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Chao CT. Consideration of confounding factors in assessing the associations between physical parameters and glycated hemoglobin levels among older patients with diabetes mellitus. Geriatr Gerontol Int 2024; 24:743-744. [PMID: 38800837 DOI: 10.1111/ggi.14913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Chia-Ter Chao
- Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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George C, Matsha TE, Korf M, Zemlin AE, Erasmus RT, Kengne AP. The agreement between fasting glucose and markers of chronic glycaemic exposure in individuals with and without chronic kidney disease: a cross-sectional study. BMC Nephrol 2020; 21:32. [PMID: 32000712 PMCID: PMC6990590 DOI: 10.1186/s12882-020-1697-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background To assess whether the agreement between fasting glucose and glycated proteins is affected by chronic kidney disease (CKD) in a community-based sample of 1621 mixed-ancestry South Africans. Methods CKD was defined as an estimated glomerular filtration rate < 60 ml/min/1.73 m2. Fasting plasma glucose and haemoglobin A1c (HbA1c) concentrations were measured by enzymatic hexokinase method and high-performance liquid chromatography, respectively, with fructosamine and glycated albumin measured by immunoturbidimetry and enzymatic method, respectively. Results Of those with CKD (n = 96), 79, 16 and 5% where in stages 3, 4 and 5, respectively. Those with CKD had higher levels of HbA1c (6.2 vs. 5.7%; p < 0.0001), glycated albumin (15.0 vs. 13.0%; p < 0.0001) and fructosamine levels (269.7 vs. 236.4 μmol/l; p < 0.0001), compared to those without CKD. Higher fasting glucose levels were associated with higher HbA1c, glycated albumin and fructosamine, independent of age, gender, and CKD. However, the association with HbA1c and glycated albumin differed by CKD status, at the upper concentrations of the respective markers (interaction term for both: p ≤ 0.095). Conclusion Our results suggest that although HbA1c and glycated albumin perform acceptably under conditions of normoglycaemia, these markers correlate less well with blood glucose levels in people with CKD who are not on dialysis.
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Affiliation(s)
- Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, South Africa.
| | - Tandi E Matsha
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, South Africa
| | - Marizna Korf
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Annalise E Zemlin
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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Campbell L, Pepper T, Shipman K. HbA1c: a review of non-glycaemic variables. J Clin Pathol 2018; 72:12-19. [PMID: 30361394 DOI: 10.1136/jclinpath-2017-204755] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 09/23/2018] [Accepted: 10/02/2018] [Indexed: 12/28/2022]
Abstract
Identification of the correlation between HbA1c and diabetic complications has yielded one of the most clinically useful biomarkers. HbA1c has revolutionised the diagnosis and monitoring of diabetes mellitus. However, with widespread adoption of HbA1c has come increasing recognition that non-glycaemic variables can also affect HbA1c, with varying clinical significance. Furthermore, the identification of a discrepancy between predicted and measured HbA1c in some individuals, the so-called 'glycation gap', may be clinically significant. We aimed to review the current body of evidence relating to non-glycaemic variables to quantify any significance and provide subsequent suggestions. A PubMed-based literature search was performed, using a variety of search terms, to retrieve articles detailing the non-glycaemic variables suggested to affect HbA1c. Articles were reviewed to assess the relevance of any findings in clinical practice and where possible guidance is given. A range of non-glycaemic variables have statistically significant effects on HbA1c. While the clinical implications are generally irrelevant, a small number of non-glycaemic variables do have clinically significant effects and alternative biomarkers should be considered instead of, or in addition to, HbA1c. There are a small number of non-glycaemic variables which have a clinically significant effect on HbA1c, However, the vast majority of non-glycaemic variables have no clinical relevance. While clinicians should have an awareness of those non-glycaemic variables with clinical significance, in the vast majority of clinical scenarios HbA1c should continue to be used with confidence.
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Affiliation(s)
- Leon Campbell
- Department of Medicine, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - Tessa Pepper
- Department of Medicine, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - Kate Shipman
- Department of Chemical Pathology, Western Sussex Hospitals NHS Foundation Trust, Worthing, England
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Dion F, Dumayne C, Henley N, Beauchemin S, Arias EB, Leblond FA, Lesage S, Lefrançois S, Cartee GD, Pichette V. Mechanism of insulin resistance in a rat model of kidney disease and the risk of developing type 2 diabetes. PLoS One 2017; 12:e0176650. [PMID: 28459862 PMCID: PMC5411038 DOI: 10.1371/journal.pone.0176650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/13/2017] [Indexed: 12/19/2022] Open
Abstract
Chronic kidney disease is associated with homeostatic imbalances such as insulin resistance. However, the underlying mechanisms leading to these imbalances and whether they promote the development of type 2 diabetes is unknown. The effect of chronic kidney disease on insulin resistance was studied on two different rat strains. First, in a 5/6th nephrectomised Sprague-Dawley rat model of chronic kidney disease, we observed a correlation between the severity of chronic kidney disease and hyperglycemia as evaluated by serum fructosamine levels (p<0.0001). Further, glucose tolerance tests indicated an increase of 25% in glycemia in chronic kidney disease rats (p<0.0001) as compared to controls whereas insulin levels remained unchanged. We also observed modulation of glucose transporters expression in several tissues such as the liver (decrease of ≈40%, p≤0.01) and muscles (decrease of ≈29%, p≤0.05). Despite a significant reduction of ≈37% in insulin-dependent glucose uptake in the muscles of chronic kidney disease rats (p<0.0001), the development of type 2 diabetes was never observed. Second, in a rat model of metabolic syndrome (Zucker Leprfa/fa), chronic kidney disease caused a 50% increased fasting hyperglycemia (p<0.0001) and an exacerbated glycemic response (p<0.0001) during glucose challenge. Similar modulations of glucose transporters expression and glucose uptake were observed in the two models. However, 30% (p<0.05) of chronic kidney disease Zucker rats developed characteristics of type 2 diabetes. Thus, our results suggest that downregulation of GLUT4 in skeletal muscle may be associated with insulin resistance in chronic kidney disease and could lead to type 2 diabetes in predisposed animals.
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Affiliation(s)
- François Dion
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec, Canada
- Département de pharmacologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- * E-mail: (VP); (FD)
| | - Christopher Dumayne
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec, Canada
- Département de pharmacologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Nathalie Henley
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec, Canada
| | - Stéphanie Beauchemin
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec, Canada
| | - Edward B. Arias
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - François A. Leblond
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec, Canada
| | - Sylvie Lesage
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec, Canada
- Département de microbiologie, infectiologie et immunologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Stéphane Lefrançois
- Centre INRS-Institut Armand-Frappier, Institut National de la Recherche Scientifique, Laval, Québec, Canada
- Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
| | - Gregory D. Cartee
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Vincent Pichette
- Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l’Université de Montréal, Montréal, Québec, Canada
- Département de pharmacologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- * E-mail: (VP); (FD)
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Grossman A, Gafter-Gvili A, Schmilovitz-Weiss H, Koren-Morag N, Beloosesky Y, Weiss A. Association of glycated hemoglobin with hemoglobin levels in elderly nondiabetic subjects. Eur J Intern Med 2016; 36:32-35. [PMID: 27594416 DOI: 10.1016/j.ejim.2016.08.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Glycated hemoglobin (HgbA1C) is being increasingly used for the diagnosis of diabetes mellitus due to its high availability and reproducibility. Several studies have shown that HgbA1C levels may be affected by levels of hemoglobin and nutritional factors associated with anemia, such as vitamin B12 and iron deficiency. However, none included elderly subjects. The aim of the present study was to investigate these effects in the older nondiabetic population. METHODS A retrospective cohort study design was used. The computerized database of a large health management organization was reviewed for all subjects without diabetes mellitus who underwent at least one measurement of HgbA1C and other hemoglobin parameters in 2002 at age≥65years. HgbA1C levels were correlated with hemoglobin, hematocrit, ferritin, iron, transferrin, vitamin B12, and folic acid levels. RESULTS A total of 11,352 subjects met the study criteria. Those with HgbA1C levels in the highest quintile (6.21-6.49%, 44.4-47.7mmol/mol) had significantly lower levels of hemoglobin, hematocrit, and iron than patients with HgbA1C levels in the lowest quintile (<5.4%, 36mmol/mol), but no linear correlation was found. There was no correlation of HgbA1C level with levels of ferritin, vitamin B12, and folic acid. CONCLUSIONS In elderly nondiabetic subjects, HgbA1C levels are not correlated with hemoglobin level or nutritional factors associated with anemia and may be interpreted without consideration of these factors.
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Affiliation(s)
- Alon Grossman
- Department of Internal Medicine E, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Anat Gafter-Gvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Department of Internal Medicine A, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel.
| | - Hemda Schmilovitz-Weiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Gastroenterology Unit, Rabin Medical Center - Hasharon Hospital, Petach Tikva 4941492, Israel.
| | - Nira Koren-Morag
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Yichayaou Beloosesky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Department of Geriatrics, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel.
| | - Avraham Weiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Department of Geriatrics, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel.
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Shipman KE, Jawad M, Sullivan KM, Ford C, Gama R. Fructosamine; is the current interest in alternative glycaemic markers justified? Diabet Med 2015; 32:1116-7. [PMID: 25819596 DOI: 10.1111/dme.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 12/16/2022]
Affiliation(s)
- K E Shipman
- Clinical Chemistry, New Cross Hospital, Wolverhampton
| | - M Jawad
- Clinical Chemistry, New Cross Hospital, Wolverhampton
| | - K M Sullivan
- Clinical Chemistry, New Cross Hospital, Wolverhampton
| | - C Ford
- Clinical Chemistry, New Cross Hospital, Wolverhampton
| | - R Gama
- Clinical Chemistry, New Cross Hospital, Wolverhampton
- Research Institute, Healthcare Sciences, Wolverhampton University, Wolverhampton, UK
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