Distinct biomarker roles for HbA1c and glycated albumin in patients with type 2 diabetes on hemodialysis

Aims: HbA(1c) and glycated albumin (GA) are used to monitor glycemia, but their accuracy to represent glycemic profiles in hemodialysis remains controversial. Methods: Continuous glucose monitoring in 97 patients with type 2 diabetes (41 on hemodialysis [HD] and 56 without nephropathy) was analyzed to evaluate whether HbA(1c), and/or GA serve as appropriate glycemic profile markers. Results: The average glucose significantly correlated with HbA(1c), in both HD group and group without nephropathy (r = 0.59, P < 0.0001; r = 0.40, P < 0.005). The slopes of linear regression lines were statistically indistinguishable (F = 030, P = 0.744), while the y-intercepts were significantly different (F = 57.86, P < 0.0001). GA showed strong correlation with the glycemic standard deviation (r = 0.68, P < 0.0001), and with the average glucose (r = 0.42, P < 0.001). Least square analysis revealed that only HbA(1c), but not GA, was significantly associated with the average glucose (F = 10.20, P < 0.0005; F = 0.38, P = 0.5427), while only GA was significantly associated with the glycemic variability in HD group. Conclusions: In HD participants, HbA(1c), correlates with the average glucose more than GA, but underestimates it, and a correction formula of HbA(1c) can be developed as an appreciable marker. GA value itself reflects the average glucose, but less accurately than HbA(1c) while it could serve as an indicator for hyperglycemia/hypoglycemia excursion. (C) 2016 Elsevier Inc. All rights reserved.