Performance of non‐traditional hyperglycemia biomarkers by chronic kidney disease status in older adults with diabetes: Results from the Atherosclerosis Risk in Communities Study

Abstract

In older adults with severe or very severe CKD, HbA1c, glycated albumin, and fructosamine were not highly correlated with fasting glucose. The results suggest there may be no particular advantage of glycated albumin or fructosamine over HbA1c for monitoring glycemic control in CKD.

Association of characteristics of people with type 2 diabetes mellitus with discordant values of fasting glucose and HbA1c

“…Kidney disease assessed by low eGFR was strongly related to discordant HbA1c and fasting glucose values. It is well established that in chronic kidney disease HbA1c may yield biased results for glycemic control . As an example, a low correlation was recently found between HbA1c and fasting glucose ( r = 0.52) in people with diabetes and severe chronic kidney disease …”

How does CKD affect HbA1c?

“…Recognizing that the dataset may be limited, Jung et al nevertheless give an intriguingly negative answer to the first question, of the reliability of HbA1c with kidney disease. Using Deming regression analysis, Jung et al showed that the correlation between HbA1c and fasting glucose weakens as renal function worsens, and, moreover, that this appears particularly to be the case in people with anemia (hemoglobin <130 and <120 g/L for men and women, respectively), confirming earlier observations .…”

“…How, then, should we assess a given diabetic person's degree of glycemic control in the presence of CKD (or of anemia, which, per Jung et al, was, even without CKD, also associated with a reduction in the correlation between HbA1c and fasting glucose)? Jung et al suggest the use of continuous glucose monitoring to estimate average glucose. Although becoming recognized as an important tool, this technology is not as generally available as the simpler self‐monitoring of blood glucose (SMBG).…”

“…3 Among those diabetic people with neither anemia nor CKD, the correlation coefficient between HbA1c and fasting glucose was r = 0.70, compared with r = 0.35 among those with both anemia and very severe CKD (estimated glomerular filtration rate [eGFR] <30 or <45 mL/min per 1.73 m 2 with at least microalbuminuria, or eGFR <60 mL/min per 1.73 m 2 with macroalbuminuria). As far as the second question, of whether the alternative measures, namely fructosamine and glycated albumin, may be more useful with CKD, Jung et al 2 found that these parameters are equally flawed with CKD. Intriguingly, this suggests that anemia affects indirect measures of glycemic exposure not only by its association with more rapid erythrocyte turnover, but, more generally, also as a marker of a catabolic state with altered plasma protein turnover.How, then, should we assess a given diabetic person's degree of glycemic control in the presence of CKD (or of anemia, which, per Jung et al, 2 was, even without CKD, also associated with a reduction in the correlation between HbA1c and fasting glucose)?…”

“…Intriguingly, this suggests that anemia affects indirect measures of glycemic exposure not only by its association with more rapid erythrocyte turnover, but, more generally, also as a marker of a catabolic state with altered plasma protein turnover.How, then, should we assess a given diabetic person's degree of glycemic control in the presence of CKD (or of anemia, which, per Jung et al, 2 was, even without CKD, also associated with a reduction in the correlation between HbA1c and fasting glucose)? Jung et al 2 suggest the use of continuous glucose monitoring to estimate average glucose. Although becoming recognized as an important tool, 4 this technology is not as generally available as the simpler self-monitoring of blood glucose (SMBG).…”