Utility of HbA1c assessment in people with diabetes awaiting liver transplantation
Utility of HbA1c assessment in people with diabetes awaiting liver transplantation
Aims: to investigate the relationship between HbA1c and glucose in people with co-existing liver disease and diabetes awaiting transplant, and in those with diabetes but no liver disease.
Methods: HbA1c and random plasma glucose data were collected for 125 people with diabetes without liver disease and for 29 people awaiting liver transplant with diabetes and cirrhosis. Cirrhosis was caused by non-alcoholic fatty liver disease, hepatitis C, alcoholic liver disease, hereditary haemochromatosis, polycystic liver/kidneys, cryptogenic/non-cirrhotic portal hypertension and α-1-antitrypsin-related disease.
Results: the median (interquartile range) age of the diabetes with cirrhosis group was 55 (49–63) years compared to 60 (50–71) years (P=0.13) in the group without cirrhosis. In the diabetes with cirrhosis group there were 21 men (72%) compared with 86 men (69%) in the group with diabetes and no cirrhosis (P=0.82). Of the group with diabetes and cirrhosis, 27 people (93%) were of white European ethnicity, two (7%) were South Asian and none was of Afro-Caribbean/other ethnicity compared with 94 (75%), 16 (13%), 10 (8%)/5 (4%), respectively, in the group with diabetes and no cirrhosis (P=0.20). Median (interquartile range) HbA1c was 41 (32–56) mmol/mol [5.9 (5.1–7.3)%] vs 61 (52–70) mmol/mol [7.7 (6.9–8.6)%] (P<0.001), respectively, in the diabetes with cirrhosis group vs the diabetes without cirrhosis group. The glucose concentrations were 8.4 (7.0–11.2) mmol/l vs 7.3 (5.2–11.5) mmol/l (P=0.17). HbA1c was depressed by 20 mmol/mol (1.8%; P<0.001) in 28 participants with cirrhosis but elevated by 28 mmol/mol (2.6%) in the participant with α-1-antitrypsin disorder. Those with cirrhosis and depressed HbA1c had fewer larger erythrocytes, and higher red cell distribution width and reticulocyte count. This was reflected in the positive association of glucose with mean cell volume (r=0.39) and haemoglobin level (r=0.49) and the negative association for HbA1c (r=–0.28 and r=–0.26, respectively) in the diabetes group with cirrhosis.
Conclusion: HbA1c is not an appropriate test for blood glucose in people with cirrhosis and diabetes awaiting transplant as it reflects altered erythrocyte presentation.
1444-1452
Bhattacharjee, D.
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Vracar, S.
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Round, R.A.
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Nightingale, P.G.
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Williams, J.A.
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Gkoutos, G.V.
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Stratton, I.M.
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Parker, R.
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Luzio, S.D.
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Webber, J.
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Manley, S.E.
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Roberts, G.A.
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Ghosh, S.
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30 April 2019
Bhattacharjee, D.
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Vracar, S.
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Round, R.A.
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Nightingale, P.G.
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Williams, J.A.
a6517424-7784-460b-a6c6-7d947a3c1572
Gkoutos, G.V.
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Stratton, I.M.
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Parker, R.
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Luzio, S.D.
256a34ad-9e73-40df-93b3-e50bf5f6699e
Webber, J.
395e2b89-0251-4371-81e8-bbbbc3b08c73
Manley, S.E.
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Roberts, G.A.
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Ghosh, S.
fbfd6b3a-bbdf-41b2-8b6d-01b5cc97a5b8
Bhattacharjee, D., Vracar, S., Round, R.A., Nightingale, P.G., Williams, J.A., Gkoutos, G.V., Stratton, I.M., Parker, R., Luzio, S.D., Webber, J., Manley, S.E., Roberts, G.A. and Ghosh, S.
(2019)
Utility of HbA1c assessment in people with diabetes awaiting liver transplantation.
Diabetic Medicine, 36 (11), .
(doi:10.1111/dme.13870).
Abstract
Aims: to investigate the relationship between HbA1c and glucose in people with co-existing liver disease and diabetes awaiting transplant, and in those with diabetes but no liver disease.
Methods: HbA1c and random plasma glucose data were collected for 125 people with diabetes without liver disease and for 29 people awaiting liver transplant with diabetes and cirrhosis. Cirrhosis was caused by non-alcoholic fatty liver disease, hepatitis C, alcoholic liver disease, hereditary haemochromatosis, polycystic liver/kidneys, cryptogenic/non-cirrhotic portal hypertension and α-1-antitrypsin-related disease.
Results: the median (interquartile range) age of the diabetes with cirrhosis group was 55 (49–63) years compared to 60 (50–71) years (P=0.13) in the group without cirrhosis. In the diabetes with cirrhosis group there were 21 men (72%) compared with 86 men (69%) in the group with diabetes and no cirrhosis (P=0.82). Of the group with diabetes and cirrhosis, 27 people (93%) were of white European ethnicity, two (7%) were South Asian and none was of Afro-Caribbean/other ethnicity compared with 94 (75%), 16 (13%), 10 (8%)/5 (4%), respectively, in the group with diabetes and no cirrhosis (P=0.20). Median (interquartile range) HbA1c was 41 (32–56) mmol/mol [5.9 (5.1–7.3)%] vs 61 (52–70) mmol/mol [7.7 (6.9–8.6)%] (P<0.001), respectively, in the diabetes with cirrhosis group vs the diabetes without cirrhosis group. The glucose concentrations were 8.4 (7.0–11.2) mmol/l vs 7.3 (5.2–11.5) mmol/l (P=0.17). HbA1c was depressed by 20 mmol/mol (1.8%; P<0.001) in 28 participants with cirrhosis but elevated by 28 mmol/mol (2.6%) in the participant with α-1-antitrypsin disorder. Those with cirrhosis and depressed HbA1c had fewer larger erythrocytes, and higher red cell distribution width and reticulocyte count. This was reflected in the positive association of glucose with mean cell volume (r=0.39) and haemoglobin level (r=0.49) and the negative association for HbA1c (r=–0.28 and r=–0.26, respectively) in the diabetes group with cirrhosis.
Conclusion: HbA1c is not an appropriate test for blood glucose in people with cirrhosis and diabetes awaiting transplant as it reflects altered erythrocyte presentation.
Text
Diabetic Medicine - 2018 - Bhattacharjee - Utility of HbA1c assessment in people with diabetes awaiting liver
- Version of Record
More information
Accepted/In Press date: 22 November 2018
e-pub ahead of print date: 26 November 2018
Published date: 30 April 2019
Additional Information:
Funding Information: the laboratory measurements were produced by the biomedical scientists in Clinical Laboratory Sciences at Queen Elizabeth Hospital Birmingham. We would like to thank Dr Radhika Susarla (Research Scientist, Diabetes Translational Research Group) for her assistance with the manuscript. We would also like to thank Dr Paul Cockwell (Consultant Nephrologist, Renal Medicine, Queen Elizabeth Hospital Birmingham) and Professor Wasim Hanif (Professor of Diabetes and Endocrinology, Diabetes Centre, Queen Elizabeth Hospital Birmingham) for their support and encouragement. The datasets generated during and/or analysed during the study are not publicly available. The dataset contains clinical data which cannot be shared publicly as a result of UK data protection legislation.
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Local EPrints ID: 487100
URI: http://eprints.soton.ac.uk/id/eprint/487100
ISSN: 0742-3071
PURE UUID: eebd5f22-84f2-4385-8826-542cde5e3fe1
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Date deposited: 13 Feb 2024 17:32
Last modified: 18 Mar 2024 04:01
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Contributors
Author:
D. Bhattacharjee
Author:
S. Vracar
Author:
R.A. Round
Author:
P.G. Nightingale
Author:
J.A. Williams
Author:
G.V. Gkoutos
Author:
I.M. Stratton
Author:
R. Parker
Author:
S.D. Luzio
Author:
J. Webber
Author:
S.E. Manley
Author:
G.A. Roberts
Author:
S. Ghosh
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