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Monitoring HIV-infected Patients with Diabetes: Hemoglobin A1c, Fructosamine, or Glucose?

BACKGROUND: Published studies report inappropriately low hemoglobin A1C (HbA1c) values that underestimate glycemia in HIV patients. METHODS: We reviewed the charts of all HIV patients with diabetes mellitus (DM) at our clinic. Fifty-nine patients had HbA1c data, of whom 26 patients also had fructosa...

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Autores principales: Kim, So-Young, Friedmann, Patricia, Seth, Amit, Fleckman, Adrienne M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Libertas Academica 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259549/
https://www.ncbi.nlm.nih.gov/pubmed/25520565
http://dx.doi.org/10.4137/CMED.S19202
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author Kim, So-Young
Friedmann, Patricia
Seth, Amit
Fleckman, Adrienne M
author_facet Kim, So-Young
Friedmann, Patricia
Seth, Amit
Fleckman, Adrienne M
author_sort Kim, So-Young
collection PubMed
description BACKGROUND: Published studies report inappropriately low hemoglobin A1C (HbA1c) values that underestimate glycemia in HIV patients. METHODS: We reviewed the charts of all HIV patients with diabetes mellitus (DM) at our clinic. Fifty-nine patients had HbA1c data, of whom 26 patients also had fructosamine data. We compared the most recent HbA1c to finger-stick (FS) glucose averaged over three months, and fructosamine to FS averaged over six weeks. Predicted average glucose (pAG) was calculated as reported by Nathan et al: pAG (mg/dL) = 28.7 × A1C% − 46.7. Data were analyzed using the Statistical Analysis System (SAS) and Kruskal–Wallis test. RESULTS: HbA1c values underestimated (UE) actual average glucose (aAG) in 19% of these patients and overestimated (OE) aAG in 27%. HbA1c estimated aAG within the established range in only 54% of the patients. There were no statistical differences in the types of HIV medication used in patients with UE, OE, or accurately estimated (AE) glycemia. A Spearman correlation coefficient between HbA1c and aAG was r = 0.53 (P < 0.0001). Correlation between fructosamine and aAG was r = 0.47 (P = 0.016). CONCLUSIONS: The correlations between HbA1c and aAG and between fructosamine and aAG were weaker than expected, and fructosamine was not more accurate than HbA1c.
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spelling pubmed-42595492014-12-17 Monitoring HIV-infected Patients with Diabetes: Hemoglobin A1c, Fructosamine, or Glucose? Kim, So-Young Friedmann, Patricia Seth, Amit Fleckman, Adrienne M Clin Med Insights Endocrinol Diabetes Original Research BACKGROUND: Published studies report inappropriately low hemoglobin A1C (HbA1c) values that underestimate glycemia in HIV patients. METHODS: We reviewed the charts of all HIV patients with diabetes mellitus (DM) at our clinic. Fifty-nine patients had HbA1c data, of whom 26 patients also had fructosamine data. We compared the most recent HbA1c to finger-stick (FS) glucose averaged over three months, and fructosamine to FS averaged over six weeks. Predicted average glucose (pAG) was calculated as reported by Nathan et al: pAG (mg/dL) = 28.7 × A1C% − 46.7. Data were analyzed using the Statistical Analysis System (SAS) and Kruskal–Wallis test. RESULTS: HbA1c values underestimated (UE) actual average glucose (aAG) in 19% of these patients and overestimated (OE) aAG in 27%. HbA1c estimated aAG within the established range in only 54% of the patients. There were no statistical differences in the types of HIV medication used in patients with UE, OE, or accurately estimated (AE) glycemia. A Spearman correlation coefficient between HbA1c and aAG was r = 0.53 (P < 0.0001). Correlation between fructosamine and aAG was r = 0.47 (P = 0.016). CONCLUSIONS: The correlations between HbA1c and aAG and between fructosamine and aAG were weaker than expected, and fructosamine was not more accurate than HbA1c. Libertas Academica 2014-12-04 /pmc/articles/PMC4259549/ /pubmed/25520565 http://dx.doi.org/10.4137/CMED.S19202 Text en © 2014 the author(s), publisher and licensee Libertas Academica Ltd. This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.
spellingShingle Original Research
Kim, So-Young
Friedmann, Patricia
Seth, Amit
Fleckman, Adrienne M
Monitoring HIV-infected Patients with Diabetes: Hemoglobin A1c, Fructosamine, or Glucose?
title Monitoring HIV-infected Patients with Diabetes: Hemoglobin A1c, Fructosamine, or Glucose?
title_full Monitoring HIV-infected Patients with Diabetes: Hemoglobin A1c, Fructosamine, or Glucose?
title_fullStr Monitoring HIV-infected Patients with Diabetes: Hemoglobin A1c, Fructosamine, or Glucose?
title_full_unstemmed Monitoring HIV-infected Patients with Diabetes: Hemoglobin A1c, Fructosamine, or Glucose?
title_short Monitoring HIV-infected Patients with Diabetes: Hemoglobin A1c, Fructosamine, or Glucose?
title_sort monitoring hiv-infected patients with diabetes: hemoglobin a1c, fructosamine, or glucose?
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259549/
https://www.ncbi.nlm.nih.gov/pubmed/25520565
http://dx.doi.org/10.4137/CMED.S19202
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