scholarly journals High Glycated Albumin and Mortality in Persons with Diabetes Mellitus on Hemodialysis

2017 ◽  
Vol 63 (2) ◽  
pp. 477-485 ◽  
Author(s):  
Christina W Chen ◽  
Christiane Drechsler ◽  
Pirianthini Suntharalingam ◽  
S Ananth Karumanchi ◽  
Christoph Wanner ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Proportional Hazards ◽  
Glycated Albumin ◽  
Hemodialysis Patients ◽  
Cox Proportional Hazards ◽  
Repeated Measurements ◽  
Alternative Measure ◽  
Time Varying ◽  
Patients With Diabetes

Abstract BACKGROUND Monitoring of glycemic control with hemoglobin A1c (A1c) in hemodialysis patients may be compromised by anemia and erythropoietin therapy. Glycated albumin (GA) is an alternative measure of glycemic control but is not commonly used because of insufficient evidence of association to clinical outcomes. We tested whether GA measurements were associated with mortality in hemodialysis patients with diabetes mellitus. METHODS The German Diabetes and Dialysis Study (4D) investigated effects of atorvastatin on survival in 1255 patients with diabetes mellitus receiving hemodialysis. We measured GA during months 0, 6, and 12. Cox proportional hazards analysis was used to measure associations between GA and A1c and all-cause mortality. RESULTS Patients with high baseline GA (fourth quartile) had a 42% higher 4-year mortality compared to those in the first quartile (HR 1.42; 95% CI, 1.09–1.85, P = 0.009). Repeated measurements of GA during year one also demonstrated that individuals in the top quartile for GA (analyzed as a time-varying covariate) had a 39% higher 4-year mortality (HR 1.39; 95% CI, 1.05–1.85, P = 0.022). The associations between high A1c and mortality using similar analyses were less consistent; mortality in individuals with baseline A1c values in the 3rd quartile was increased compared to 1st quartile (HR 1.36; 95% CI, 1.04–1.77, P = 0.023), but risk was not significantly increased in the 2nd or 4th quartiles, and there was a less consistent association between time-varying A1c values and mortality. CONCLUSIONS High GA measurements are consistently associated with increased mortality in patients with diabetes mellitus on hemodialysis.

MO050GLYCEMIC CONTROL AND THE RISK OF AKI IN PATIENTS WITH DIABETES AND CKD: PARALLEL POPULATION-BASED COHORT STUDIES IN U.S. AND SWEDEN ROUTINE CARE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yang Xu ◽  
Aditya Surapaneni ◽  
Jim Alkas ◽  
Alexander Chang ◽  
Morgan Grams ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Cohort Studies ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Sensitivity Analyses ◽  
Time Varying ◽  
Baseline Hba1c ◽  
Patients With Diabetes ◽  
Swedish Cohort ◽  
The U.S

Abstract Background and Aims Patients with diabetes and chronic kidney disease (CKD) have increased susceptibility to acute kidney injury (AKI), but the underlying mechanisms are not well known. We here explore the association between glycemic control and risk of AKI. Method We created two parallel observational cohort studies of Swedish (SCREAM project, Stockholm, 2006-2011) and U.S. (Geisinger Heath system, Pennsylvania, 1996-2018) adult patients with diabetes mellitus and confirmed CKD stages G3-G5. Glycemic control was evaluated through repeated HbA1c measurements, which were categorized into 5 levels of glycemic control intensity, with HbA1c 6-6.9% as referent category, and continuously using cubic splines. We evaluated the association between baseline and time-varying HbA1c levels with AKI (defined as increase in creatinine >=0.3 mg/d over 48 hours or 1.5x creatinine over 7 days) using Cox proportional hazards regression and, in sensitivity analyses, Fine and Gray competing risk models accounting for death. Results In the Swedish cohort, there were 13932 patients with median age 76 years, 51% women, median eGFR 50.8 (Interquartile Range (IQR) 41.4-57.1) ml/min/1.73. In the U.S. cohort, there were 26520 patients with median age 71 years, 55% women and 52.1 (IQR 43.4-57.5) ml/min/1.73 m2. During a median of 2.3 and 3.1 years of follow up, 3172 and 8671 AKI events were recorded in the Swedish and US cohorts, respectively. The adjusted association between baseline HbA1c and AKI was similar in both cohorts, with the lowest risk between 6-6.9% and higher risk at higher levels of HbA1c. Compared to baseline HbA1c 6-6.9%, baseline HbA1c>9% associated with a 1.28 fold (95% CI 1.11-1.47) higher risk of AKI in the Swedish cohort, and a 1.14 (95% CI 1.04-1.25) higher risk in the U.S. cohort. Conversely, baseline HbA1c<6% did not associate with AKI. When using time-varying HbA1c, AKI risk was higher for HbA1c>9% (HR 1.18, 95% CI 1.03-1.37 in Swedish cohort and 1.27, 1.17-1.37 in U.S. cohort); AKI risk was also higher for HbA1c<6% in the U.S. cohort (1.12, 1.04-1.19), but not in the Swedish cohort (1.06, 0.97-1.16)). Conclusion Higher A1c was associated with AKI in adults with diabetes and CKD, suggesting that better glycemic control may also reduce risk of AKI.

scholarly journals SP423IS GLYCATED ALBUMIN GOOD INDICATOR OF GLYCEMIC CONTROL IN HEMODIALYSIS PATIENTS WITH DIABETES MELLITUS?

2018 ◽  
Vol 33 (suppl_1) ◽  
pp. i490-i491
Author(s):  
Ana Bulatovic ◽  
Svetlana Jelic ◽  
Jelena Tosic ◽  
Petar Djuric ◽  
Aleksandar Jankovic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Glycated Albumin ◽  
Hemodialysis Patients ◽  
Patients With Diabetes

Glycemic Control and Infections among U.S. Hemodialysis Patients with Diabetes Mellitus

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1588-P
Author(s):  
JINNIE J. RHEE ◽  
YUANCHAO ZHENG ◽  
MARIA MONTEZ-RATH ◽  
WOLFGANG WINKELMAYER
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Hemodialysis Patients ◽  
Patients With Diabetes

scholarly journals Glycemic Control and Infections Among US Hemodialysis Patients With Diabetes Mellitus

2020 ◽  
Vol 5 (7) ◽  
pp. 1014-1025 ◽  
Author(s):  
Jinnie J. Rhee ◽  
Yuanchao Zheng ◽  
Sai Liu ◽  
Maria E. Montez-Rath ◽  
Richard J. Hamill ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Hemodialysis Patients ◽  
Patients With Diabetes

scholarly journals Implications of neuroendocrine tumor and diabetes mellitus on patient outcomes and care: a matched case–control study

2021 ◽  
pp. FSO684
Author(s):  
Yael N Kusne ◽  
Heidi E Kosiorek ◽  
Matthew R Buras ◽  
Patricia M Verona ◽  
Kyle E Coppola ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Kaplan Meier ◽  
Matched Case ◽  
After Cancer ◽  
The Impact ◽  
Matched Case Control Study ◽  
Control Study

Aim: We aimed to determine the impact of diabetes mellitus (DM) on survival of patients with neuroendocrine tumors (NETs) and of NETs on glycemic control. Patients & methods: Patients with newly diagnosed NETs with/without DM were matched 1:1 by age, sex and diagnosis year (2005–2017), and survival compared (Kaplan–Meier and Cox proportional hazards). Mixed models compared hemoglobin A1c (HbA1c) and glucose during the year after cancer diagnosis. Results: Three-year overall survival was 72% (95% CI: 60–86%) for DM patients versus 80% (95% CI: 70–92%) for non-DM patients (p = 0.82). Hazard ratio was 1.33 (95% CI: 0.56–3.16; p = 0.51); mean DM HbA1c, 7.3%. Conclusion: DM did not adversely affect survival of patients with NET. NET and its treatment did not affect glycemic control.

scholarly journals Glycemic control in patients with diabetes mellitus on hemodialysis

2019 ◽  
Vol 91 (10) ◽  
pp. 124-134 ◽  
Author(s):  
K G Lobanova ◽  
A S Severina ◽  
S A Martinov ◽  
M Sh Shamkhalova ◽  
M V Shestakova
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Glycated Albumin ◽  
Glucose Monitoring ◽  
Hypoglycemic Agents ◽  
Routine Practice ◽  
Oral Hypoglycemic Agents ◽  
Patients With Diabetes ◽  
The Moment

Achievement of stabilization of carbohydrate metabolism in patients with diabetes mellitus, receiving renal replacement therapy with hemodialysis, is a significant problem in endocrinology. It has to do with multiple factors of this cohort of patients, which affect the level of glycemia, pharmacokinetic of drugs, the efficiency of glycemic control. At the moment, the most efficiency method of glycemic control in patients with type 2 diabetes mellitus on hemodialysis is insulin therapy in the basis - bolus regime by analogues of human insulin. The use of oral hypoglycemic agents is significantly limited. The hemoglobin A1c (HbA1c) remains the main parameter of glycemic control. The simultaneous use of continuous glucose monitoring allows to reveal the true level of glucose of the blood and to carry out the timely correction of therapy in order to achieve targets for glycemic control and to decrease the risk of hypoglycemic episodes. At the moment other glycemic control markers such as glycated albumin and fructosamine are described. However, in routine practice at the moment these indicators are not used due to the lack of sufficient evidentiary base of their use in this cohort of patients.

Influence of Diabetes Duration and Glycemic Control on Dementia: A Cohort Study

2021 ◽  
Author(s):  
Fu-Rong Li ◽  
Hai-Lian Yang ◽  
Rui Zhou ◽  
Jia-Zhen Zheng ◽  
Guo-Chong Chen ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Diabetes Duration ◽  
Self Report ◽  
Diabetes Diagnosis ◽  
Duration Of Diabetes ◽  
Incident Dementia ◽  
Patients With Diabetes ◽  
The Uk

Abstract Background To investigate the influence of diabetes duration and glycemic control, assessed by glycated hemoglobin (HbA1c) levels, on risk of incident dementia. Methods The present study is a prospective study of 461,563 participants from the UK Biobank. The age at diabetes diagnosis was determined by self-report. Diabetes duration was calculated as baseline age minus age at diagnosis. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidential intervals (CIs). Results During a median follow-up of 8.1 y, 2,233 dementia cases were recorded. As compared with normoglycemic individuals, individuals with diabetes had higher risk of all-cause dementia, and the risk increased with increasing duration of diabetes; compared with participants with diabetes duration of <5 y, the multivariable-adjusted HRs (95% CIs) were 1.49 (1.12-1.97), 1.71 (1.21-2.41), and 2.15 (1.60-2.90) for those with diabetes durations ≥5 to < 10, ≥10 to <15, and ≥ 15 y, respectively (P for trend < 0.001). Among participants with diabetes, those with both longer diabetes duration (diabetes duration ≥10 y) and poor glycemic control (HbA1c ≥8%) had the highest risk of All-cause dementia (multivariable-adjusted HR =2.07, 95% CI 1.45, 2.94), compared with patients with shorter duration of diabetes and better glycemic control (diabetes duration <10 y and HbA1c <8%). Conclusions Diabetes duration appeared to be associated with the risk of incident dementia due to factors beyond glycemic control. Clinicians should consider not only glycemic control but also diabetes duration in dementia risk assessments for patients with diabetes.

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