[en] [en] INTRODUCTION: Assessment of glucose exposure via glycated hemoglobin A1c (HbA1c) has limitations for interpretation in individuals with diabetes and chronic kidney disease (CKD). The glucose management indicator (GMI) derived from continuous glucose monitoring (CGM) data could be an alternative. However, the concordance between HbA1c measured in laboratory and GMI (HbA1c-GMI) is uncertain in individuals with CKD. The purpose of this study is to analyze this discrepancy.
MATERIAL AND METHOD: We performed a multicentric, retrospective, observational study. A group of individuals with diabetes and CKD (n = 170) was compared with a group of individuals with diabetes without CKD (n = 185). All individuals used an intermittently scanned continuous glucose monitoring (isCGM). A comparison of 14-day and 90-day glucose data recorded by the isCGM was performed to calculate GMI and the discordance between lab HbA1c and GMI was analyzed by a Bland-Altman method and linear regression.
RESULTS: HbA1c-GMI discordance was significantly higher in the CKD group versus without CKD group (0.78 ± 0.57 [0.66-0.90] vs 0.59 ± 0.44 [0.50-0.66]%, P < .005). An absolute difference >0.5% was found in 68.2% of individuals with CKD versus 42.2% of individuals without CKD. We suggest a new specific formula to estimate HbA1c from the linear regression between HbA1c and mean glucose CGM, namely CKD-GMI = 0.0261 × 90-day mean glucose (mg/L) + 3.5579 (r2 = 0.59).
CONCLUSIONS: HbA1c-GMI discordance is frequent and usually in favor of an HbA1c level higher than the GMI value, which can lead to errors in changes in glucose-lowering therapy, especially for individuals with CKD. This latter population should benefit from the CGM to measure their glucose exposure more precisely.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Oriot, Philippe ; Service de diabétologie et endocrinologie, Centre Hospitalier de Mouscron, Mouscron, Belgium
Viry, Claire; Service d'endocrinologie, diabète et maladies métaboliques, CHU de Rouen, Université de Rouen Normandie, Rouen, France
Vandelaer, Antoine ; Département de médecine interne > Service de cardiologie
Grigioni, Sébastien; Service de nutrition, CHU de Rouen, Rouen, France ; Normandy University, Rouen, France ; Centre d'Investigation Clinique, CHU de Rouen, Rouen, France
Roy, Malanie; Service d'endocrinologie, diabète et maladies métaboliques, CHU de Rouen, Université de Rouen Normandie, Rouen, France
Philips, Jean-Christophe ; Centre Hospitalier Universitaire de Liège - CHU > > Service de diabétologie, nutrition, maladies métaboliques
Prévost, Gaëtan; Service d'endocrinologie, diabète et maladies métaboliques, CHU de Rouen, Université de Rouen Normandie, Rouen, France ; Centre d'Investigation Clinique, CHU de Rouen, Rouen, France
Language :
English
Title :
Discordance Between Glycated Hemoglobin A1c and the Glucose Management Indicator in People With Diabetes and Chronic Kidney Disease.
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