Bomholt Tobias, Feldt-Rasmussen Bo, Butt Rizwan, Borg Rikke, Sarwary Mir Hassan, Elung-Jensen Thomas, Almdal Thomas, Knop Filip K, Nørgaard Kirsten, Ranjan Ajenthen G, Larsson Anders, Rix Marianne, Hornum Mads
Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Nephron. 2022;146(2):146-152. doi: 10.1159/000519493. Epub 2021 Nov 3.
Shortened erythrocyte life span and erythropoietin-stimulating agents may affect hemoglobin A1c (HbA1c) levels in patients receiving peritoneal dialysis (PD). We compared HbA1c with interstitial glucose measured by continuous glucose monitoring (CGM) in patients with type 2 diabetes receiving PD.
Fourteen days of CGM (Ipro2, Medtronic) were performed in 23 patients with type 2 diabetes receiving PD and in 23 controls with type 2 diabetes and an estimated glomerular filtration rate over 60 mL/min/1.73 m2. Patients were matched on gender and age (±5 years). HbA1c (mmol/mol), its derived estimate of mean plasma glucose (eMPGA1c) (mmol/L), and fructosamine (µmol/L) were measured at the end of the CGM period and compared with the mean sensor glucose (mmol/L) from CGM.
In the PD group, mean sensor glucose was 0.98 (95% con-fidence interval (CI): 0.43-1.54) mmol/L higher than the eMPGA1c compared with the control group (p = 0.002) where glucose levels were nearly identical (-0.05 (95% CI: -0.35-0.25) mmol/L). A significant association was found between fructosamine and mean sensor glucose using linear regression with no difference between slopes (p = 0.89) or y-intercepts (p = 0.28).
DISCUSSION/CONCLUSION: HbA1c underestimates mean plasma glucose levels in patients with type 2 diabetes receiving PD. However, the clinical significance of this finding is undetermined. Fructosamine seems to more accurately reflect glycemic status. CGM or fructosamine could complement HbA1c to increase the accuracy of glycemic monitoring in the PD population.
红细胞寿命缩短和促红细胞生成素刺激剂可能会影响接受腹膜透析（PD）患者的糖化血红蛋白（HbA1c）水平。我们比较了接受PD的2型糖尿病患者的HbA1c与通过持续葡萄糖监测（CGM）测量的组织间液葡萄糖水平。
对23例接受PD的2型糖尿病患者和23例2型糖尿病且估计肾小球滤过率超过60 mL/min/1.73 m2的对照者进行了为期14天的CGM（美敦力Ipro2）监测。患者按性别和年龄（±5岁）进行匹配。在CGM期结束时测量HbA1c（mmol/mol）、其衍生的平均血浆葡萄糖估计值（eMPGA1c）（mmol/L）和果糖胺（µmol/L），并与CGM测得的平均传感器葡萄糖（mmol/L）进行比较。
与对照组相比，PD组的平均传感器葡萄糖比eMPGA1c高0.98（95%置信区间（CI）：0.43 - 1.54）mmol/L，而对照组的葡萄糖水平几乎相同（-0.05（95%CI：-0.35 - 0.25）mmol/L）（p = 0.002）。使用线性回归发现果糖胺与平均传感器葡萄糖之间存在显著关联，斜率（p = 0.89）或截距（p = 0.28）无差异。
讨论/结论：HbA1c低估了接受PD的2型糖尿病患者的平均血浆葡萄糖水平。然而，这一发现的临床意义尚未确定。果糖胺似乎能更准确地反映血糖状态。CGM或果糖胺可补充HbA1c，以提高PD人群血糖监测的准确性。
