Hba1c is unreliable in CKD patients on anaemia therapy

HbA1c levels are an unreliable indicator of diabetes control in patients given erythropoietin-stimulating agents or intravenous iron, research has shown.

HbA1c levels should not be the sole index by which diabetes in measured in CKD patients
HbA1c levels should not be the sole index by which diabetes in measured in CKD patients

A team from Hull York Medical School studied 15 patients with type-2 diabetes and chronic kidney disease (CKD).

The researchers point out that erythropoietin stimulating agents and intravenous iron are commonly used therapies in the management of anemia in patients with CKD. In addition, patients with both diabetes and CKD have a higher prevalence of severe anemia as compared to patients with CKD alone.

They showed that erythropoietin-stimulating agents or intravenous iron can lead to falls in HbA1c, without a change in glycaemic control.

Writing online in Diabetes Care, the researchers said: ‘It is essential that healthcare professionals are aware of the potential fluctuations of HbA1c that can occur in this patient group.’

Capillary glucose measurement and concurrent use of continuous glucose monitoring are the best alternative means of measuring glycaemic control, they said.

‘Alternative methods for measuring glycaemic control such as capillary glucose testing and continuous glucose monitoring should be employed and therapy should not be based on the HbA1c value alone,’ they argued.

‘This has particular significance when considering national, international or health service glycaemic targets such as the QOF in the UK which almost exclusively use HbA1c as the sole index by which treatment success is judged,’ they said.

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