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  • 1
    Online Resource
    Online Resource
    The Use of HbA1c, Glycated Albumin and Continuous Glucose Monitoring to Assess Glucose Control in the Chronic Kidney Disease Population Including Dialysis
    S. Karger AG ; 2021
    In:  Nephron Vol. 145, No. 1 ( 2021), p. 14-19
    Details
    In: Nephron, S. Karger AG, Vol. 145, No. 1 ( 2021), p. 14-19
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Glycated haemoglobin A 〈 sub 〉 1c 〈 /sub 〉 (HbA 〈 sub 〉 1c 〈 /sub 〉 ) has limitations as a glycemic marker for patients with diabetes and CKD and for those receiving dialysis. Glycated albumin is an alternative glycemic marker, and some studies have found that glycated albumin more accurately reflects glycemic control than HbA 〈 sub 〉 1c 〈 /sub 〉 in these groups. However, several factors are known to influence the value of glycated albumin including proteinuria. Continuous glucose monitoring (CGM) is another alternative to HbA 〈 sub 〉 1c 〈 /sub 〉 . CGM allows one to assess mean glucose, glucose variability, and the time spent in hypo-, normo-, and hyperglycemia. Currently, several different CGM models are approved for use in patients receiving dialysis; CKD (not on dialysis) is not a contraindication in any of these models. Some devices are for blind recording, while others provide real-time data to patients. Small studies suggest that CGM could improve glycemic control in hemodialysis patients, but this has not been studied for individual CKD stages. 〈 b 〉 〈 i 〉 Summary: 〈 /i 〉 〈 /b 〉 Glycated albumin and CGM avoid the pitfalls of HbA 〈 sub 〉 1c 〈 /sub 〉 in CKD and dialysis populations. However, the value of glycated albumin may be affected by several factors. CGM provides a precise estimation of the mean glucose. Here, we discuss the strengths and limitations for using HbA1c, glycated albumin, or CGM in CKD and dialysis population. 〈 b 〉 〈 i 〉 Key Messages: 〈 /i 〉 〈 /b 〉 Glycated albumin is an alternative glycemic marker but is affected by proteinuria. CGM provides a precise estimation of mean glucose and glucose variability. It remains unclear if CGM improves glycemic control in the CKD and dialysis populations.
    Type of Medium: Online Resource
    ISSN: 1660-8151 , 2235-3186
    URL: Article
    DOI: 10.1159/000511614
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 2810853-X
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  • 2
    Online Resource
    Online Resource
    The Accuracy of Hemoglobin A1c and Fructosamine Evaluated by Long-Term Continuous Glucose Monitoring in Patients with Type 2 Diabetes Undergoing Hemodialysis
    S. Karger AG ; 2022
    In:  Blood Purification Vol. 51, No. 7 ( 2022), p. 608-616
    Details
    In: Blood Purification, S. Karger AG, Vol. 51, No. 7 ( 2022), p. 608-616
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 The accuracy of hemoglobin A1c (HbA1c) as a glycemic marker in patients with type 2 diabetes (T2D) receiving hemodialysis (HD) remains unknown. To assess accuracy, we compared HbA1c and fructosamine levels with interstitial glucose measured by continuous glucose monitoring (CGM) in patients with T2D receiving HD. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Thirty patients in the HD group and 36 patients in the control group (T2D and an estimated glomerular filtration rate & #x3e;60 mL/min/1.73 m 〈 sup 〉 2 〈 /sup 〉 ) completed the study period of 17 weeks. CGM (Ipro2 〈 sup 〉 ® 〈 /sup 〉 , 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. 〈 b 〉 〈 i 〉 Findings: 〈 /i 〉 〈 /b 〉 In the HD group, mean sensor glucose was 1.4 mmol/L (95% confidence interval [CI]: 1.0–1.8) higher than the eMPGA1c, whereas the difference for controls was 0.1 mmol/L (95% CI: −0.1–[0.4] ; 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Adjusted for mean sensor glucose, HbA1c was lower in the HD group (−7.3 mmol/mol, 95% CI: −10.0–[−4.7]) than in the control group ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), with no difference detected for fructosamine ( 〈 i 〉 p 〈 /i 〉 = 0.64). 〈 b 〉 〈 i 〉 Discussion: 〈 /i 〉 〈 /b 〉 HbA1c evaluated by CGM underestimates plasma glucose levels in patients receiving HD. The underestimation represents a clinical challenge in optimizing glycemic control in the HD population. 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.
    Type of Medium: Online Resource
    ISSN: 0253-5068 , 1421-9735
    URL: Article
    DOI: 10.1159/000519050
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 605548-5
    detail.hit.zdb_id: 1482025-0
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  • 3
    Online Resource
    Online Resource
    Hemoglobin A1c and Fructosamine Evaluated in Patients with Type 2 Diabetes Receiving Peritoneal Dialysis Using Long-Term Continuous Glucose Monitoring
    S. Karger AG ; 2022
    In:  Nephron Vol. 146, No. 2 ( 2022), p. 146-152
    Details
    In: Nephron, S. Karger AG, Vol. 146, No. 2 ( 2022), p. 146-152
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Shortened erythrocyte life span and erythropoietin-stimulating agents may affect hemoglobin A 〈 sub 〉 1c 〈 /sub 〉 (HbA 〈 sub 〉 1c 〈 /sub 〉 ) levels in patients receiving peritoneal dialysis (PD). We compared HbA 〈 sub 〉 1c 〈 /sub 〉 with interstitial glucose measured by continuous glucose monitoring (CGM) in patients with type 2 diabetes receiving PD. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Fourteen days of CGM (Ipro2, Medtronic) were performed in 23 patients with type 2 diabetes receiving PD and in 23 controls with type 2 diabetes and an estimated glomerular filtration rate over 60 mL/min/1.73 m 〈 sup 〉 2 〈 /sup 〉 . Patients were matched on gender and age (±5 years). HbA 〈 sub 〉 1c 〈 /sub 〉 (mmol/mol), its derived estimate of mean plasma glucose (eMPG 〈 sub 〉 A1c 〈 /sub 〉 ) (mmol/L), and fructosamine (µmol/L) were measured at the end of the CGM period and compared with the mean sensor glucose (mmol/L) from CGM. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In the PD group, mean sensor glucose was 0.98 (95% con­fidence interval (CI): 0.43–1.54) mmol/L higher than the eMPG 〈 sub 〉 A1c 〈 /sub 〉 compared with the control group ( 〈 i 〉 p 〈 /i 〉 = 0.002) where glucose levels were nearly identical (−0.05 (95% CI: −0.35–0.25) mmol/L). A significant association was found between fructosamine and mean sensor glucose using linear regression with no difference between slopes ( 〈 i 〉 p 〈 /i 〉 = 0.89) or y-intercepts ( 〈 i 〉 p 〈 /i 〉 = 0.28). 〈 b 〉 〈 i 〉 Discussion/Conclusion: 〈 /i 〉 〈 /b 〉 HbA 〈 sub 〉 1c 〈 /sub 〉 underestimates mean plasma glucose levels in patients with type 2 diabetes receiving PD. However, the clinical significance of this finding is undetermined. Fructosamine seems to more accurately reflect glycemic status. CGM or fructosamine could complement HbA 〈 sub 〉 1c 〈 /sub 〉 to increase the accuracy of glycemic monitoring in the PD population.
    Type of Medium: Online Resource
    ISSN: 1660-8151 , 2235-3186
    URL: Article
    DOI: 10.1159/000519493
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 2810853-X
    Location Call Number Limitation Availability
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    Online Resource
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