Division of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
Division of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO.
Diabetes Care. 2018 Jul;41(7):1406-1413. doi: 10.2337/dc17-2419. Epub 2018 Apr 19.
In cystic fibrosis (CF), hemoglobin A (HbA) is thought to underestimate glycemia. However, few studies have directly assessed the relationship between HbA and average glucose in CF. We determined the relationships among glycemic markers-HbA, fructosamine (FA), glycated albumin (%GA), and 1,5-anhydroglucitol (1,5-AG)-and continuous glucose monitoring (CGM) in CF, hypothesizing that alternate markers would better predict average sensor glucose (ASG) than HbA.
CF participants and a group of healthy control subjects (HCs), ages 6-25 years, wore CGM for up to 7 days. Pearson correlations assessed the relationships between CGM variables and HbA, FA, %GA, and 1,5-AG. The regression line between HbA and ASG was compared in CF versus HC. Linear regressions determined whether alternate markers predicted ASG after adjustment for HbA.
CF ( = 93) and HC ( = 29) groups wore CGM for 5.2 ± 1 days. CF participants were 14 ± 3 years of age and 47% were male, with a BMI score -0.1 ± 0.8 and no different from HCs in age, sex, or BMI. Mean HbA in CF was 5.7 ± 0.8% (39 ± 9 mmol/mol) vs. HC 5.1 ± 0.2% (32 ± 2 mmol/mol) ( < 0.0001). All glycemic markers correlated with ASG ( ≤ 0.01): HbA ( = 0.86), FA ( = 0.69), %GA ( = 0.83), and 1,5-AG ( = -0.26). The regression line between ASG and HbA did not differ in CF versus HC ( = 0.44). After adjustment for HbA, %GA continued to predict ASG ( = 0.0009) in CF.
HbA does not underestimate ASG in CF as previously assumed. No alternate glycemic marker correlated more strongly with ASG than HbA. %GA shows strong correlation with ASG and added to the prediction of ASG beyond HbA. However, we are not advocating use of HbA for diabetes screening in CF based on these results. Further study will determine whether glycemic measures other than ASG differ among different types of diabetes for a given HbA.
在囊性纤维化（CF）中，血红蛋白 A（HbA）被认为会低估血糖。然而，很少有研究直接评估 HbA 与 CF 中的平均血糖之间的关系。我们确定了血糖标志物-HbA、果糖胺（FA）、糖化白蛋白（%GA）和 1,5-脱水葡萄糖醇（1,5-AG）-与 CF 中的连续血糖监测（CGM）之间的关系，假设替代标志物比 HbA 更能预测平均传感器血糖（ASG）。
CF 参与者和一组健康对照组（HCs），年龄 6-25 岁，佩戴 CGM 长达 7 天。Pearson 相关性评估了 CGM 变量与 HbA、FA、%GA 和 1,5-AG 之间的关系。比较了 CF 与 HC 中 HbA 与 ASG 之间的回归线。线性回归确定了在调整 HbA 后替代标志物是否可以预测 ASG。
CF（=93）和 HC（=29）组佩戴 CGM 的时间为 5.2±1 天。CF 参与者的年龄为 14±3 岁，47%为男性，BMI z 评分-0.1±0.8，与 HCs 的年龄、性别或 BMI 无差异。CF 中的平均 HbA 为 5.7±0.8%（39±9mmol/mol），而 HC 为 5.1±0.2%（32±2mmol/mol）（<0.0001）。所有血糖标志物均与 ASG 相关（≤0.01）：HbA（=0.86）、FA（=0.69）、%GA（=0.83）和 1,5-AG（=-0.26）。CF 与 HC 相比，ASG 和 HbA 之间的回归线没有差异（=0.44）。在调整 HbA 后，%GA 仍然可以预测 CF 中的 ASG（=0.0009）。
HbA 并未如先前假设的那样低估 CF 中的 ASG。没有其他替代的血糖标志物比 HbA 与 ASG 相关性更强。%GA 与 ASG 有很强的相关性，并在 HbA 之外增加了对 ASG 的预测。但是，我们不主张根据这些结果将 HbA 用于 CF 中的糖尿病筛查。进一步的研究将确定在给定 HbA 的情况下，不同类型的糖尿病是否存在不同的血糖测量值。
