Underestimation of impaired glucose tolerance and usefulness of a continuous glucose monitoring system in chronic liver disease
Background and Aim The prevalence of glucose intolerance in chronic liver disease patients is high, but glucose intolerance may be overlooked in a single blood test. The purpose of this study is to evaluate blood glucose variability in patients with chronic liver disease by a continuous glucose moni...
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| Veröffentlicht in: | Journal of gastroenterology and hepatology 2022-03, Vol.37 (3), p.592-599 |
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| creator | Ogawa, Yutaro Nakahara, Takashi Ono, Masafumi Kawaguchi, Takumi Isoda, Hiroshi Hiramatsu, Akira Uchikawa, Shinsuke Fujino, Hatsue Murakami, Eisuke Kawaoka, Tomokazu Yamauchi, Masami Tsuge, Masataka Munekage, Kensuke Ochi, Tsunehiro Hayes, C Nelson Imamura, Michio Aikata, Hiroshi Takahashi, Hirokazu Torimura, Takuji Chayama, Kazuaki |
| description | Background and Aim
The prevalence of glucose intolerance in chronic liver disease patients is high, but glucose intolerance may be overlooked in a single blood test. The purpose of this study is to evaluate blood glucose variability in patients with chronic liver disease by a continuous glucose monitoring system (CGMS) and to examine the discrepancy between hemoglobin A1c (HbA1c) levels estimated from average blood glucose levels and HbA1c.
Methods
This study included 335 patients with chronic liver disease associated with glucose intolerance. A fasting blood test and 72‐h CGMS were performed. The estimated HbA1c was calculated from the average blood glucose level, and the correlation between hepatic functional reserve and blood glucose‐related parameters was analyzed. From the obtained data, we created a new formula to calculate HbA1c without using CGMS.
Results
As hepatic functional reserve decreased, average blood glucose and insulin resistance increased while HbA1c decreased (P |
| doi_str_mv | 10.1111/jgh.15766 |
| format | Article |
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The prevalence of glucose intolerance in chronic liver disease patients is high, but glucose intolerance may be overlooked in a single blood test. The purpose of this study is to evaluate blood glucose variability in patients with chronic liver disease by a continuous glucose monitoring system (CGMS) and to examine the discrepancy between hemoglobin A1c (HbA1c) levels estimated from average blood glucose levels and HbA1c.
Methods
This study included 335 patients with chronic liver disease associated with glucose intolerance. A fasting blood test and 72‐h CGMS were performed. The estimated HbA1c was calculated from the average blood glucose level, and the correlation between hepatic functional reserve and blood glucose‐related parameters was analyzed. From the obtained data, we created a new formula to calculate HbA1c without using CGMS.
Results
As hepatic functional reserve decreased, average blood glucose and insulin resistance increased while HbA1c decreased (P < 0.0001). The discrepancy between the estimated HbA1c calculated from the mean blood glucose level and the serum HbA1c (ΔHbA1c) increased as the liver reserve decreased. Using multiple regression analysis, a formula based on fasting blood glucose, HbA1c, body mass index, albumin, and liver function was constructed, and its validity was demonstrated in a study using a different control group.
Conclusions
Hemoglobin A1c may be underestimated because of decreased hepatic functional reserve. CGMS was useful in assessing accurate glycemic control of blood glucose and in detecting postprandial hyperglycemia and nocturnal hypoglycemia. Patients with chronic hepatic impairment should be corrected for hepatic functional reserve before glycemic control.</description><identifier>ISSN: 0815-9319</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/jgh.15766</identifier><identifier>PMID: 34928509</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Blood glucose ; Blood tests ; Body mass index ; Chromium ; Chronic Disease ; Continuous glucose monitoring system (CGMS) ; Glucose ; Glucose Intolerance - diagnosis ; Glucose Intolerance - epidemiology ; Glucose monitoring ; Glucose tolerance ; Glycated Hemoglobin A - analysis ; HbA1c ; Hemoglobin ; Humans ; Hyperglycemia ; Hypoglycemia ; Insulin ; Insulin resistance ; Intolerance ; Liver cirrhosis ; Liver cirrhosis (LC) ; Liver diseases ; Liver Diseases - blood ; Monitoring systems ; Monitoring, Physiologic ; Multiple regression analysis</subject><ispartof>Journal of gastroenterology and hepatology, 2022-03, Vol.37 (3), p.592-599</ispartof><rights>2021 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd</rights><rights>2021 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.</rights><rights>2022 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4086-3587307ee9cc2a7aaa7b0a8615e6649a051568cbb24782bb6e58107dcf3537b93</citedby><cites>FETCH-LOGICAL-c4086-3587307ee9cc2a7aaa7b0a8615e6649a051568cbb24782bb6e58107dcf3537b93</cites><orcidid>0000-0001-7762-4629 ; 0000-0002-2374-2889 ; 0000-0002-1538-4946 ; 0000-0002-5530-5341 ; 0000-0002-7064-4325 ; 0000-0003-0357-2795 ; 0000-0002-0745-991X ; 0000-0002-8549-6492 ; 0000-0002-3475-5802</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgh.15766$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgh.15766$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34928509$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ogawa, Yutaro</creatorcontrib><creatorcontrib>Nakahara, Takashi</creatorcontrib><creatorcontrib>Ono, Masafumi</creatorcontrib><creatorcontrib>Kawaguchi, Takumi</creatorcontrib><creatorcontrib>Isoda, Hiroshi</creatorcontrib><creatorcontrib>Hiramatsu, Akira</creatorcontrib><creatorcontrib>Uchikawa, Shinsuke</creatorcontrib><creatorcontrib>Fujino, Hatsue</creatorcontrib><creatorcontrib>Murakami, Eisuke</creatorcontrib><creatorcontrib>Kawaoka, Tomokazu</creatorcontrib><creatorcontrib>Yamauchi, Masami</creatorcontrib><creatorcontrib>Tsuge, Masataka</creatorcontrib><creatorcontrib>Munekage, Kensuke</creatorcontrib><creatorcontrib>Ochi, Tsunehiro</creatorcontrib><creatorcontrib>Hayes, C Nelson</creatorcontrib><creatorcontrib>Imamura, Michio</creatorcontrib><creatorcontrib>Aikata, Hiroshi</creatorcontrib><creatorcontrib>Takahashi, Hirokazu</creatorcontrib><creatorcontrib>Torimura, Takuji</creatorcontrib><creatorcontrib>Chayama, Kazuaki</creatorcontrib><title>Underestimation of impaired glucose tolerance and usefulness of a continuous glucose monitoring system in chronic liver disease</title><title>Journal of gastroenterology and hepatology</title><addtitle>J Gastroenterol Hepatol</addtitle><description>Background and Aim
The prevalence of glucose intolerance in chronic liver disease patients is high, but glucose intolerance may be overlooked in a single blood test. The purpose of this study is to evaluate blood glucose variability in patients with chronic liver disease by a continuous glucose monitoring system (CGMS) and to examine the discrepancy between hemoglobin A1c (HbA1c) levels estimated from average blood glucose levels and HbA1c.
Methods
This study included 335 patients with chronic liver disease associated with glucose intolerance. A fasting blood test and 72‐h CGMS were performed. The estimated HbA1c was calculated from the average blood glucose level, and the correlation between hepatic functional reserve and blood glucose‐related parameters was analyzed. From the obtained data, we created a new formula to calculate HbA1c without using CGMS.
Results
As hepatic functional reserve decreased, average blood glucose and insulin resistance increased while HbA1c decreased (P < 0.0001). The discrepancy between the estimated HbA1c calculated from the mean blood glucose level and the serum HbA1c (ΔHbA1c) increased as the liver reserve decreased. Using multiple regression analysis, a formula based on fasting blood glucose, HbA1c, body mass index, albumin, and liver function was constructed, and its validity was demonstrated in a study using a different control group.
Conclusions
Hemoglobin A1c may be underestimated because of decreased hepatic functional reserve. CGMS was useful in assessing accurate glycemic control of blood glucose and in detecting postprandial hyperglycemia and nocturnal hypoglycemia. Patients with chronic hepatic impairment should be corrected for hepatic functional reserve before glycemic control.</description><subject>Blood glucose</subject><subject>Blood tests</subject><subject>Body mass index</subject><subject>Chromium</subject><subject>Chronic Disease</subject><subject>Continuous glucose monitoring system (CGMS)</subject><subject>Glucose</subject><subject>Glucose Intolerance - diagnosis</subject><subject>Glucose Intolerance - epidemiology</subject><subject>Glucose monitoring</subject><subject>Glucose tolerance</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>HbA1c</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hypoglycemia</subject><subject>Insulin</subject><subject>Insulin resistance</subject><subject>Intolerance</subject><subject>Liver cirrhosis</subject><subject>Liver cirrhosis (LC)</subject><subject>Liver diseases</subject><subject>Liver Diseases - blood</subject><subject>Monitoring systems</subject><subject>Monitoring, Physiologic</subject><subject>Multiple regression analysis</subject><issn>0815-9319</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10c1O3DAUBWALFcFAu-gLVJa6gUXgOvFflhWiQ9FIbGAdOc7N4FFiT-2k1ax4dTwdyqJSvbFkfT669iHkM4Mrltf1Zv18xYSS8ogsGOdQMMXlB7IAzURRV6w-JWcpbQCAgxIn5LTidakF1Avy8uQ7jJgmN5rJBU9DT924NS5iR9fDbENCOoUBo_EWqfEdnRP28-AxpT021AY_OT-HOb1fGIN3U4jOr2napQlH6jy1zzEfWzq4Xxhp5xKahB_JcW-GhJ_e9nPy9P328eauWD0sf9x8WxWWg5ZFJbSqQCHW1pZGGWNUC0ZLJlBKXhsQTEht27bkSpdtK1FoBqqzfSUq1dbVObk45G5j-Dnn9zajSxaHwXjMkzelZCXwEoTO9Os_dBPm6PN0WVUKdM34Xl0elI0hpYh9s435D-OuYdDsW2lyK82fVrL98pY4tyN27_JvDRlcH8BvN-Du_0nN_fLuEPkKDnaYHg</recordid><startdate>202203</startdate><enddate>202203</enddate><creator>Ogawa, Yutaro</creator><creator>Nakahara, Takashi</creator><creator>Ono, Masafumi</creator><creator>Kawaguchi, Takumi</creator><creator>Isoda, Hiroshi</creator><creator>Hiramatsu, Akira</creator><creator>Uchikawa, Shinsuke</creator><creator>Fujino, Hatsue</creator><creator>Murakami, Eisuke</creator><creator>Kawaoka, Tomokazu</creator><creator>Yamauchi, Masami</creator><creator>Tsuge, Masataka</creator><creator>Munekage, Kensuke</creator><creator>Ochi, Tsunehiro</creator><creator>Hayes, C Nelson</creator><creator>Imamura, Michio</creator><creator>Aikata, Hiroshi</creator><creator>Takahashi, Hirokazu</creator><creator>Torimura, Takuji</creator><creator>Chayama, Kazuaki</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7762-4629</orcidid><orcidid>https://orcid.org/0000-0002-2374-2889</orcidid><orcidid>https://orcid.org/0000-0002-1538-4946</orcidid><orcidid>https://orcid.org/0000-0002-5530-5341</orcidid><orcidid>https://orcid.org/0000-0002-7064-4325</orcidid><orcidid>https://orcid.org/0000-0003-0357-2795</orcidid><orcidid>https://orcid.org/0000-0002-0745-991X</orcidid><orcidid>https://orcid.org/0000-0002-8549-6492</orcidid><orcidid>https://orcid.org/0000-0002-3475-5802</orcidid></search><sort><creationdate>202203</creationdate><title>Underestimation of impaired glucose tolerance and usefulness of a continuous glucose monitoring system in chronic liver disease</title><author>Ogawa, Yutaro ; Nakahara, Takashi ; Ono, Masafumi ; Kawaguchi, Takumi ; Isoda, Hiroshi ; Hiramatsu, Akira ; Uchikawa, Shinsuke ; Fujino, Hatsue ; Murakami, Eisuke ; Kawaoka, Tomokazu ; Yamauchi, Masami ; Tsuge, Masataka ; Munekage, Kensuke ; Ochi, Tsunehiro ; Hayes, C Nelson ; Imamura, Michio ; Aikata, Hiroshi ; Takahashi, Hirokazu ; Torimura, Takuji ; Chayama, Kazuaki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4086-3587307ee9cc2a7aaa7b0a8615e6649a051568cbb24782bb6e58107dcf3537b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Blood glucose</topic><topic>Blood tests</topic><topic>Body mass index</topic><topic>Chromium</topic><topic>Chronic Disease</topic><topic>Continuous glucose monitoring system (CGMS)</topic><topic>Glucose</topic><topic>Glucose Intolerance - diagnosis</topic><topic>Glucose Intolerance - epidemiology</topic><topic>Glucose monitoring</topic><topic>Glucose tolerance</topic><topic>Glycated Hemoglobin A - analysis</topic><topic>HbA1c</topic><topic>Hemoglobin</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Hypoglycemia</topic><topic>Insulin</topic><topic>Insulin resistance</topic><topic>Intolerance</topic><topic>Liver cirrhosis</topic><topic>Liver cirrhosis (LC)</topic><topic>Liver diseases</topic><topic>Liver Diseases - blood</topic><topic>Monitoring systems</topic><topic>Monitoring, Physiologic</topic><topic>Multiple regression analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ogawa, Yutaro</creatorcontrib><creatorcontrib>Nakahara, Takashi</creatorcontrib><creatorcontrib>Ono, Masafumi</creatorcontrib><creatorcontrib>Kawaguchi, Takumi</creatorcontrib><creatorcontrib>Isoda, Hiroshi</creatorcontrib><creatorcontrib>Hiramatsu, Akira</creatorcontrib><creatorcontrib>Uchikawa, Shinsuke</creatorcontrib><creatorcontrib>Fujino, Hatsue</creatorcontrib><creatorcontrib>Murakami, Eisuke</creatorcontrib><creatorcontrib>Kawaoka, Tomokazu</creatorcontrib><creatorcontrib>Yamauchi, Masami</creatorcontrib><creatorcontrib>Tsuge, Masataka</creatorcontrib><creatorcontrib>Munekage, Kensuke</creatorcontrib><creatorcontrib>Ochi, Tsunehiro</creatorcontrib><creatorcontrib>Hayes, C Nelson</creatorcontrib><creatorcontrib>Imamura, Michio</creatorcontrib><creatorcontrib>Aikata, Hiroshi</creatorcontrib><creatorcontrib>Takahashi, Hirokazu</creatorcontrib><creatorcontrib>Torimura, Takuji</creatorcontrib><creatorcontrib>Chayama, Kazuaki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ogawa, Yutaro</au><au>Nakahara, Takashi</au><au>Ono, Masafumi</au><au>Kawaguchi, Takumi</au><au>Isoda, Hiroshi</au><au>Hiramatsu, Akira</au><au>Uchikawa, Shinsuke</au><au>Fujino, Hatsue</au><au>Murakami, Eisuke</au><au>Kawaoka, Tomokazu</au><au>Yamauchi, Masami</au><au>Tsuge, Masataka</au><au>Munekage, Kensuke</au><au>Ochi, Tsunehiro</au><au>Hayes, C Nelson</au><au>Imamura, Michio</au><au>Aikata, Hiroshi</au><au>Takahashi, Hirokazu</au><au>Torimura, Takuji</au><au>Chayama, Kazuaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Underestimation of impaired glucose tolerance and usefulness of a continuous glucose monitoring system in chronic liver disease</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>J Gastroenterol Hepatol</addtitle><date>2022-03</date><risdate>2022</risdate><volume>37</volume><issue>3</issue><spage>592</spage><epage>599</epage><pages>592-599</pages><issn>0815-9319</issn><eissn>1440-1746</eissn><abstract>Background and Aim
The prevalence of glucose intolerance in chronic liver disease patients is high, but glucose intolerance may be overlooked in a single blood test. The purpose of this study is to evaluate blood glucose variability in patients with chronic liver disease by a continuous glucose monitoring system (CGMS) and to examine the discrepancy between hemoglobin A1c (HbA1c) levels estimated from average blood glucose levels and HbA1c.
Methods
This study included 335 patients with chronic liver disease associated with glucose intolerance. A fasting blood test and 72‐h CGMS were performed. The estimated HbA1c was calculated from the average blood glucose level, and the correlation between hepatic functional reserve and blood glucose‐related parameters was analyzed. From the obtained data, we created a new formula to calculate HbA1c without using CGMS.
Results
As hepatic functional reserve decreased, average blood glucose and insulin resistance increased while HbA1c decreased (P < 0.0001). The discrepancy between the estimated HbA1c calculated from the mean blood glucose level and the serum HbA1c (ΔHbA1c) increased as the liver reserve decreased. Using multiple regression analysis, a formula based on fasting blood glucose, HbA1c, body mass index, albumin, and liver function was constructed, and its validity was demonstrated in a study using a different control group.
Conclusions
Hemoglobin A1c may be underestimated because of decreased hepatic functional reserve. CGMS was useful in assessing accurate glycemic control of blood glucose and in detecting postprandial hyperglycemia and nocturnal hypoglycemia. Patients with chronic hepatic impairment should be corrected for hepatic functional reserve before glycemic control.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34928509</pmid><doi>10.1111/jgh.15766</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7762-4629</orcidid><orcidid>https://orcid.org/0000-0002-2374-2889</orcidid><orcidid>https://orcid.org/0000-0002-1538-4946</orcidid><orcidid>https://orcid.org/0000-0002-5530-5341</orcidid><orcidid>https://orcid.org/0000-0002-7064-4325</orcidid><orcidid>https://orcid.org/0000-0003-0357-2795</orcidid><orcidid>https://orcid.org/0000-0002-0745-991X</orcidid><orcidid>https://orcid.org/0000-0002-8549-6492</orcidid><orcidid>https://orcid.org/0000-0002-3475-5802</orcidid></addata></record> |
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| ispartof | Journal of gastroenterology and hepatology, 2022-03, Vol.37 (3), p.592-599 |
| issn | 0815-9319 1440-1746 |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Blood glucose Blood tests Body mass index Chromium Chronic Disease Continuous glucose monitoring system (CGMS) Glucose Glucose Intolerance - diagnosis Glucose Intolerance - epidemiology Glucose monitoring Glucose tolerance Glycated Hemoglobin A - analysis HbA1c Hemoglobin Humans Hyperglycemia Hypoglycemia Insulin Insulin resistance Intolerance Liver cirrhosis Liver cirrhosis (LC) Liver diseases Liver Diseases - blood Monitoring systems Monitoring, Physiologic Multiple regression analysis |
| title | Underestimation of impaired glucose tolerance and usefulness of a continuous glucose monitoring system in chronic liver disease |
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