Hemoglobin A1c Has Suboptimal Performance to Diagnose and Monitor Diabetes Mellitus in Patients with Cirrhosis DIGESTIVE DISEASES AND SCIENCES Addepally, N. S., George, N., Martinez-Macias, R., Garcia-Saenz-de-Sicilia, M., Kim, W., Duarte-Rojo, A. 2018; 63 (12): 3498–3508

Abstract

Glycated hemoglobin A1c (HbA1c) is routinely used to diagnose and monitor type 2 diabetes mellitus (T2DM) in cirrhotic patients. Remarkably, HbA1c may be falsely low in such patients.We assessed the diagnostic and monitoring yield of HbA1c in cirrhotic patients with T2DM (DM-Cirr) and without T2DM (NoDM-Cirr).We conducted a composite study allocating 21 NoDM-Cirr into a cross-sectional module and 16 DM-Cirr plus 13 controls with T2DM only (DM-NoCirr) into a prospective cohort. Oral glucose tolerance test (OGTT) was performed in NoDM-Cirr. DM-Cirr and DM-NoCirr were matched by sex, age, BMI, and T2DM treatment and studied with continuous glucose monitoring (CGM). Percent deviations from target, low/high blood glucose indexes (LBGI/HBGI) were calculated from CGM, as well as the average daily risk range (ADRR) as a marker of glucose variability.Overall, HbA1c and OGTT diagnostic yield agreed in 12 patients (57%, ??=?0.45, p??9) when compared to DM-NoCirr, and they also showed higher glucose variability (ADRR 13.9?±?2.5 vs. 8.9?±?1.8, respectively, p?=?0.03).HbA1c inaccurately represents chronic glycemia in patients with cirrhosis, likely in relation to increased glucose variability.

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