title: Adequacy of glycemic control in hemodialysis patients with diabetes.
abstract: OBJECTIVE
  We sought to measure the prevalence of inadequate glycemic control in prevalent hemodialysis patients with diabetes and to examine independent predictors of inadequate glycemic control in these patients.
  
  
  METHODS
  This is a cross-sectional study of prevalent hemodialysis patients with diabetes in southeastern Ontario (n = 100). Data were collected by chart review and interview. The outcome variable was inadequate glycemic control defined as HbA1c (A1C) >0.07. Other measured variables were diabetes type, diabetes duration, diabetes physician, blood glucose monitoring, diabetes medications, BMI, time on dialysis, and other demographic, clinical, and laboratory variables.
  
  
  RESULTS
  Fifty-four patients had A1C >0.07. In bivariate analysis, these patients had a longer diabetes duration (23.6 vs. 14.7 years, P < 0.001), higher proportion with insulin use (81.5 vs. 58.7%, P = 0.012), higher proportion with microvascular complications (66.7 vs. 43.5%, P = 0.017), and lower erythropoietin (EPO) dose (7.0 vs. 11.9 x 10(3) units/week, P < 0.01) than patients with adequate glycemic control. There was no difference between the two groups in terms of macrovascular complications (59.3 vs. 65.2%, P = 0.54). In multiple logistic regression controlling for age and diabetes type, the diabetes duration (odds ratio 1.09 [95% CI 1.04-1.15], P < 0.001), EPO dose (0.90 [0.85-0.97], P < 0.01), and blood glucose monitoring (10.06 [1.03-98.74], P = 0.05) were the only significant independent predictors of A1C >0.07.
  
  
  CONCLUSIONS
  A high proportion of hemodialysis patients with diabetes had inadequate glycemic control, particularly those with longstanding disease. Patients with inadequate glycemic control had a significantly higher burden of microvascular complications.
authors.affiliation: Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tascona
authors.forename: A Ross
authors.initials: AR
authors.lastname: Morton
authors.forename: Edwin B
authors.initials: EB
authors.lastname: Toffelmire
authors.forename: David C
authors.initials: DC
authors.lastname: Holland
authors.forename: Eduard A
authors.initials: EA
authors.lastname: Iliescu
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D006435:Renal Dialysis
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin