Abstract
We investigated the reliability of using HbA1c and glycoalbumin (GA) levels to estimate the blood glucose (BG) condition in 41 diabetic patients (31 males, 10 females; mean age, 65±9 years) undergoing hemodialysis (HD). All patients underwent HD during the daytime, with a mean start time 143 minutes after breakfast. BG levels were measured at 3 points; pre-dialysis, before lunch, and post-dialysis, while HbA1c and GA levels were simultaneously measured at the pre-dialysis point. Mean BG levels at the pre-dialysis point for the past 4 weeks (BG4W) or the past 2 weeks (BG2W) were obtained from the medical records of each patient. We found a correlation between HbA1c and GA levels (r=0.663, p<0.001). Further, GA levels were correlated to BG levels at the pre-dialysis point and before lunch, while HbA1c did not show any correlation to those values. There were also significant relationships among BG4W, HbA1c, and GA level, and among BG2W, HbA1c and GA level. Additionally, BG4W and BG2W each correlated with the ratio of GA to HbA1c (GA/HbA1c) (r=0.418, r=0, 431, respectively), while GA/HbA1c increased with deterioration of BG. In a comparison of 3 patient groups classified by BG4W levels (group A, <150mg/dL; group B, 150-199mg/dL; group C, ≥200mg/dL), HbA1c, GA, and GA/HbA1c levels were significantly higher in group C than in group A, though GA/HbA1c in group A was as high as 3.5. In diabetic patients undergoing HD, absolute levels of HbA1c were low even if BG conditions were good, though the levels maintained a relationship with BG levels. Further, the absolute levels became lower with deterioration of BG levels. Our findings support the hypothesis that GA measurement provides a better estimation of BG status than HbA1c measurement in diabetic patients undergoing HD.
