Nakamura Akihiko, Kodera Ryo, Sakamoto Noriko, Ujike Haruyo, Wada Jun, Shikata Kenichi, Makino Hirofumi
Osafune Clinic, 332-1 Haji, Osafune, Setouchi, Okayama 701-4264 Japan.
2Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata, Kita-ku, Okayama, Japan.
Diabetol Int. 2018 Jan 18;9(3):179-188. doi: 10.1007/s13340-018-0342-6. eCollection 2018 Jul.
We developed a novel estimation method for hemoglobin A1c (HbA1c) in type 2 diabetes (T2D) patients with end-stage renal disease (ESRD). This method is based on the glycated albumin (GA) level.
Of the 788 Japanese patients with T2D included in this study, 545 had normal renal function (NRF group) and 243 had ESRD. Oral glucose tolerance tests (OGTTs) were performed in 80 subjects. The variables GA, body mass index (BMI), hemoglobin (Hb), and estimated glomerular filtration rate (eGFR) were significantly associated with the GA-to-HbA1c ratio and were used to determine the estimated HbA1c (eHbA1c). One method of estimating HbA1c involved dividing GA by the GA-to-HbA1c ratio predicted from the estimated regression equation; the estimated HbA1c obtained in this manner was denoted eHbA1c-1.
eHbA1c-1 (%) = GA × [4.688 - 18.833 × GA - 0.015 × BMI - 0.037 × Hb (- 0.002 × eGFR for patients without ESRD)]; adjusted = 0.676 for actual HbA1c. The sensitivity of eHbA1c-1 was better than that of GA for diabetes diagnosis using the 75-g OGTT. There were no differences in the slope of eHbA1c-1 versus GA and the variance of eHbA1c-1 between the ESRD and NRF groups. eHbA1c-1 was not associated with Hb, erythropoiesis-stimulating agent use, or ESRD concomitance.
eHbA1c-1 may be a useful parameter for estimating HbA1c in T2D patients with ESRD.
我们为终末期肾病（ESRD）的2型糖尿病（T2D）患者开发了一种新的糖化血红蛋白（HbA1c）估算方法。该方法基于糖化白蛋白（GA）水平。
本研究纳入的788例日本T2D患者中，545例肾功能正常（NRF组），243例患有ESRD。对80名受试者进行了口服葡萄糖耐量试验（OGTT）。变量GA、体重指数（BMI）、血红蛋白（Hb）和估算肾小球滤过率（eGFR）与GA与HbA1c的比值显著相关，并用于确定估算的HbA1c（eHbA1c）。估算HbA1c的一种方法是将GA除以根据估算回归方程预测的GA与HbA1c的比值；以这种方式获得的估算HbA1c记为eHbA1c-1。
eHbA1c-1（%）=GA×[4.688 - 18.833×GA - 0.015×BMI - 0.037×Hb（无ESRD患者为 - 0.002×eGFR）]；与实际HbA1c的调整后 = 0.676。使用75克OGTT进行糖尿病诊断时，eHbA1c-1的敏感性优于GA。ESRD组和NRF组之间，eHbA1c-1与GA的斜率以及eHbA1c-1的方差没有差异。eHbA1c-1与Hb、促红细胞生成素使用或ESRD合并症无关。
eHbA1c-1可能是估算ESRD的T2D患者HbA1c的有用参数。
