Critical discrepancy in blood glucose control levels evaluated by glycated albumin and estimated hemoglobin A1c levels determined from a flash continuous glucose monitoring system in patients with type 2 diabetes on hemodialysis

We aimed to investigate if estimated hemoglobin A1c (eHbA1c) levels determined using a flash continuous glucose monitoring system could be an indicator of glycemic control status in hemodialysis patients with diabetes. Hemodialysis patients with type 2 diabetes were recruited. eHbA1c levels were measured using the FreeStyle Libre Flash Glucose Monitoring System(®). A total of 18 hemodialysis patients with diabetes were included in the study. The eHbA1c(GA) – calculated based on glycated albumin level, and body mass index and serum hemoglobin concentration were also included in the formula – was higher than the eHbA1c in most patients. Furthermore, the eHbA1c(GA) – eHbA1c values were >2% in all patients with body mass index <18.5 kg/m(2); the maximal value was 4.1%. This study shows that eHbA1c can be used as a reliable indicator for evaluating glycemic control and avoiding hypoglycemia in hemodialysis patients with diabetes, particularly those with decreased body mass index.