Glycemic control and association with metabolic Factors in Hemodialysis Patients with Diabetes Mellitus

Background: Diabetes mellitus is the leading cause of end-stage renal disease and is associated with significant cardiovascular morbidity and mortality. Good glycemic control remains the key to prevent or delay its complication. We conducted a cross-sectional study to assess the regimens of diabetes treatment and effect of therapy, and examine the relationship between clinical features and metabolic factors. Methods: Adult diabetic patients on chronic hemodialysis were investigated. Their demographic and biochemical data were reviewed and recorded. Treatments for diabetes were compared and glycemic control was assessed by average random blood sugar and glycated hemoglobin (HbA1C) levels. The association between blood sugar levels, high sensitivity C-reactive protein (hsCRP), and other metabolic factors were examined. Results: In 123 enrolled patients, 107 patients (87%) were on insulin injection or anti-diabetic agents (ADA). The average HbA1C was 82±2.1% (4.2-13.1%). The HbA1C level was lower in patients without the need of medication than in other treatment regiment groups (6.1±1.4% vs. 8.6±1.9%, p＜0.05). Neither albumin level. nor lipid profile showed significant difference among treatment groups. Average random glucose level showed a negative correlation with albumin (r=-0.237, p＜0.01), and was directly related to HbA1C (r=0.745, p＜0.001), and triglyceride (r=0.225, p＜0.05). No association was found between HbA1C and hsCRP level, in a follow-up period of 20 months, there were 14 deaths in this study cohort (11.4%). Patients with HbA1C greater than 9.1% had significantly increased mortality (20.5% vs. 7.1% in HbA1C less than 9.1%, p＜0.05). Conclusion: Glycemic control in diabetic HD patients is not adequate even under insulin treatment. The HbA1C level correlated well with average random sugar level but was not related to chronic inflammatory marker. Poor glycemic control was associated with poor outcome.