Kidney Week

Abstract: SA-PO160

Glycated Hemoglobin and Serum Fructosamine as Indicators of Glycemic Status in Patients with Type 2 Diabetes and CKD

Session Information

• Diabetic Kidney Disease: Clinical - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Presswala, Lubaina, Zucker School of Medicine at Hofstra / Northwell, Great Neck, New York, United States

Lubaina Presswala,

• Harris, Yael Tobi, Zucker School of Medicine at Hofstra / Northwell, Great Neck, New York, United States

Yael Tobi Harris,

• Hong, Susana, Zucker School of Medicine at Hofstra / Northwell, Great Neck, New York, United States

Susana Hong,

• Jhaveri, Kenar D., Zucker School of Medicine at Hofstra / Northwell, Great Neck, New York, United States

Kenar D. Jhaveri,

• Sakhiya, Vipulbhai, Zucker School of Medicine at Hofstra / Northwell, Great Neck, New York, United States

Vipulbhai Sakhiya,

• Zhang, Meng, Zucker School of Medicine at Hofstra / Northwell, Great Neck, New York, United States

Meng Zhang,

• Fishbane, Steven, Zucker School of Medicine at Hofstra / Northwell, Great Neck, New York, United States

Steven Fishbane,

Group or Team Name

• CGM Study

Background

Among patients with type 2 diabetes mellitus (T2DM) and nondialysis chronic kidney disease (n-CKD) it is unclear whether measures of chronic glycemia, HbA1C and serum fructosamine (SF), are accurate. Previous studies have been of very small sample size or failed to use continuous glucose monitoring (CGM), relying instead on a few random glucose levels. The purpose of this study was to determine the accuracy of HbA1C and SF in T2DM and n-CKD by relating to CGM data.

Methods

We studied 60 patients with T2Dm and n-CKD defined as eGFR 0-45 ml/min. Patients wore the CGM (Abbott FreeStyle Libre Pro) for 14 days, with glucose recorded every 15 minutes (maximum of 1,344 glucose measurements) . Blood tests were drawn in the fasting state after the 14 day CGM. HbA1C and SF were compared by linear regression to patients’ average glucose concentration (AGC) calculated as all of a patient’s CGM glucose results divided by the total number of measurements.

Results

60 patients wore the CGM for a mean of 12.7±2.9 days. Mean age was 72.4±10.4 years, 75% of patients were men, 15% were black, and mean eGFR 25.6±10.5. The mean glucose concentration was 152.2±56.6 mg/dL, mean HbA1C 7.1±1.5% and SF 301.9±57.7 μmol/L. HbA1C was significantly correlated with AGC, r=0.83, p<0.0001. The relationship was characterized by the formula, AGC=31.8 x HbA1C - 73.3. A sensitivity analysis among the 39 patients with eGFR < 30 ml/min. HbA1C remained significantly correlated with AGC, r=0.80, p=0.01 in these patients. There was no significant correlation between serum fructosamine and AGC, r=0.54, p=0.8.

Conclusion

HbA1C, but not serum fructosamine, was an excellent measure of chronic glycemic control among patients with type 2 diabetes and CKD. Further studies with larger sample sizes would be helpful to confirm these findings.

Funding

• Clinical Revenue Support