The Glycemic Indices in Dialysis Evaluation (GIDE) study: Comparative measures of glycemic control in diabetic dialysis patients

Abstract

The validity of hemoglobin A1c (HgbA1c) is undergoing increasing scrutiny in the advanced CKD/ESRD (chronic kidney disease/end-stage renal disease) population, where it appears to be discordant from other glycemic indices. In the Glycemic Indices in Dialysis Evaluation (GIDE) Study, we sought to assess correlation of HgbA1c with casual glucose, glycated albumin, and serum fructosamine in a large group of diabetic patients on dialysis. From 26 dialysis facilities in the United States, 1758 diabetic patients (hemodialysis = 1476, peritoneal dialysis = 282) were enrolled in the first quarter of 2013. The distributions of HgbA1c and the other glycemic indices were analyzed. Intra-patient coefficients of variation and correlations among the four glycemic indices were determined. Patients with low HgbA1c values were both on higher erythropoietin (ESA) doses and more anemic. Serum glucose exhibited the highest intra-patient variability over a 3-month period; variability was modest among the other glycemic indices, and least with HgbA1c. Statistical analyses inclusive of all glycemic markers indicated modest to strong correlations. HgbA1c was more likely to be in the target range than glycated albumin or serum fructosamine, suggesting factors which may or may not be directly related to glycemic control, including anemia, ESA management, and iron administration, in interpreting HgbA1c values. These initial results from the GIDE Study clarify laboratory correlations among glycemic indices and add to concerns about reliance on HgbA1c in patients with diabetes and advanced kidney disease.

High Glycated Albumin and Mortality in Persons with Diabetes Mellitus on Hemodialysis

“…(5, 6) Furthermore, these studies observed that A1c correlated positively with hemoglobin and negatively with erythropoietin stimulating agents. (4, 5, 7, 32) In the present study, we observed similar trends, finding that the ratio of GA compared to A1c was higher in HD patients compared to participants with normal renal function. Furthermore, the correlation between GA and A1c was significantly more diffuse amongst patients on HD compared to the correlation found in non-uremic patients.…”

“…Together, these findings suggest that patient variables other than time-average glucose may be affecting A1c values in the participants with end-stage kidney disease, as has been previously reported. (4, 5, 7, 15, 32)…”

Frutosamina como principal parâmetro glicêmico do paciente diabético em hemodiálise

“…Williams et al 49 The glycemic indices in dialysis evaluation (GIDE) study: 24 , sendo uma condição que resulta na alteração dos vasos sanguíneos renais, levando à perda de proteína na urina. Nessa ordem, quando não controlada, pode levar o órgão à redução de sua função lenta e progressivamente.…”

“…Outro estudo realizado por Williams et al 49 , por outro lado, mostrou que a HbA1c foi o parâmetro que melhor representou os níveis glicêmicos dos pacientes avaliados em ambos os grupos estudados -pacientes em hemodiálise e diálise peritoneal. Ou seja, a HbA1c foi o analito que teve melhor correlação com os valores médios de glicose em relação à frutosamina e albumina glicada.…”

The relationships between glucose variability and renal function in type 2 diabetes patients on basal-bolus insulin therapy

“…По обобщенным данным, ВГ ассоциирована с развитием микрососудистых ослож-нений при СД2 [7]. Показаны особенности ВГ у больных СД, получающих лечение диализом [8]. Взаимосвязь ВГ с функцией почек у больных СД2 с додиализными стадиями ХБП не изучена.…”