title: Use of complementary markers in assessing glycaemic control in people with diabetic kidney disease undergoing iron or erythropoietin treatment.
abstract: OBJECTIVE
  HbA(1c) values are unreliable in patients with diabetes who have chronic kidney disease who receive iron and/or erythropoiesis stimulating agents. The study aimed to evaluate the utility of the complementary glycaemic markers glycated albumin, fructosamine and 1,5 anhydroglucitol in this group of patients.
  
  
  METHODS
  A prospective study of patients with Type 2 diabetes and chronic kidney disease stage IIIB/IV undergoing intravenous iron or erythropoiesis-stimulating agent therapy. Glycaemic control was monitored using HbA(1c), seven-point daily glucose thrice weekly, continuous glucose monitoring, glycated albumin, fructosamine and 1,5 anhydroglucitol.
  
  
  RESULTS
  Fifteen patients [9 men; median age 72 years (interquartile range 68-74), follow-up period (16.4 ± 3.7 weeks)] received parenteral iron; 15 patients [11 men; 70 years (interquartile range 62-75), (17.3 ± 3.3 weeks)] received erythropoiesis-stimulating agent. HbA(1c) fell following treatment with both iron [57 mmol/mol (7.4%) to 53 mmol/mol (7.0%), P < 0.001] and erythropoiesis-stimulating agent [56 mmol/mol (7.3%) to 49 mmol/mol (6.6%), P = 0.01] despite mean blood glucose remaining unchanged (iron: 9.55 to 9.71 mmol/l, P = 0.07; erythropoiesis-stimulating agent: 8.72 to 8.78 mmol/l, P = 0.89). Unlike HbA1c , the glycated albumin, fructosamine and 1,5 anhydroglucitol levels did not change following iron [glycated albumin (16.8 to 16.3%, P = 0.10); fructosamine (259.5 to 256 μmol/l, P = 0.89); 1,5 anhydroglucitol (54.2 to 50.9 μmol/l, P = 0.89)] or erythropoiesis-stimulating agent [glycated albumin (17.9 to 17.5%, P = 0.29), fructosamine (324.3 to 306.0 μmol/l, P = 0.52), 1,5 anhydroglucitol (58.2 to 46.7 μmol/l, P = 0.35)]. Despite this, HbA(1c) was consistently the marker most closely related to mean blood glucose before and after each treatment (R range 0.7-0.88).
  
  
  CONCLUSIONS
  These data indicate that HbA(1c) was statistically most closely related to mean blood glucose, but clinical trends in glycaemia in patients undergoing iron or erythropoiesis-stimulating agent therapy are likely best assessed by including one of these additional glycaemic markers.
authors.affiliation: Department of Diabetes and Endocrinology, University of Hull, Hull, UK.
authors.forename: J
authors.initials: J
authors.lastname: Konya
authors.forename: J M
authors.initials: JM
authors.lastname: Ng
authors.forename: H
authors.initials: H
authors.lastname: Cox
authors.forename: M
authors.initials: M
authors.lastname: Cooke
authors.forename: N
authors.initials: N
authors.lastname: Lewis
authors.forename: S
authors.initials: S
authors.lastname: Bhandari
authors.forename: S L
authors.initials: SL
authors.lastname: Atkin
authors.forename: E S
authors.initials: ES
authors.lastname: Kilpatrick
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003695:Delivery of Health Care; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D019270:Fructosamine / Q000097:blood; D006442:Glycated Hemoglobin / Q000187:drug effects* / Q000378:metabolism*; D017127:Glycation End Products, Advanced; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007501:Iron / Q000627:therapeutic use*; D008297:Male; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D000093423:Glycated Serum Albumin
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D000068817:Epoetin Alfa; D004921:Erythropoietin; D019270:Fructosamine; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D006397:Hematinics; D007501:Iron; D011994:Recombinant Proteins; D012709:Serum Albumin; D000093423:Glycated Serum Albumin; C517652:hemoglobin A1c protein, human