Qayyum Ahad, Chowdhury Tahseen A, Oei Elizabeth Ley, Fan Stanley L
Joint International Society of Nephrology and Kidney Research UK Fellow at the Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK.
Blood Purif. 2016;41(1-3):18-24. doi: 10.1159/000439242. Epub 2015 Oct 20.
Glycated hemoglobin is used to assess diabetic control although its accuracy in dialysis has been questioned. How does it compare to the Continuous Glucose Monitoring System (CGMS) in peritoneal dialysis (PD) patients?
We conducted a retrospective analysis of 60 insulin-treated diabetic patients on PD. We determined the mean interstitial glucose concentration and the proportion of patients with hypoglycemia (<4 mmol/l) or hyperglycemia (>11 mmol/l).
The correlation between HbA1c and glucose was 0.48, p < 0.0001. Three of 15 patients with HbA1c >75 mmol/mol experienced significant hypoglycemia (14-144 min per day). The patients with frequent episodes of hypoglycemia could not be differentiated from those with frequent hyperglycemia by demographics or PD prescription.
HbA1c and average glucose levels measured by the CGMS are only weakly correlated. On its own, HbA1c as an indicator of glycemic control in patients with diabetes on PD appears inadequate. We suggest that the CGMS technology should be more widely adopted.
糖化血红蛋白用于评估糖尿病控制情况，尽管其在透析中的准确性受到质疑。在腹膜透析（PD）患者中，它与连续血糖监测系统（CGMS）相比如何？
我们对60例接受胰岛素治疗的PD糖尿病患者进行了回顾性分析。我们测定了平均组织间液葡萄糖浓度以及低血糖（<4 mmol/l）或高血糖（>11 mmol/l）患者的比例。
糖化血红蛋白（HbA1c）与血糖之间的相关性为0.48，p<0.0001。15例HbA1c>75 mmol/mol的患者中有3例经历了显著低血糖（每天14 - 144分钟）。通过人口统计学或PD处方无法区分频繁发生低血糖的患者与频繁发生高血糖的患者。
HbA1c与CGMS测量的平均血糖水平仅呈弱相关。就其本身而言，HbA1c作为PD糖尿病患者血糖控制的指标似乎并不充分。我们建议应更广泛地采用CGMS技术。
