Utility of HbA_1c assessment in people with diabetes awaiting liver transplantation

Abstract

AimsTo investigate the relationship between HbA1c and glucose in people with co‐existing liver disease and diabetes awaiting transplant, and in those with diabetes but no liver disease.MethodsHbA1c and random plasma glucose data were collected for 125 people with diabetes without liver disease and for 29 people awaiting liver transplant with diabetes and cirrhosis. Cirrhosis was caused by non‐alcoholic fatty liver disease, hepatitis C, alcoholic liver disease, hereditary haemochromatosis, polycystic liver/kidneys, cryptogenic/non‐cirrhotic portal hypertension and α‐1‐antitrypsin‐related disease.ResultsThe median (interquartile range) age of the diabetes with cirrhosis group was 55 (49–63) years compared to 60 (50–71) years (P=0.13) in the group without cirrhosis. In the diabetes with cirrhosis group there were 21 men (72%) compared with 86 men (69%) in the group with diabetes and no cirrhosis (P=0.82). Of the group with diabetes and cirrhosis, 27 people (93%) were of white European ethnicity, two (7%) were South Asian and none was of Afro‐Caribbean/other ethnicity compared with 94 (75%), 16 (13%), 10 (8%)/5 (4%), respectively, in the group with diabetes and no cirrhosis (P=0.20). Median (interquartile range) HbA1c was 41 (32–56) mmol/mol [5.9 (5.1–7.3)%] vs 61 (52–70) mmol/mol [7.7 (6.9–8.6)%] (P<0.001), respectively, in the diabetes with cirrhosis group vs the diabetes without cirrhosis group. The glucose concentrations were 8.4 (7.0–11.2) mmol/l vs 7.3 (5.2–11.5) mmol/l (P=0.17). HbA1c was depressed by 20 mmol/mol (1.8%; P<0.001) in 28 participants with cirrhosis but elevated by 28 mmol/mol (2.6%) in the participant with α‐1‐antitrypsin disorder. Those with cirrhosis and depressed HbA1c had fewer larger erythrocytes, and higher red cell distribution width and reticulocyte count. This was reflected in the positive association of glucose with mean cell volume (r=0.39) and haemoglobin level (r=0.49) and the negative association for HbA1c (r=–0.28 and r=–0.26, respectively) in the diabetes group with cirrhosis.ConclusionHbA1c is not an appropriate test for blood glucose in people with cirrhosis and diabetes awaiting transplant as it reflects altered erythrocyte presentation.

Validating Self‐Reported Unhealthy Alcohol Use With Phosphatidylethanol (PEth) Among Patients With HIV

“…Furthermore, given the current limited knowledge of inter-individual differences in PEth synthesis and elimination, additional research is needed to better understand this and improve our understanding of the relationship between self-reported alcohol use and PEth concentrations. Additionally, given that liver disease is associated with shortened red cell survival (Bhattacharjee et al, 2018), our findings that self-reported alcohol use was more strongly associated with PEth among the MALD participants may be explained by the fact that PEth reflects alcohol use over shorter period of time among PWH and comorbid liver disease and would thus be less subject to recall bias.…”

Inborn and acquired risk factors for severe liver disease in Europeans with type 2 diabetes from the UK Biobank

“…Additionally, in both studies HbA1c was found to be not related to increased risk of SLD. Since the well-established association of HbA1c with higher risk of chronic micro-and macro-vascular complications of type 2 diabetes [37], this finding might be explained by the fact that HbA1c does not accurately reflect glycemic control in individuals with diabetes and cirrhosis [38][39][40].…”

The haemoglobin glycation index is associated with nonalcoholic fatty liver disease in healthy subjects

“…HbA1c levels can be affected by many factors in addition to mean plasma glucose (MPG) level, and considerable variation can be seen even among individuals with similar mean blood glucose levels. Therefore, interpreting the HbA1c results requires consideration of many factors, such as age, anaemia/haemoglobinopathies, pregnancy, and renal and hepatic disease . To overcome this limitation, the HGI was introduced as an alternative method of determining interindividual variations in HbA1c by Hempe et al in 2002 .…”

“…Therefore, interpreting the HbA1c results requires consideration of many factors, such as age, anaemia/haemoglobinopathies, pregnancy, and renal and hepatic disease. [18][19][20][21][22] To overcome this limitation, the HGI was introduced as an alternative method of determining interindividual variations in HbA1c by Hempe et al in 2002. 2 Several studies have subsequently demonstrated that HGI can reflect the biovariability of HbA1c.…”