| Objective:Glycated hemoglobin Alc(HbAlc) is the proportion of hemoglobin combined with glucose in total hemoglobin.The result of HbAlc is expressed as a percentage and the production rate of HbAlc is affected by the blood glucose level and hemoglobin concentration.The life expectancy of red blood cell is about 120 days in human.So HbAlc can reflect the mean blood glucose(MBG) level of the recent 2～3 months.Glycated serum protein(GSP) is more sensitive to the change of blood glucose and undisturbed by pregnancy and hemolytic disease.The half-life of plasma albumin is approximately 21 days and GSP reflects the MBG level of the recent 2～3 weeks.But it is affected by the plasma albumin concentration.The pathological statuses of chronic renal failure(CRF),such as anemia,acidosis,hypoalbuminemia and so on,can affect the testing results of HbAlc and GSP.It is becoming more and more popular that the blood glucose monitoring research in diabetics with CRF,which has not been determined in abroad and not reported in domestic yet.In our study,GSP and HbAlc were observed to discuss which was more suitable for type 2 diabetics with CRF.Methods:(1) We recruited 103 type 2 diabetics in the First Hospital of Qin Huangdao from December,2007 to February,2009.All type 2 diabetics were divided into two groups according to the plasma creatinine level.Simple type 2 diabetes mellitus group(group A) was 53 cases(30 males,23 females) with mean age(63.0±14.1) years old.Type 2 diabetes mellitus with CRF group(group B) was 50 cases(31 males,19 females,7 cases on dialysis) with mean age(65.9±9.7) years old.(2)Height,weight,blood pressure,blood lipid,renal function, HbAlc,GSP,hemoglobin(Hb),albumin(Alb) and MBG were determined and the MBG was calculated by measuring blood glucose level seven times a day(before and at 2 hours after three meals and at bedtime)Results:(1) The levels of BMI,SBP and TG in group B were significantly higher than those in group A(P＜0.05) while the level of HDL-C was significantly lower than that in group A (P＜0.01).(2) The detection rate of hypertension was higher in group B 70.00%(35/50) than that in group A 43.40%(23/53)(χ~2 =7.40,P＜0.01 ).The detection rate of dyslipidemia was higher in group B 62.00%(31/50 ) than that in group A 37.74%(20/53) and the difference was very significant(χ~2 = 6.06,P＜0.05 ).The detection rate of overweight was higher in group B 68.00% (34/50) than that in group A 47.17%(25/53)(χ~2=4.56, P<0.05).(3) The detection rate of anemia was higher in group B 70%(35/50) than that in group A 7.55%(4/53)(χ~2=42.65, P<0.01).The detection rate of hypoalbuminemia was higher in group B 30%(15/50) than that in group A 0%(0/53)(χ~2= 18.61,P<0.01).(4) A positive correlation was observed between HbA1c and Hb(r=0.406,P＜0.05) while no correlation was between GSP and Alb(r=0.007,P>0.05) in group A.A positive correlation was observed between HbA1c and Hb(r=0.325, P<0.05) as well as between GSP and Alb(r=0.802,P<0.001) in group B.(5) A positive correlation was observed between MBG and HbA1c(r=0.453,P<0.01) as well as between MBG and GSP(r=0.450,P<0.01) in group A.A positive correlation was observed between MBG and HbA1c(r=0.700,P<0.01) while there was no correlation between MBG and GSP(r=0.123, P>0.05)in group B.Conclusions:(1) The detection rates of hypertension, dyslipidemia and overweight in type 2 diabetics with CRF are higher than those in simple diabetics.So blood glucose,blood lipid,blood pressure and weight should be under good control in order to prevent the occurrence and development of CRF.(2)Hypoproteinemia and anemia can affect the results of GSP and HbA1c in type 2 diabetics with chronic renal failure.(3)There is a correlation between MBG and HbA1c.Due to being greatly impacted by plasma albumin,there is no correlation between MBG and GSP in type 2 diabetics with chronic renal failure.The testing of HbA1c is essential and maybe it is a better indicator of blood glucose monitoring in the type 2 diabetics with CRF. |
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