Navigation Links
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 and GA levels, despite paradoxically lower HbA1c results. The relationship between GA and HbA1c differed between diabetic dialysis patients and those without kidney disease, demonstrating that the HbA1c did not accurately reflect blood sugar control in those on hemodialysis.

Researchers believe the major reason for the discrepancy is that HbA1c depends on red blood cell survival and these cells dont live as long in hemodialysis patients. Most dialysis patients have anemia requiring treatment with medications that stimulate red blood cell production (erythropoietin).

The current study confirmed a report in Japanese patients and is the first to demonstrate the inaccuracy of the HbA1c in black and white dialysis patients. The Wake Forest researchers will soon determine whether these concerns also apply to patients on peritoneal dialysis and to people with kidney disease not yet on dialysis.

Controlling blood sugar is important because high levels are risk factors for developing hardening of the arteries (atherosclerosis) and lead to higher rates of kidney disease, heart attack, stroke, nerve damage and blindness. People with diabetes who undergo hemodialysis are at especially high risk. About one out of four diabetic dialysis patients (23 percent) in the U.S. will die from cardiovascular and infection complications during their first year on dialysis, and only 31 percent survive five years.

Control of blood sugar improves outcomes of diabetic patients, so accurate assessment is critical, said Freedman. This study supports the GA test as a more accurate measure of long-term blood sugar control among diabetic patients who are on hemodialysis.

The GA test is not currently available in the United States. Freedman said that until it is available, doctors and patients should be aware that the HbA1c underestimates glucose control and is affected by both erythropoietin administration and the hemoglobin concentration.


'/>"/>

Contact: Karen Richardson
krchrdsn@wfubmc.edu
336-716-4453
Wake Forest University Baptist Medical Center
Source:Eurekalert

Related medicine news :

1. Standard & Poors Announces Change to U.S. Index
2. CAQH Core Rules Final Component of HITSP Interoperability Standards Formally Recognized By HHS Sec. Leavitt
3. New hospital standards needed for pediatric flu vaccines
4. Pharma Product Commercialization: Standardized Team Processes Help Save Complex Drug Launches
5. Health Care Solutions Provider Payformance Health Standardizes on PGP Encryption for Data Security
6. Digirad to Introduce New Clinical Standard for Cardiac SPECT
7. HHS Secretary Recognizes Products of HITSP Standards Work
8. URAC Seeks Public Comment on Standards for New Pharmacy Accreditation Programs
9. Standard Septic Shock Treatments Ineffective
10. NIST reference materials are gold standard for bio-nanotech research
11. OSHA Extends Comment Period for Lookback Review of Methylene Chloride Standard
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:4/30/2016)... ... April 30, 2016 , ... ... 2016 questioned the use of the HyProCure sinus tarsi implant. ( http://www.cbc.ca/news/canada/ottawa/banned-quebec-dentist-pierre-dupont-working-as-chiropodist-in-ottawa-1.3515494 ... EOTTS-HyProCure is a minimally invasive procedure performed, when indicated, to correct the ...
(Date:4/29/2016)... ... April 30, 2016 , ... Mercy College is expanding its Graduate Business ... will be expanding due to high demand: Master of Business Administration (MBA), Master of ... summer. , School of Business Graduate Program Chair Dr. Ray Manganelli said: ...
(Date:4/29/2016)... ... April 29, 2016 , ... Shamangelic Healing, Sedona Arizona's ... brand Alpha BRAIN and New Mood Daily-Stress Formula for brain optimization and wellness ... to the store is just one more way Shamangelic Healing supports people’s quest ...
(Date:4/29/2016)... CA (PRWEB) , ... April 29, 2016 , ... ... advocating optimistic healthcare awareness and author of best seller "LOVE, MEDICINE and MIRACLES") ... Radio Monday, May 2, 2016 and podcasted thereafter . Dr. Bernie Siegel, ...
(Date:4/29/2016)... St. Petersburg, Fla. (PRWEB) , ... April 29, ... ... All Children’s Hospital surgeon reveals that infants born with severe congenital diaphragmatic hernia ... 3,000 babies is born with congenital diaphragmatic hernia (CDH)—a condition where the diaphragm ...
Breaking Medicine News(10 mins):
(Date:4/27/2016)... -- Hologic, Inc. (Nasdaq: HOLX ) announced ... second quarter ended March 26, 2016.  GAAP diluted ... and non-GAAP diluted EPS of $0.47 increased 14.6%.  ... reported basis, and 6.3% on a constant currency ... quarter, highlighted by 14.6% growth in non-GAAP EPS," ...
(Date:4/27/2016)... , April 27, 2016 ... accelerator (MR-linac) platform will be the focal point of ... of the European Society for Radiotherapy & Oncology, taking ... MR-linac integrates a state-of-the-art radiotherapy system and a high-field ... to clearly see the patient,s anatomy in real time. ...
(Date:4/27/2016)... 27, 2016  Bayer Animal Health today announced ... the University of Florida College of Veterinary Medicine, ... in Communication Award (BECA). Brittany was selected from ... a total of $70,000 in scholarship funds through ... Bayer has provided a total of $232,500 in ...
Breaking Medicine Technology: