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Observational Study
. 2023 Nov;17(6):1553-1562.
doi: 10.1177/19322968221092050. Epub 2022 Apr 25.

Discordance Between Glycated Hemoglobin A1c and the Glucose Management Indicator in People With Diabetes and Chronic Kidney Disease

Philippe Oriot  1 , Claire Viry  2 , Antoine Vandelaer  3 , Sébastien Grigioni  4   5   6 , Malanie Roy  2 , Jean Christophe Philips  3 , Gaëtan Prévost  2   6
Affiliations
Observational Study

Discordance Between Glycated Hemoglobin A1c and the Glucose Management Indicator in People With Diabetes and Chronic Kidney Disease

Philippe Oriot et al. J Diabetes Sci Technol. 2023 Nov.

Abstract

Introduction: Assessment of glucose exposure via glycated hemoglobin A1c (HbA1c) has limitations for interpretation in individuals with diabetes and chronic kidney disease (CKD). The glucose management indicator (GMI) derived from continuous glucose monitoring (CGM) data could be an alternative. However, the concordance between HbA1c measured in laboratory and GMI (HbA1c-GMI) is uncertain in individuals with CKD. The purpose of this study is to analyze this discrepancy.

Material and method: We performed a multicentric, retrospective, observational study. A group of individuals with diabetes and CKD (n = 170) was compared with a group of individuals with diabetes without CKD (n = 185). All individuals used an intermittently scanned continuous glucose monitoring (isCGM). A comparison of 14-day and 90-day glucose data recorded by the isCGM was performed to calculate GMI and the discordance between lab HbA1c and GMI was analyzed by a Bland-Altman method and linear regression.

Results: HbA1c-GMI discordance was significantly higher in the CKD group versus without CKD group (0.78 ± 0.57 [0.66-0.90] vs 0.59 ± 0.44 [0.50-0.66]%, P < .005). An absolute difference >0.5% was found in 68.2% of individuals with CKD versus 42.2% of individuals without CKD. We suggest a new specific formula to estimate HbA1c from the linear regression between HbA1c and mean glucose CGM, namely CKD-GMI = 0.0261 × 90-day mean glucose (mg/L) + 3.5579 (r2 = 0.59).

Conclusions: HbA1c-GMI discordance is frequent and usually in favor of an HbA1c level higher than the GMI value, which can lead to errors in changes in glucose-lowering therapy, especially for individuals with CKD. This latter population should benefit from the CGM to measure their glucose exposure more precisely.

Keywords: HbA1c; chronic kidney disease; continuous glucose monitoring; diabetes management; end-stage renal disease; flash glucose monitoring; glucose management indicator.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Individuals were subdivided as a percentage ratio based on the relative difference HbA1c-GMI threshold between CKD and no-CKD groups. Abbreviations: GMI, glucose management indicator; CKD, chronic kidney disease.
Figure 2.
Figure 2.
Bland-Altman test in CKD and no-CKD groups shows the difference HbA1c and GMI on the y-axis. The average of HbA1c and GMI is given on the x-axis. Abbreviations: CKD, chronic kidney disease; GMI, glucose management indicator.
Figure 3.
Figure 3.
The regression linear of the CKD-GMI equation was plotted in solid black line. The 95% regression confidence intervals were shown in dark gray area and the prediction intervals were plotted in dotted black. The red line represents the GMI equation used in the CKD group. Abbreviations: CKD, chronic kidney disease; GMI, glucose management indicator.
Figure 4.
Figure 4.
Individuals were subdivided as a percentage ratio based on the relative difference HbA1c-GMI threshold between CKD and no-CKD groups. Abbreviations: GMI, glucose management indicator; CKD, chronic kidney disease.
See this image and copyright information in PMC

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