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Table 2 Advantages and disadvantages of different methods for glycemic assessment in patients with chronic kidney disease

From: Assessment of glycemia in 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
  1. Abbreviations: CKD chronic kidney disease, eGFR estimated glomerular filtration rate, A1C hemoglobin A1C, 1,5AG one, five-anhydroglucitol, SMBG self-monitored blood glucose, CGM continuous glucose monitoring