Hemoglobin A1c and Fructosamine for Assessing Glycemic Control in Diabetic Patients With CKD Stages 3 and 4

Chen, Harn-Shen; Wu, Tzu-En; Lin, Hong-Da; Jap, Tjin-Shing; Hsiao, Li-Chuan; Lee, Shen-Hung; Lin, Shu-Hsia

doi:10.1053/j.ajkd.2009.10.064

« Previous Next »American Journal of Kidney Diseases
Volume 55, Issue 5 , Pages 867-874, May 2010

Hemoglobin A_1c and Fructosamine for Assessing Glycemic Control in Diabetic Patients With CKD Stages 3 and 4

Harn-Shen Chen, MD, PhD
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Address correspondence to Harn-Shen Chen, MD, PhD, Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC, 201, Sec. 2, Shih-Pai Rd, Taipei, Taiwan
Tzu-En Wu, MD
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Public Health and National Yang-Ming University School of Medicine, Taipei, Taiwan
Hong-Da Lin, MD
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
Tjin-Shing Jap, MD
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
Li-Chuan Hsiao, BSC
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
Shen-Hung Lee, BSC
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
Shu-Hsia Lin, BSC
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

Received 8 July 2009; accepted 27 October 2009. published online 04 March 2010.

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.

Study Design

Diagnostic test study.

Setting & Participants

Type 2 diabetic patients with normal (n = 30) and abnormal kidney function (n = 30) were recruited in Taipei Veterans General Hospital, Taiwan.

Index Tests

HbA_1c and fructosamine.

Reference Test

Self-monitoring of blood glucose levels.

Measurements

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).

Limitations

Relatively small number of participants with limited amount of blood glucose measurement data.

Conclusion

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.

Index Words: Hemoglobin A_1c, fructosamine, diabetes, chronic kidney disease