Background: The value of measurement of glycosylated hemoglobin (HgbA(1C)) in determining the degree of glycemic control in patients with chronic kidney disease (CKD) is unclear.
Methods: A single-center, prospective cohort study was conducted in 128 veterans with diabetes mellitus and CKD. HgbA(1C) was measured as clinically indicated and its relationship with random blood glucose (RBG) measurement evaluated prospectively over up to 10 years in three groups (end-stage renal disease (ESRD), CKD and controls who had diabetes but no CKD).
Results: Between 1995 and 2011, in the control group, glycemic control as assessed by HgbA(1C) was stable but improved when assessed by RBG. However, both the CKD and ESRD groups experienced declines in RBG and HgbA(1C). Declining HgbA(1C) and RBG were noted prior to onset of dialysis. A fall in HgbA(1C) remained after adjustment for RBG. A strong inverse relationship was seen between CKD stage and HgbA(1C) even after adjusting for RBG such that the relationship between RBG levels and HgbA(1C) was modified by CKD.
Conclusions: In diabetic patients with late-stage CKD, glycemic control shows an improvement. However, HgbA(1C) <7% may overestimate the degree of glycemic control. Therefore, reliance on HgbA(1C) without home blood glucose monitoring may result in poor diabetes control.
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