Table 2 Advantages and disadvantages of different methods for glycemic assessment in patients with chronic kidney disease
Modality | Advantages | Disadvantages |
|---|---|---|
Hemoglobin A1C | - Widely available - Standardized assays - Reflects glycemic status over the previous 90 days - Clinical trial outcomes data - Limitations are well known | - Unreliable in many comorbidities associated with CKD, including anemia - Unreliable in advanced CKD (eGFR < 30 ml/min/1.73 m2) |
Glycated proteins (fructosamine, glycated albumin) | - Assays are commercially available - Reflect glycemic control over the previous 2–4 weeks - Useful in the presence of anemia or use of erythropoietin supplementation agents | - Assays are not standardized - Protein turnover may limit use in patients with proteinuric CKD - Clinical trial outcome data are limited |
1,5 AG | - Reflects glycemic control over the previous 2 weeks - Useful in detecting glycemic excursions | - Assays are not standardized - Lack of data on accuracy and diagnostic validity - Clinical trial outcome data are limited |
SMBG | - Widely available and FDA approved. - Reliable measurement of current glucose level - Clinical trial outcome data | - Diagnostic accuracy is affected by strip-to-strip variation, altitude, temperature, hyperuricemia, and some medications - The discomfort from fingersticks limits use |
CGM | - Provides detailed snapshot of glycemic control over the duration of sensor - Allows care to be individualized to each patient - Clinical trials outcomes data are emerging | - Cost is higher compared to other tests - Lack of familiarity limits use by non-endocrinologists |