Denmark: Evaluation of HbA1c by continuous glucose monitoring (CGM) underestimates plasma glucose levels in type 2 diabetes (T2D) receiving hemodialysis, and for optimizing blood sugar control, underestimation is a clinical challenge. Now, a recent study states that fructosamine is not affected by the factors affecting HbA1c and may be more accurate for glycemic monitoring. Thus, CGM or fructosamine could complement HbA1c for getting a more accurate blood sugar control in T2D patients receivivxc
Continuous glucose monitoring (CGM) or fructosamine can be used in addition to HbA1c in obtaining a more accurate blood sugar control in type 2 diabetes patients (T2D) receiving hemodialysis (HD), a recent study has suggested. The study appears in Blood Purification, a journal from Karger's publication.
To assess the accuracy of hemoglobin A1c (HbA1c) as a glycemic marker in the above study population, Bomholt T., Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, and colleagues aimed to compare HbA1c and fructosamine levels with interstitial glucose measured by CGM in patients with T2D receiving HD.
Thirty patients in the HD group and 36 patients in the control group (T2D and an estimated glomerular filtration rate >60 mL/min/1.73 m2) completed the study period of 17 weeks.
CGM (Ipro2®, Medtronic) was performed 5 times for periods of up to 7 days (with 4-week intervals) during a 16-week period. HbA1c (mmol/mol), the estimated mean plasma glucose from HbA1c (eMPGA1c [mmol/L]) and fructosamine (μmol/L) was measured at week 17 and compared with mean sensor glucose levels from CGM.
Key findings include:
In the HD group, mean sensor glucose was 1.4 mmol/L higher than the eMPGA1c, whereas the difference for controls was 0.1 mmol/L.
Adjusted for mean sensor glucose, HbA1c was lower in the HD group (−7.3 mmol/mol) than in the control group, with no difference detected for fructosamine.
The researchers concluded, "Fructosamine is unaffected by the factors affecting HbA1c and appears to be more accurate for glycemic monitoring. CGM or fructosamine could thus complement HbA1c in obtaining more accurate glycemic control in this patient group."
Reference:
Bomholt T, Rix M, Almdal T, Knop F, K, Rosthøj S, Heinrich N, S, Jørgensen M, B, Larsson A, Hilsted L, Feldt-Rasmussen B, Hornum M: The Accuracy of Hemoglobin A1c and Fructosamine Evaluated by Long-Term Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Hemodialysis. Blood Purif 2021. doi: 10.1159/000519050