally, Naga Saranya; George, Nayana; Martinez-Macias, Roberto; Garcia‐Saenz‐de‐Sicilia, Mauricio; Kim, Woojin; Duarte‐Rojo, Andrés

doi:10.1007/s10620-018-5265-3

Cited by 15 publications

(17 citation statements)

References 27 publications

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“…Given the strong interrelationship between the metabolic syndrome and NASH, the FILI score needs to be further validated following interventions not targeting weight loss and an improved metabolic profile. Also, since hemoglobin A1c loses accuracy in the setting of cirrhosis-especially if decompensated-it is less clear whether this index can be reproduced patients with F4 staging (63).…”

Section: Dynamic Changes In Niald Following Therapeutic Strategiesmentioning

confidence: 99%

Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease

Altamirano

Choudhry

et al. 2020

Transl Gastroenterol Hepatol

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Non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) are becoming the leading causes of chronic liver disease worldwide, significantly impacting public health and healthcare cost.The development of fibrosis is the main factor leading to early mortality and morbidity in NAFLD and ALD. Thus, it is important to timely and reliably evaluate these diseases at early stages, when fibrosis is not advanced or when steatosis predominates. Liver biopsy has been the standard of reference for fibrosis and steatosis, however, its invasiveness precludes its widespread use. There is growing research on non-invasive methods for diagnosing and stratifying fibrosis and steatosis in NAFLD and ALD. This review presents clinical evidence on the use of non-invasive assessment of liver disease (blood-based and imaging-based) in patients with NALFD and ALD, and proposes algorithms incorporating these tests into their management.

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Section: Dynamic Changes In Niald Following Therapeutic Strategiesmentioning

confidence: 99%

Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease

Altamirano

Choudhry

et al. 2020

Transl Gastroenterol Hepatol

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“…A1c value can also be affected unpredictably by blood transfusion[ 100 , 101 ]. More importantly, the inherent biochemical characteristics of the glycation process limit the ability of A1c to capture the excessive blood glucose lability exhibited by patients with CLD, as demonstrated in a recent study that compared A1c against continuous glucose monitoring in diabetic patients with cirrhosis[ 102 ]. This shortcoming may have crucial clinical implications since glycemic variability was shown to be an independent predictor for fibrosis in NAFLD as well as cardiovascular disease and all-cause mortality in the general population[ 103 , 104 ].…”

Section: Traditional Glycemic Markers For Patients With Liver Diseasementioning

confidence: 99%

“…Indeed, an older study on a small cohort of cirrhotic patients demonstrated an inverse correlation between fructosamine levels and serum albumin levels [ 113 ]. A more recent study comparing fructosamine against continual glucose monitoring confirmed the poor association in diabetic patients with cirrhosis[ 102 ]. Several entities, including albumin-corrected fructosamine, total protein-corrected fructosamine, and CLD-A1c, have been proposed in an attempt to improve the diagnostic performance of GA and fructosamine by correcting for variations in serum protein concentrations[ 114 , 115 ].…”

Section: Non-traditional Glycemic Markers For Patients With Liver Dismentioning

confidence: 99%

Clinical implications, diagnosis, and management of diabetes in patients with chronic liver diseases

Chung

Promrat

Wands

2020

WJH

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Diabetes mellitus (DM) negatively affects the development and progression of chronic liver diseases (CLD) of various etiologies. Concurrent DM and CLD are also associated with worse clinical outcomes with respect to mortality, the occurrence of hepatic decompensation, and the development of hepatocellular carcinoma (HCC). Unfortunately, early diagnosis and optimal treatment of DM can be challenging, due to the lack of established clinical guidelines as well as the medical complexity of this patient population. We conducted an exploratory review of relevant literature to provide an up-to-date review for internists and hepatologists caring for this patient population. We reviewed the epidemiological and pathophysiological associations between DM and CLD, the impact of insulin resistance on the progression and manifestations of CLD, the pathogenesis of hepatogenic diabetes, as well as the practical challenges in diagnosis and monitoring of DM in this patient population. We also reviewed the latest clinical evidence on various pharmacological antihyperglycemic therapies with an emphasis on liver disease-related clinical outcomes. Finally, we proposed an algorithm for managing DM in patients with CLD and discussed the clinical and research questions that remain to be addressed.

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“…69 Glycated hemoglobin A1c (HBA1c) is a reliable test to assess chronic glycemia in patients with T2DM, but has suboptimal performance in patients with cirrhosis. 70 A normal HbA1c may not necessarily rule out T2DM in the setting of cirrhosis and in patients with decompensated cirrhosis. 70 Fructosamine may be a better marker to assess glycemic control in patients with cirrhosis and T2DM, 71 but validated laboratories cut-offs do not exist at present.…”

Section: Type 2 Diabetesmentioning

confidence: 99%

“…70 A normal HbA1c may not necessarily rule out T2DM in the setting of cirrhosis and in patients with decompensated cirrhosis. 70 Fructosamine may be a better marker to assess glycemic control in patients with cirrhosis and T2DM, 71 but validated laboratories cut-offs do not exist at present. With the exception of metformin, most of the established, older antiglycemic medications are weight-promoting (i.e., glicazides, thiazolidinediones, insulin), which may in turn worsen adiposity and potentially portal hypertension in NASH cirrhosis.…”

Section: Type 2 Diabetesmentioning

confidence: 99%

Peculiarities of Cirrhosis due to Nonalcoholic Steatohepatitis (NASH)

El‐Sherif

Armstrong

2019

Semin Liver Dis

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The prevalence of cirrhosis due to nonalcoholic steatohepatitis (NASH) has increased 2.5-fold in the United States in the last decade. These patients pose new challenges to hepatologists given their older age and higher frequency of coexisting metabolic diseases such as obesity and diabetes compared with other etiologies of liver disease. Patients with NASH cirrhosis are at higher risk for renal and cardiovascular disease, and the presence of these extrahepatic comorbidities has a significant impact on outcomes and survival. This review outlines how NASH cirrhosis differs from other etiologies of cirrhosis including natural history, noninvasive assessment, and the challenges in the management of the complications of cirrhosis including hepatic encephalopathy and hepatocellular carcinoma. Nutritional assessment and the impact of sarcopenic obesity and frailty in this population, and strategies to address the latter, are discussed. This review also addresses liver transplantation in patients with NASH cirrhosis in relation to assessment and posttransplant care.

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Hemoglobin A1c Has Suboptimal Performance to Diagnose and Monitor Diabetes Mellitus in Patients with Cirrhosis

Abstract: HbA1c inaccurately represents chronic glycemia in patients with cirrhosis, likely in relation to increased glucose variability.

Cited by 15 publications

References 27 publications

Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease

Non-invasive diagnosis: non-alcoholic fatty liver disease and alcoholic liver disease

Clinical implications, diagnosis, and management of diabetes in patients with chronic liver diseases

Peculiarities of Cirrhosis due to Nonalcoholic Steatohepatitis (NASH)

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