2012 Volume 45 Issue 10 Pages 947-953
It has been reported that glycoalbumin (GA) is more suitable than the hemoglobin A1c (HbA1c) level as an indicator of diabetes control in hemodialysis (HD) patients with diabetes. Because of the use of Erythropoiesis Stimulating Agent (ESA), HbA1c has been underestimated by about 30% in HD patients. We measured casual plasma glucose (PG), HbA1c, and GA of 58 diabetes HD patients, and evaluated the current diabetes control situation in HbA1c and GA. Sixteen of 30 patients (53.3%) with HbA1c<5.8% showed a GA level of more than 20%, and 25 of 40 patients (62.5%) with HbA1c<6.5% showed a GA level of more than 20%. We have come to be able to use Alogliptin, Dipeptidyl-peptidase IV inhibitor, in HD patients with diabetes. After Alogliptin at 6.25 mg/day was administered to the 13 HD patients with GA>20%, the mean PG level decreased significantly one month later, and HbA1c and GA levels decreased significantly two months later (p<0.05). The mean PG, HbA1c, and GA levels were 178.8±39.5 mg/dL, 6.05±1.16%, and 26.1±5.95% before dosage, 150.9±30.6 mg/dL, 5.35±0.83%, and 21.2±1.74% three months later, and 151.8±29.8 mg/dL, 5.18±0.72%, and 20.3±2.41% five months later. Although the HbA1c<6.5% achievement rate before dosage was 53.8%, the HbA1c<6.5% achievement rate had significantly increased to 84.6% three months later, and to 100% five months later (p<0.05). The GA<20% achievement rate was 0% before dosage and 23.1% three months later, but increased significantly to 38.4% four months later, and to 46.2% five months later (p<0.05). Therefore, GA is useful in diabetes management of HD patients. Alogliptin is beneficial in the treatment of HD patients with diabetes.
