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Correlates of low hemoglobin A1c in maintenance hemodialysis patients.

ABSTRACT: The optimal target for glycemic control has not been established for diabetic maintenance hemodialysis (MHD) patients.A 6-year cohort (October 2001- December 2006) of 347 diabetic MHD patients with HbA1c data was examined for associations between HbA1c and mortality. Death hazard ratios (HR) were estimated using Cox regressions and cubic splines.In these 347 patients (age, 59 ± 11 years; 49 % women; 28 % African Americans; and 55 % Hispanics), each 0.5 % decline in HbA1c below 6 % was associated with a 4.7 times higher death risk (HR = 4.7; 95 % CI 1.7-12.7) in the fully adjusted model. Factors associated with lower HbA1c levels (<6 % compared to 6-7 %) were: Hispanic ethnicity (OR = 2.9; 95 % CI 1.1-7.9), higher mid-arm muscle circumstance (OR = 1.1; 95 % CI 1.0-1.3), higher total iron-binding capacity (OR = 1.03; 95 % CI 1.01-1.05), and higher iron saturation ratio (OR = 1.14; 95 % CI 1.03-1.26). HbA1c levels >7 % showed a consistent trend toward elevated mortality risk (HR = 1.18; 95 % CI 0.99-1.41) after multivariate adjustment.In diabetic MHD patients with burnt-out diabetes, characterized by HbA1c <6 %, even lower HbA1c levels are associated with significantly higher death risk. Additional studies are needed to determine the optimal target for HbA1c levels in different subgroups of diabetic MHD patients.

SUBMITTER: Kim Y

PROVIDER: S-EPMC4326056 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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Correlates of low hemoglobin A1c in maintenance hemodialysis patients.

Kim Youngmee Y Park Jong Chan JC Molnar Miklos Z MZ Shah Anuja A Benner Debbie D Kovesdy Csaba P CP Kopple Joel D JD Kalantar-Zadeh Kamyar K

International urology and nephrology 20120609 4

<h4>Purpose</h4>The optimal target for glycemic control has not been established for diabetic maintenance hemodialysis (MHD) patients.<h4>Methods</h4>A 6-year cohort (October 2001- December 2006) of 347 diabetic MHD patients with HbA1c data was examined for associations between HbA1c and mortality. Death hazard ratios (HR) were estimated using Cox regressions and cubic splines.<h4>Results</h4>In these 347 patients (age, 59 ± 11 years; 49 % women; 28 % African Americans; and 55 % Hispanics), each ...[more]

PMID: 22684796

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Project description:ImportanceLow-carbohydrate diets decrease hemoglobin A1c (HbA1c) among patients with type 2 diabetes at least as much as low-fat diets. However, evidence on the effects of low-carbohydrate diets on HbA1c among individuals with HbA1c in the range of prediabetes to diabetes not treated by diabetes medications is limited.ObjectiveTo study the effect of a behavioral intervention promoting a low-carbohydrate diet compared with usual diet on 6-month changes in HbA1c among individuals with elevated untreated HbA1c.Design, setting, and participantsThis 6-month randomized clinical trial with 2 parallel groups was conducted from September 2018 to June 2021 at an academic medical center in New Orleans, Louisiana. Laboratory analysts were blinded to assignment. Participants were aged 40 to 70 years with untreated HbA1c of 6.0% to 6.9% (42-52 mmol/mol). Data analysis was performed from November 2021 to September 2022.InterventionsParticipants were randomized to a low-carbohydrate diet intervention (target <40 net grams of carbohydrates during the first 3 months; <60 net grams for months 3 to 6) or usual diet. The low-carbohydrate diet group received dietary counseling.Main outcomes and measuresSix-month change in HbA1c was the primary outcome. Outcomes were measured at 0, 3, and 6 months.ResultsOf 2722 prescreened participants, 962 underwent screening, and 150 were enrolled (mean [SD] age, 58.9 [7.9] years; 108 women [72%]; 88 Black participants [59%]) and randomized to either the low-carbohydrate diet intervention (75 participants) or usual diet (75 participants) group. Six-month data were collected on 142 participants (95%). Mean (SD) HbA1c was 6.16% (0.30%) at baseline. Compared with the usual diet group, the low-carbohydrate diet intervention group had significantly greater 6-month reductions in HbA1c (net difference, -0.23%; 95% CI, -0.32% to -0.14%; P < .001), fasting plasma glucose (-10.3 mg/dL; 95% CI, -15.6 to -4.9 mg/dL; P < .001), and body weight (-5.9 kg; 95% CI, -7.4 to -4.4 kg; P < .001).Conclusions and relevanceIn this randomized clinical trial, a low-carbohydrate dietary intervention led to improvements in glycemia in individuals with elevated HbA1c not taking glucose-lowering medication, but the study was unable to evaluate its effects independently of weight loss. This diet, if sustained, might be a useful dietary approach for preventing and treating type 2 diabetes, but more research is needed.Trial registrationClinicalTrials.gov Identifier: NCT03675360.

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Correlates of low hemoglobin A1c in maintenance hemodialysis patients.

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Correlates of low hemoglobin A1c in maintenance hemodialysis patients.

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