{"id":299,"date":"2008-12-26T10:21:09","date_gmt":"2008-12-26T09:21:09","guid":{"rendered":"http:\/\/localhost\/new\/htb\/?p=299"},"modified":"2013-08-23T12:56:08","modified_gmt":"2013-08-23T12:56:08","slug":"haemoglobin-a1c-hba1c-may-underestimate-glycaemia-in","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/299","title":{"rendered":"Haemoglobin A1c (HbA1c) may underestimate glycaemia in patients with diabetes on HIV therapy"},"content":{"rendered":"<p><strong>Satyajit Das, HIV i-Base<\/strong><\/p>\n<p><strong>The HbA1c gives an estimate of blood sugar control in last 6-12 weeks. However, previous retrospective studies suggested that HbA1c may not be accurate in HIV-positive patients.<\/strong><\/p>\n<p>Kim and colleagues from Washington Hospital investigated the relationship between HbA1c and glycaemia in HIV-positive patients with diabetes or hyperglycaemia.<\/p>\n<p>This was a prospective cohort study of over 100 HIV-positive patients (70% male) with type-2 diabetes (77%) or fasting hyperglycaemia without anaemia or known kidney disease. In addition to a detailed medical history, evaluation included fasting and non-fasting glucose, haptoglobin, viral load, HbA1c, and fructosamine levels. Results were compared to 200 HIV-negative, sex-race-age matched type-2 diabetic controls.<\/p>\n<p>Compared to HIV-negative, non-diabetic controls, HbA1c underestimated mean (+SE) plasma glucose in HIV patients by 29 (\u00b1 4) mg\/dL. Univariate analyses found that current NRTI use, mean cell volume (MCV), haemoglobin, low HIV viral load and low haptoglobin were significantly associated with HbA1c-glucose discordance, but current PI and NNRTI use were not.<\/p>\n<p>In a multivariate analysis of these factors, MCV was the only significant independent predictor (p=.002) of HbA1c-glucose discordance. When individual NRTIs were assessed, only ABC use (p=0.0004) and MCV (p=0.001) were independent predictors in a multivariate model. Fructosamine more closely reflected glycaemia than HbA1c.<\/p>\n<p>The authors concluded that HbA1c may underestimate glucose levels by as much as 16% in patients with HIV on HAART and that &#8220;this appeared to be a direct effect of NRTI use, in particular abacavir&#8221; and that other markers may be more appropriate in this setting.<\/p>\n<h3>Comment<\/h3>\n<p><strong>Fructosamine gives a picture of blood sugar control from the previous 2 to 3 weeks and may be a better marker of blood glucose control in HIV patients. However, falsely low fructosamine results are seen with decreased serum total protein and\/or albumin.<\/strong><\/p>\n<p>Reference:<\/p>\n<p>Kim P et al Hemoglobin A1c Does Not Accurately Reflect Glycemia in HIV Patients on HAART. 48th ICAAC, 25-28 October 2008. Washington. Abstract H2304.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Satyajit Das, HIV i-Base The HbA1c gives an estimate of blood sugar control in last 6-12 weeks. However, previous retrospective studies suggested that HbA1c may not be accurate in HIV-positive patients. Kim and colleagues from Washington Hospital investigated the relationship &hellip;<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,8,27],"tags":[102],"class_list":["post-299","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-side-effects","category-weight-diabetes-metabolic-complications","tag-icaac-48th-2008"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/299","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=299"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/299\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=299"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=299"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=299"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}