Use of complementary markers in assessing glycaemic control in people with diabetic kidney disease undergoing iron or erythropoietin treatment

作者：Konya J^*; Ng J M; Cox H; Cooke M; Lewis N; Bhandari S; Atkin S L; Kilpatrick E S

来源：Diabetic Medicine, 2013, 30(10): 1250-1254.

DOI：10.1111/dme.12249

AimsHbA(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. %26lt;br%26gt;MethodsA prospective study of patients with Type2 diabetes and chronic kidney disease stageIIIB/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. %26lt;br%26gt;ResultsFifteen patients [9 men; median age 72years (interquartile range 68-74), follow-up period (16.43.7weeks)] received parenteral iron; 15 patients [11 men; 70years (interquartile range 62-75), (17.33.3weeks)] received erythropoiesis-stimulating agent. HbA(1c) fell following treatment with both iron [57mmol/mol (7.4%) to 53mmol/mol (7.0%), P%26lt;0.001] and erythropoiesis-stimulating agent [56mmol/mol (7.3%) to 49mmol/mol (6.6%), P=0.01] despite mean blood glucose remaining unchanged (iron: 9.55 to 9.71mmol/l, P=0.07; erythropoiesis-stimulating agent: 8.72 to 8.78mmol/l, P=0.89). Unlike HbA(1c), 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 256mol/l, P=0.89); 1,5 anhydroglucitol (54.2 to 50.9mol/l, P=0.89)] or erythropoiesis-stimulating agent [glycated albumin (17.9 to 17.5%, P=0.29), fructosamine (324.3 to 306.0mol/l, P=0.52), 1,5 anhydroglucitol (58.2 to 46.7mol/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). %26lt;br%26gt;ConclusionsThese 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.

• 出版日期2013-10