Continuous glucose monitoring and use of alternative markers to assess glycemia in chronic kidney disease
Open accessAbstract
Objective In chronic kidney disease, glycated albumin and fructosamine have been postulated to be better biomarkers of glycemic control than HbA 1c . We evaluated the accuracy, variability, and covariate bias of three biomarkers (HbA 1c , glycated albumin, and fructosamine) compared with continuous glucose monitoring (CGM)-derived measurement of glycemia across estimated glomerular filtration rate (eGFR) in type 2 diabetes. Research design and methods A prospective cohort study was conducted of 104 participants with type 2 diabetes, 80 with eGFR 2 (not treated with dialysis) and 24 frequency-matched control subjects with eGFR ≥60 mL/min/1.73 m 2 . Participants wore a blinded CGM for two 6-day periods separated by 2 weeks, with blood and urine collected at the end of each CGM period. HbA 1c , glycated albumin, and fructosamine were measured by high-performance liquid chromatographic, enzymatic, and colorimetric nitroblue tetrazolium methods, respectively. Results Within-person biomarker values were strongly correlated between the two CGM periods ( r = 0.92-0.95), although no marker fully captured the within-person variability of mean CGM glucose. All markers were similarly correlated with mean CGM glucose ( r = 0.71-77). Compared with mean CGM glucose, glycated albumin and fructosamine were significantly biased by age, BMI, serum iron concentration, transferrin saturation, and albuminuria; HbA 1c was underestimated in those with albuminuria. Conclusions Glycated albumin and fr…
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HbA1c remains the glycemic biomarker of choice in advanced CKD because glycated albumin and fructosamine provide no advantages over HbA1c and have clinically relevant assay biases to low and high levels, respectively, with hypoalbuminemia.
“However, HbA1c remains the glycemic biomarker of choice in advanced CKD because glycated albumin and fructosamine provide no advantages over HbA1c and have clinically relevant assay biases to the low and high levels, respectively, with hypoalbuminemia, a common condition among patients with proteinuria, malnutrition, or treated by peritoneal dialysis. 228”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [228]
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- Authors
- Zelnick, L. R., Batacchi, Z. O., Ahmad, I., Dighe, A., Little, R. R., Trence, D. L., Hirsch, I. B., & de Boer, I. H.
- Affiliations
- University of Washington (US)
- Summit Medical Group (United States) (US)
- Banner MD Anderson Cancer Center (US)
- University of Missouri (US)
- Kidney Research Institute, University of Washington, Seattle, WA
- Corresponding author
- Zelnick, Leila R.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2020-08-11
- Volume
- 43
- Issue
- 10
- Pages
- 2379-2387
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC7510019
- OpenAlex
- W3048686460
- Cited by
- 55
- References
- 43
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 13 · 2023: 11 · 2022: 14 · 2021: 7 · 2020: 2
- FWCI
- 6.41
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Diabetes Care (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Diabetes Association (#4-15-CKD-20)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01-DK-088762, R01-087726, T32-DK-007247)
- Puget Sound Veterans Affairs Health Care System
- Northwest Kidney Centers
- Medtronic
- Abbott Laboratories
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Advanced Glycation End Products research
- Keywords
- chronic kidney disease, glycemic control, glycated albumin, fructosamine, HbA1c, continuous glucose monitoring, type 2 diabetes, estimated glomerular filtration rate, glycemic variability, albuminuria, glycemic markers
- MeSH terms
- Glycated Serum Albumin, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glomerular Filtration Rate, Glycated Hemoglobin, Humans, Male, Middle Aged, Serum Albumin, Blood Glucose Self-Monitoring, Cohort Studies, Biomarkers, Case-Control Studies, Glycation End Products, Advanced, Fructosamine, Renal Insufficiency, Chronic
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