Significance of hemoglobin A1C in the management of diabetes in dialysis patients

Abstract

According to latest guidelines hemoglobin A1C plays a central role in the diagnosis of diabetes mellitus. It is well-known from epidemiologic studies that a high rate of diabetic patients enters into dialysis programs and these patients have an unfavourable mortality outcome. Based on surveys conducted in recent years in this patient group, hemoglobin A1C has an important role in assessing carbohydrate metabolism. However, there are several factors independent of blood glucose may affect hemoglobin A1C values both in hemodialysis and peritoneal dialysis patients. Hemodialysis disturbs hemoglobin A1c assessment because of an accelerated turnover of lost red blood cells. During peritoneal dialysis a considerable amount of glucose may be absorbed from the peritoneal solutions that may influence hemoglobin A1C level. Several alternative markers such as glycated albumin and fructosamine have been evaluated but they failed to have prognostic advantage. It has been concluded that among dialysis patients the hemoglobin A1C range between 6.5 and 8% is associated with the lowest mortality risk.

Relationships of social support, health‐promoting lifestyles, glycemic control, and bone turnover among adults with type 2 diabetes

“…Given that HbA1c level below 8.0% is associated with the lowest mortality risk in the management of diabetes (Mácsai, Rakk, Miléder, & Fulcz, ), all participants were divided into three groups, including two diabetes groups with different HbA1c levels and one control group. Group A consisted of 66 participants with HbA1c levels above 8.0% (affinity chromatography); group B of 64 participants with HbA1c levels between 6.1 and 8.0%; and group C consisted of 45 participants without T2DM (HbA1c level, 4.0–6.0%).…”

“…Given that HbA1c level below 8.0% is associated with the lowest mortality risk in the management of diabetes (Mácsai, Rakk, Miléder, & Fulcz, 2014), all participants were divided into three groups, including two diabetes groups with different HbA1c levels and one control group.…”

The effect of hemodialysis on glycemic variability

“…Główną przyczyną śmiertelności w populacji chorych z niewydolnością nerek w trakcie hemodializoterapii pozostają choroby układu sercowo-naczyniowego [19]. Spośród metod leczenia nerkozastępczego należy wymienić hemodializę, dializę otrzewnową i transplantację nerek, która uznawana jest za najlepszą metodę dającą 5) zaburzenia metaboliczne występujące w trakcie hemodializy; 6) transfuzje preparatów krwiopochodnych; 7) leczenie erytropoetyną [43,44,45,46,47,48,49].…”

Frutosamina como principal parâmetro glicêmico do paciente diabético em hemodiálise

“…Mácsai et al 48 Significance of hemoglobin A1c in the management of diabetes in dialysis patient (2014) Orv Hetil…”

“…O estudo foi realizado em apenas 23 pacientes diabéticos em tratamento por hemodiálise em comparação a um grupo controle composto por oito pacientes não portadores de diabetes mellitus dialíticos. Em outro estudo, Mácsai et al 48 aponta que a margem de HbA1c associada ao baixo risco de mortalidade encontra-se entre 6,5% e 8,0% para pacientes com diálise peritoneal. O trabalho mostra a frutosamina como uma grande alternativa, mas aponta fragilidades nos dois marcadores.…”