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Standard test for blood sugar control not accurate in diabetic dialysis patients
Date:2/20/2008

WINSTON-SALEM, N.C. The standard test for measuring blood sugar control in people with diabetes is not accurate in those on kidney hemodialysis, according to new research at Wake Forest University Baptist Medical Center.

Wake Forest investigators reported in Kidney International that the hemoglobin A1c test (HbA1c) underestimates true glucose control in hemodialysis patients and could give false comfort to patients and physicians. Hemodialysis, in which blood is passed through an artificial kidney machine for cleansing, is used in cases of kidney failure.

These results suggest that the nearly 200,000 diabetic hemodialysis patients in the United States who use this test may not be receiving optimal care for their blood sugar, said Barry I. Freedman, M.D., senior author and a professor of internal medicine and nephrology.

Diabetic dialysis patients who believe their blood sugars are in the ideal range may still have unacceptably high blood sugars. This was a surprise to the nephrology community, said Freedman. The test weve all come to accept as the gold standard has proven to be inaccurate in this patient population.

HbA1c measures the percentage of hemoglobin (a protein in red blood cells) that has reacted with glucose. This measure, also known as glycosylated hemoglobin, reflects blood sugar control over the previous 30-120 days.

This study evaluated 307 patients with diabetes 258 with end-stage kidney disease on hemodialysis and 49 who did not have kidney failure. The researchers compared the standard HbA1c test with a newer test (glycated albumin, or GA) that measures the amount of blood sugar that has reacted with albumin, a protein in the plasma. The GA test reflects blood sugar control over the previous three to four weeks. Blood samples were also analyzed to determine recent blood sugar levels.

Compared to those without kidney failure, diabetic patients on hemodialysis had higher blood sugars a
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Contact: Karen Richardson
krchrdsn@wfubmc.edu
336-716-4453
Wake Forest University Baptist Medical Center
Source:Eurekalert

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