Navigation Links
Standard test for blood sugar control not accurate in diabetic dialysis patients

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
Wake Forest University Baptist Medical Center

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:
(Date:11/24/2015)... VA (PRWEB) , ... November 24, 2015 , ... Preparing ... 1:30 p.m. – 3:00 p.m. EST, , FDA has long asserted ... CLIA regulations apply to performing the tests and do not meet the device regulations. ...
(Date:11/24/2015)... (PRWEB) , ... November 24, 2015 , ... ... advisory organization, is pleased to welcome Winter-Dent & Company as its newest Partner ... day one to become a client's most trusted advisor regardless of whether that ...
(Date:11/24/2015)... ... November 24, 2015 , ... With Thanksgiving right around the ... safety tips to help protect your family and vehicle. , According to the National ... Thanksgiving holiday weekend. Amica is sharing the following safety tips from the NHTSA: ...
(Date:11/24/2015)... ... November 24, 2015 , ... Dr. Rodney E. Willey , has answered a new ... Center for Sleep Disorders, provides treatment for snoring and sleep apnea through oral ... Koala Center for Sleep Disorders in the US, one of four in the Illinois area. ...
(Date:11/24/2015)... ... 24, 2015 , ... Dr. Kevin Day, local family chiropractor in Warsaw ... this holiday season. During the Indiana winter months, Vitamin D deficiency can lead ... at AlignLife want to help provide the tools needed to combat it this year! ...
Breaking Medicine News(10 mins):
(Date:11/24/2015)... , Nov. 24, 2015  BioPlast Manufacturing, ... the medical research, clinical diagnostic and biotech environments, ... leading manufacturer of quality petri dishes. This acquisition ... clients a platform of products that are designed ... with the highest quality.  ...
(Date:11/24/2015)... brand Revo has debuted a new capsule collection ... Bono as part of the " Buy Vision, Give Sight ... than 5 million people by 2020.  --> ... sale of every pair of Revo sunglasses, including Bono,s "Vision ... to the "Buy Vision, Give Sight" initiative. These funds will ...
(Date:11/24/2015)... USA , Inc. (OTCQB: WCUI), today provided an update ... to targeted dermatology markets in Boston , ... North Carolina . This follows earlier shipments to the ... , and New York dermatology markets. ... reported on October 1, 2015 will be realized in the pending quarter, ...
Breaking Medicine Technology: