title: Assessing glycemic control in diabetic patients with severe nephropathy.
abstract: Diabetes mellitus is the leading cause of chronic kidney disease and end-stage renal failure in westernized societies, including the United States. In addition to renal manifestations, complications of poorly controlled diabetes include accelerated atherosclerosis, congestive heart failure, neuropathy, and retinopathy. The estimated total cost of diabetes care in the United States was $174 billion in 2007-a number expected to increase markedly in the coming decades. Clinicians must be able to accurately recognize patients with poor glycemic control to have opportunities to intensify treatment and potentially reduce hyperglycemia-related complications. Detecting hyperglycemia is uniquely difficult in patients with severe kidney disease. This paper reviews the literature on the accuracy of glucose monitoring assays in diabetic patients with advanced nephropathy. Interpretation of commonly used tests is affected to a great extent by the uremic milieu and frequently complicates disease management.
authors.affiliation: Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157-1053, USA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Robinson
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism; D017127:Glycation End Products, Advanced; D038321:Glycemic Index; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012709:Serum Albumin / Q000032:analysis / Q000378:metabolism; D014481:United States; D000093423:Glycated Serum Albumin
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin; C517652:hemoglobin A1c protein, human