Relationship among glycated albumin, hemoglobin A1c, and daily blood glucose profile in diabetic patients on chronic hemodialysis

Several studies have shown the usefulness of measuring glycated albumin (GA) to assess glycemic control in diabetic patients with end-stage renal disease (ESRD). To identify the characteristics of GA as a glycemic marker, we compared GA with hemoglobinA1c (HbA1c) to investigate its association with the daily blood glucose profile in these patients. Fifteen diabetic patients on chronic hemodialysis (51～82 years, HbA1c 4.5～6.8%, GA 18.6~28%) performed self-monitoring of blood glucose (SMBG) for two consecutive days. Stepwise multivariate regression analysis found that GA was independently associated with the standard deviation of SMBG values and body mass index, and that HbA1c was independently associated with the maximum SMBG values. In addition, a dataset of 31 SMBG values obtained from six patients also showed that GA was independently associated with the maximum values for SMBG and HbA1c was independently associated with fasting morning blood glucose. In conclusion, GA reflects fluctuation and postprandial elevation of blood glucose, and HbA1c reflects fasting and postprandial elevation of blood glucose in diabetic ESRD patients.