Evaluation of plasma glucose control in diabetic patients on hemodialysis a single center study
Keywords:Plasma Glucose, Diabetic patient, Renal Dialysis
Objectives: The aim of study is to evaluate plasma glucose control in diabetic patient on hemodialysis by measure plasma glycated albumin and HbA1c and correlate them with parameters like serum electrolytes blood urea, serum creatinine, hemoglobin, serum albumin, total serum bilirubin, serum uric acid, parathyroid hormone, serum ferritin; to evaluate the effects of these parameters on the level of diabetic control.
Methods: This is a cross sectional study which included type 2 diabetic patients on hemodialysis these patients are currently undergoing hemodialysis and are on hemodialysis for more than three months. Total 50 type 2 diabetic patients on hemodialysis; between ages of 47-62 years of either gender were selected randomly and comparison done between the effect of different factors on HbA1c and glycated albumin.
Results: There were 50 patients enrolled in this study with a mean age of 54.5 ± 4.7 (range: 47 – 62) years. Males represented 58% (29 patients) while female represent 42% (21 patients) of the studied group with male to female ratio of 1.38 to one. The duration of diabetes (DM) ranged 4 – 20 years and two thirds of the cases had duration of 15 years or less. Regarding the treatment of DM, 35 patients (70%) were on soluble insulin while 15 patients neither receive insulin nor oral antidiabetic agent and their treatment was off. poor glycemic control was significantly associated with younger age, patients aged < 50 years were more frequent among the poor glycemic. good glycemic control had significantly lower HbA1C% level.
Conclusion: Most of our diabetic patient on HD has controlled diabetes reflected by the level of HbA1c and GA. Serum ferritin levels is positively correlate with HbA1c levels in diabetic patient on hemodialysis which suggests that serum ferritin levels can be a marker of glycemic control in type 2 DM.
Alvin C.P. Diabetes Mellites: Diagnosis, Classification, and pathophysiology. In: Braunwald E., Faucei A.S., Kasper D. L., Hauser S. L., Longo D. L., Larry J. J. (eds). Harrison’s principles of internal medicine, 19th edn. New York. McGraw Hill Medical Publishing division, 2016, pp. 2399.
Pearson E. R. & Mc Crimmon R. J. Diabetes Mellites. In: Ralston, Penman, Strechan, Hobson (eds.). Davidson’s Principles and Practice of Medicine, 23th edn. Edinburgh London. Elsevier, 2018, pp. 722.
Alvin C. P. Diabetes Mellitus. In: Braunwald E., Faucei A. S., Kasper D. L., Hauser S. L., Longo D. L., Larry J. J. (eds) Harrison’s principles of internal medicine, 15th edn. McGraw Hill Medical Publishing division, New York 2001, pp 2109–2137.
Powers A. C. Diabetes mellitus. In: Kasper D. L., Fauci A. S., Hauser S. L., Longo D. L., Jameson J. L., Loscalzo J., (eds.) Harrison’s Principles of Internal Medicine. 19th edition. New York. McGraw Hill, 2015. p. 2422-30.
Maritime A., Sanders R., Watkins J. Diabetes, oxidative stress, and antioxidants A review. J. Biochem. Mol. Toxicol. 2003; 17:24-38.
Fuller J. H., Keen H., Jarrett R. J., Omer T., Meade T. W., & Charkrabarti R. Haemostatic variables associated with diabetes and its complications. Br Med J. 1979; 2:964-6.
National Institute of Diabetes and Digestive and Kidney Diseases: United States Renal Data System: USRDS 2005 annual Data Report. Bethesda, MD: National Institutes of Health, 2005.
Kumarpal ShriShrimal, MD, MS, peter hart, MD , FranKlin michota, MD, Managing diabetes in hemodialysis patients: Observations and recommendations Cleveland Clinic Journal of medicine , volume 76 , number11 , November 2009
Mehrotra R, Kalantar-Zadeh K, Adler S. Assessment of glycemic control in dialysis patients with diabetes: glycosylated hemoglobin or glycated albumin? Am Soc Nephrol; 2011.
Molitch ME. Glycemic Control Assessment in the Dialysis Patient: Is Glycated Albumin the Answer? Am J Nephrol. 2018;47(1):18–20.
Park CW. Diabetic kidney disease: From epidemiology to clinical perspectives. Diabetes Metab J. 2014; 38(4):252–60.
Hecking M, Bieber BA, Ethier J, Kautzky-Willer A, Sunder-Plassmann G, Säemann MD, et al. Sex-Specific Differences in Hemodialysis Prevalence and Practices and the Male-to-Female Mortality Rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS). PLoS Med. 2014;11(10). 10. Perreault L, Ma Y, Dagogo-Jack S, Horton E, Marrero D, Crandall J, et al. Sex differences in diabetes risk and the effect of intensive lifestyle modification in the Diabetes Prevention Program. Diabetes Care. 2008; 31(7):1416–21.
Neugarten J, Golestaneh L. Gender and the prevalence and progression of renal disease. Adv Chronic Kidney Dis. 2013; 20(5):390–5.
Neugarten J, Golestaneh L. Influence of Sex on the Progression of Chronic Kidney Disease. Mayo Clin Proc. 2019;94(7):1339–56.
Eriksen BO, Ingebretsen OC. The progression of chronic kidney disease: a 10 year population-based study of the effects of gender and age. Kidney Int. 2006; 69(2):375–82.
Chang P-Y, Chien L-N, Lin Y-F, Wu M-S, Chiu W-T, Chiou H-Y. Risk factors of gender for renal progression in patients with early chronic kidney disease. Medicine (Baltimore). 2016; 95(30).
Perreault L, Ma Y, Dagogo-Jack S, Horton E, Marrero D, Crandall J, et al. Sex differences in diabetes risk and the effect of intensive lifestyle modification in the Diabetes Prevention Program. Diabetes Care. 2008; 31(7):1416–21.
Meisinger C, Thorand B, Schneider A, Stieber J, Döring A, Löwel H. Sex differences in risk factors for incident type 2 diabetes mellitus: the MONICA Augsburg cohort study. Arch Intern Med. 2002; 162(1):82–9.
Alwakeel JS, Isnani AC, Alsuwaida A, AlHarbi A, Shaikh SA, AlMohaya S, et al. Factors affecting the progression of diabetic nephropathy and its complications: a single-center experience in Saudi Arabia. Ann Saudi Med. 2011; 31(3):236–42.
Hahr AJ, Molitch ME. Management of diabetes mellitus in patients with chronic kidney disease. Clin diabetes Endocrinol. 2015;1(1):2–10.
Rajput R, Sinha B, Majumdar S, Shunmugavelu M, Bajaj S. Consensus statement on insulin therapy in chronic kidney disease. Diabetes Res Clin Pract. 2017; 127:10–20.
Creme D, Mccafferty K. Glycaemic control impact on renal endpoints in diabetic patients on haemodialysis. Int J Nephrol. 2015;2015(5413).
Madhura Navule Siddappa, Kowsalya Ramprasad.Assessment of serum Ferritin level and its correlation with HbA1c in diabetic nephropathy.Asian Journal of Medical Sciences Mar-Apr 2020 | Vol 11 | Issue 2.
Rhee JJ, Ding VY, Rehkopf DH, Arce CM, Winkelmayer WC. Correlates of poor glycemic control among patients with diabetes initiating hemodialysis for end-stage renal disease. BMC Nephrol [Internet]. 2015;16(1):1–12. Available from: http://dx.doi.org/10.1186/s12882-015-0204-4
T P Peacock 1 , Z K Shihabi, A J Bleyer, E L Dolbare, J R Byers, M A Knovich, J Calles-Escandon, G B Russell, B I Freedman.Comparison of Glycated Albumin and Hemoglobin A(1c) Levels in Diabetic Subjects on Hemodialysis.Kidney Int. 2008 May;73(9):1062-8. doi: 10.1038/ki.2008.25.
How to Cite
Copyright (c) 2022 Iraq Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.