Common diabetes glucose test works poorly for dialysis patients
The gold standard long-term glucose monitoring test for patients with diabetes is of limited value in dialysis patients, according to a new study at Wake Forest Baptist Medical Center. The study appears online in the Clinical Journal of the American Society of Nephrology and is scheduled for the July print issue.
Patients and physicians rely on the hemoglobin A1c (HbA1c) test to measure an individual's average blood sugar level over the prior three months. It is the most commonly used long-term blood sugar test, and is widely trusted in the medical community.
While the American Diabetes Association has deemed the hemoglobin A1c (HbA1c) test an effective tool for diagnosing diabetes, the study recently determined that the HbA1c is not as useful for managing patients with diabetes and advanced kidney failure. Another test, the glycated albumin or GA assay, appears to be more effective in this setting, according to the study.
Blood sugar chemically interacts with the hemoglobin to identify a value for HbA1c. But HbA1c results are only accurate when red cells have a normal lifespan. Dialysis patients have shorter red cell survival, reducing the time that sugar in the bloodstream has to interact with hemoglobin, and causing lower HbA1c values.
Researchers evaluated 444 patients with diabetes undergoing dialysis. Patients continued their normal treatment and HbA1c monitoring, but also agreed to have a GA test every three months for an average of more than 2.3 years.
The GA test, developed by Tokyo-based Asahi Kasei Pharma Corporation, measures blood sugars over the past 17 days, as opposed to the longer time frame for HbA1c. In situations where rapid changes occur in blood sugar, the GA gives a more accurate picture of diabetes control. The GA test used in this study is available in Japan, China and South Korea, but is not yet FDA approved in the United States.
Wake Forest Baptist researchers compared the patients' HbA1c and GA test results, assessing their ability to predict hospitalizations and survival. They found that the HbA1c failed to predict these medical outcomes. In contrast, the GA was a strong predictor of patient survival and hospitalizations. The researchers suggest physicians not rely on the HbA1c in dialysis patients, instead suggesting that blood glucose levels be directly monitored with multiple daily readings until the GA test is available in the states.
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