Is HbA1c suitable for assessing blood glucose in people with cirrhosis awaiting transplant?

  • Bhattacharjee D & al.
  • Diabet Med
  • 26 Nov 2018

  • from Sarfaroj Khan
  • Clinical Summaries
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 Takeaway

  • HbA1c may not be an accurate reflection of blood glucose for the diagnosis/monitoring of diabetes in people with cirrhosis awaiting transplant as it reflects altered erythrocyte presentation.

 Why this matters

  • Diabetes is a leading cause of liver disease, with cirrhosis responsible for a considerable number of deaths in people with diabetes.

Study design

  • HbA1c and random plasma glucose data were collected for patients with diabetes without liver disease (n=125) and for patients awaiting liver transplant with diabetes and cirrhosis (n=29).
  • Funding: None disclosed.

Key results

  • Median (interquartile range [IQR]) for diabetes with cirrhosis group vs for the group without cirrhosis.
    • age: 55 (49-63) vs 60 (50-71) years (P=.13)
    • HbA1c concentrations: 41 (32-56) mmol/mol [5.9% (5.1%-7.3%)] vs 61 (52-70) mmol/mol [7.7% (6.9%-8.6%); P<.001>
    • glucose concentrations: 8.4 (7.0-11.2) mmol/L vs 7.3 (5.3-11.5) mmol/L (P=.17)
  • 28 patients with cirrhosis had HbA1c concentration depressed by 20 mmol/mol (1.8%; P<.001 hba1c elevated by mmol in the participant with disorder.>
  • Fewer larger erythrocytes, and higher red cell distribution width and reticulocyte count were observed in patients with cirrhosis and depressed HbA1c concentrations.
  • This was reflected in the positive association of glucose with mean cell volume (r=0.39) and haemoglobin level (r=0.49) and the negative association for HbA1c concentration (r=−0.28 and r=−0.26, respectively) in the diabetes group.

Limitations

  • Small sample of patients with cirrhosis and diabetes.