title: Hemoglobin A(1c) and fructosamine for assessing glycemic control in diabetic patients with CKD stages 3 and 4.
abstract: BACKGROUND
  Hemoglobin A(1c) (HbA(1c)) and fructosamine can be used to monitor glycemic control in diabetic patients with normal kidney function, but their validity in patients with chronic kidney disease (CKD) has not been evaluated. In this study, we evaluated the correlation and accuracy of these 2 measures of glycemic control in type 2 diabetic patients with CKD stages 3-4.
  
  
  METHODS
  Diagnostic test study.
  
  
  METHODS
  Type 2 diabetic patients with normal (n = 30) and abnormal kidney function (n = 30) were recruited in Taipei Veterans General Hospital, Taiwan.
  
  
  METHODS
  HbA(1c) and fructosamine.
  
  
  METHODS
  Self-monitoring of blood glucose levels.
  
  
  METHODS
  Blood glucose measurements consisted of 6 preprandial, 6 postprandial, and 2 bedtime assessments in a week with a cycle of 4-week intervals for 12 weeks.
  
  
  RESULTS
  Correlation coefficients between HbA(1c) level or fructosamine-albumin ratio and mean blood glucose levels were 0.836 and 0.645 in participants with normal kidney function and 0.813 and 0.649 in participants with CKD stages 3-4, respectively. In patients with CKD stages 3-4, mean blood glucose levels in weeks 1-12 were 21.9 mg/dL (95% CI, 11.6-32.5) higher than estimated average glucose (eAG) levels calculated from HbA(1c) levels in participants with normal kidney function. In patients with CKD stages 3-4, mean blood glucose levels in weeks 10-12 were 15.5 mg/dL (95% CI, 5.2-30.5) higher than eAG levels calculated from fructosamine levels in participants with normal kidney function, but without statistical significance when eAG calculated from fructosamine level was corrected for serum albumin level (difference of 5.6 mg/dL; 95% CI, -8.6 to 19.8).
  
  
  CONCLUSIONS
  Relatively small number of participants with limited amount of blood glucose measurement data.
  
  
  CONCLUSIONS
  Our data show that eAG calculated from HbA(1c) and fructosamine levels might underestimate mean blood glucose levels in patients with CKD stages 3-4. References ranges may need to be modified when interpreting results of measurements of glycemic control in type 2 diabetic patients with CKD.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. chenhs@vghtpe.gov.tw
authors.forename: Harn-Shen
authors.initials: HS
authors.lastname: Chen
authors.forename: Tzu-En
authors.initials: TE
authors.lastname: Wu
authors.forename: Hong-Da
authors.initials: HD
authors.lastname: Lin
authors.forename: Tjin-Shing
authors.initials: TS
authors.lastname: Jap
authors.forename: Li-Chuan
authors.initials: LC
authors.lastname: Hsiao
authors.forename: Shen-Hung
authors.initials: SH
authors.lastname: Lee
authors.forename: Shu-Hsia
authors.initials: SH
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1; D003928:Diabetic Nephropathies / Q000097:blood*; D005260:Female; D019270:Fructosamine / Q000097:blood*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012016:Reference Values; D051436:Renal Insufficiency, Chronic / Q000097:blood*; D055815:Young Adult
chemical_list: D019270:Fructosamine; D006442:Glycated Hemoglobin