HbA1c Levels as a Parameter of Glycemic Control in Patients with Liver Diseases
Leonardo de Lucca Schiavon
, Janaína Luz Narciso-Schiavon
Corresponding author
Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina. Brazil
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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Ann Hepatol. 2017;16:471-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 72 "formatos" => array:3 [ "EPUB" => 16 "HTML" => 23 "PDF" => 33 ] ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "Reply to “HbA1c Levels as a Parameter of Glycemic Control in Patients with Liver Cirrhosis”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "471" "paginaFinal" => "472" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jonathan G. Stine, Javelle A. Wynter, Blake Niccum, Virginia Kelly, Stephen H. Caldwell, Neeral L. Shah" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Jonathan G." "apellidos" => "Stine" ] 1 => array:2 [ "nombre" => "Javelle A." "apellidos" => "Wynter" ] 2 => array:2 [ "nombre" => "Blake" "apellidos" => "Niccum" ] 3 => array:2 [ "nombre" => "Virginia" "apellidos" => "Kelly" ] 4 => array:2 [ "nombre" => "Stephen H." "apellidos" => "Caldwell" ] 5 => array:2 [ "nombre" => "Neeral L." "apellidos" => "Shah" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119304247?idApp=UINPBA00004N" "url" => "/16652681/0000001600000003/v1_201905301200/S1665268119304247/v1_201905301200/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268119304223" "issn" => "16652681" "doi" => "10.5604/01.3001.0009.8604" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "70244" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Ann Hepatol. 2017;16:465-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 79 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 40 "PDF" => 30 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "A Rare BSEP Mutation Associated with a Mild Form of Progressive Familial Intrahepatic Cholestasis Type 2" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "465" "paginaFinal" => "468" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1121 "Ancho" => 1367 "Tamanyo" => 352249 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Case 1. Histologic features of the liver needle core biopsy. A(200X H&E): Hepatic lobules show hepatocellular swelling, pseudoro-settes and multinucleation with canalicular cholestasis (arrow). B(200X CK7): Immunohisto-chemistry with cytokeratin 7 shows absence of an interlobular bile duct in the portal tract (arrowheads) in association with aberrant staining of the hepatocytes. C(400X BSEP): BSEP immu-nohistochemistry shows retained canalicular staining of hepatocyte cell membranes (C-400X). Transmission electron microscopy shows canaliculi distended by amorphous granular bile and loss of microvilli. Mitochondria are unremarkable (D- 11000X).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Orith Waisbourd-Zinman, Lea F. Surrey, Anna E. Schwartz, Pierre A. Russo, Jessica Wen" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Orith" "apellidos" => "Waisbourd-Zinman" ] 1 => array:2 [ "nombre" => "Lea F." "apellidos" => "Surrey" ] 2 => array:2 [ "nombre" => "Anna E." "apellidos" => "Schwartz" ] 3 => array:2 [ "nombre" => "Pierre A." "apellidos" => "Russo" ] 4 => array:2 [ "nombre" => "Jessica" "apellidos" => "Wen" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119304223?idApp=UINPBA00004N" "url" => "/16652681/0000001600000003/v1_201905301200/S1665268119304223/v1_201905301200/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "HbA1c Levels as a Parameter of Glycemic Control in Patients with Liver Diseases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "469" "paginaFinal" => "470" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Leonardo de Lucca Schiavon, Janaína Luz Narciso-Schiavon" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Leonardo de" "apellidos" => "Lucca Schiavon" "email" => array:1 [ 0 => "leo-jf@uol.com.br" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "Janaína Luz" "apellidos" => "Narciso-Schiavon" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Internal Medicine, Division of Gastroenterology, Federal University of Santa Catarina. Brazil" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence and reprint request:" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0010" class="elsevierStylePara elsevierViewall">Dear editor:</p><p id="p0015" class="elsevierStylePara elsevierViewall">We read with interest the recent study by Stine, <span class="elsevierStyleItalic">et al</span>. In the article, DAA therapy for chronic hepatitis C showed no effect on glycemic control of diabetic patients as assessed by HbA1c levels.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> Although the authors highlighted some limitations of the study in the discussion section, we would like to comment on HbA1c as a marker of glycemic control.</p><p id="p0020" class="elsevierStylePara elsevierViewall">Several factors might result in falsely high or low HbA1c levels; some of those are common in patients with liver diseases. Falsely high HbA1c levels were related to severe hyperbilirubinemia<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">2</span></a> and alcoholism.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">3</span></a> On the other hand, HbA1c values are decreased in patients with liver cirrhosis and are not an accurate parameter for glycemic control in those patients, especially in the setting of a more advanced liver disease.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">4</span></a> Cacciatore, <span class="elsevierStyleItalic">et al.</span> when comparing cirrhotics with nondiabetic subjects with chronic hepatitis without cirrhosis and healthy controls showed that HbA1c levels were not different between groups, even though glucose intolerance and diabetes were present 15% and 27% of the cirrhotics, respectively.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">5</span></a> Nomura, <span class="elsevierStyleItalic">et al.</span> also observed similar HbA1c levels between patients with cirrhosis and nondiabetic controls, even though blood glucose was significantly higher in cirrhotics as compared to controls.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">6</span></a> More recently, a study included 200 patients with decompensated cirrhosis evaluated for liver transplant with HbA1c measurement and three glucose levels available for estimating HbA1c based on blood glucose.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">7</span></a> In this study, a difference > 0.5% between “measured HbA1c” and “calculated HbA1c” was observed in 47% of patients and HbA1c was < 5% in 49% of the cases.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">7</span></a> The reasons for that are not completely understood, but a possible explanation is the shortened erythrocyte life span and anemia frequent observed in patients with cirrhosis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">8</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">In the study by Stine, <span class="elsevierStyleItalic">et al.</span>,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> the inclusion of a limited number of patients, the majority of them cirrhotics, along with the potential impact of ribavirin use on HbA1c levels might have significantly influenced HbA1c measurement. Although HbA1c levels are known to be influenced by liver cirrhosis for decades, it continues to be used in several hepatology and liver transplant centers worldwide. One reason for that is the limited number of tools available for glycemic control in this specific group. Alternative tests such as fructosamine, glycated albumin and 1,5-Anhydro-glucitol are also affected by liver cirrhosis and cannot be routinely recommended. To date, the best option for diagnosing diabetes in patients with liver cirrhosis is the oral glucose tolerance test, as fasting blood glucose and HbA1c levels may be normal despite diabetes.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">5</span></a> For monitoring diabetes, self-blood glucose monitoring and continuous glucose monitoring are suitable options, especially for those with more advanced liver disease in whom HbA1c is not a reliable parameter of glycemic control.</p><p id="p0030" class="elsevierStylePara elsevierViewall">In conclusion, clinicians should be aware of the limitations of HbA1c as a parameter of glycemic control in patients with chronic liver diseases, especially liver cirrhosis. Future studies investigating new options for glycemic monitoring in those patients are urgently required.</p><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Abbreviations</span><p id="p0035" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">•</span><p id="p0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">DAA:</span> Direct antiviral agents.</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">•</span><p id="p0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HbA1c:</span> Glycated hemoglobin.</p></li></ul></p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Statement of Interests</span><p id="p0050" class="elsevierStylePara elsevierViewall">Authors’ declaration of personal interests: nothing to report.</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Declaration of Funding Interests</span><p id="p0055" class="elsevierStylePara elsevierViewall">Nothing to report.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "s0010" "titulo" => "Abbreviations" ] 1 => array:2 [ "identificador" => "s0015" "titulo" => "Statement of Interests" ] 2 => array:2 [ "identificador" => "s0020" "titulo" => "Declaration of Funding Interests" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-03-14" "fechaAceptado" => "2017-03-21" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0010" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of Treatment with Direct Acting Antiviral on Glyc-emic Control in Patients with Diabetes Mellitus and Chronic Hepatitis C" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Stine J.G." 1 => "Wynter J.A." 2 => "Niccum B." 3 => "Kelly V." 4 => "Caldwell S.H." 5 => "Shah N.L." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5604/16652681.1231579" "Revista" => array:6 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2017" "volumen" => "16" "paginaInicial" => "215" "paginaFinal" => "220" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28233744" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0015" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Difficulties in interpreting HbA(1c) results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Homa K." 1 => "Majkowska L." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pol Arch Med Wewn" "fecha" => "2010" "volumen" => "120" "paginaInicial" => "148" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20424541" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0020" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elevation of the hemoglobin A1 fraction in alcoholism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Hoberman H.D." 1 => "Chiodo S.M." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Alcohol Clin Exp Res" "fecha" => "1982" "volumen" => "6" "paginaInicial" => "260" "paginaFinal" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7048980" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0025" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetes mellitus in patients with cirrhosis: clinical implications and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Elkrief L." 1 => "Rautou P.E." 2 => "Sarin S." 3 => "Valla D." 4 => "Paradis V." 5 => "Moreau R." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/liv.13115" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2016" "volumen" => "36" "paginaInicial" => "936" "paginaFinal" => "948" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26972930" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0030" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abnormalities of glucose metabolism induced by liver cirrhosis and glycosylated hemoglobin levels in chronic liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Cacciatore L." 1 => "Cozzolino G." 2 => "Giardina M.G." 3 => "De Marco F." 4 => "Sacca L." 5 => "Esposito P." 6 => "Francica G." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes Res" "fecha" => "1988" "volumen" => "7" "paginaInicial" => "185" "paginaFinal" => "188" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3402168" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0035" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemoglobin A1 in cirrhosis of the liver" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Nomura Y." 1 => "Nanjo K." 2 => "Miyano M." 3 => "Kikuoka H." 4 => "Kuriyama S." 5 => "Mae-da M." 6 => "Miyamura K." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes Res" "fecha" => "1989" "volumen" => "11" "paginaInicial" => "177" "paginaFinal" => "180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2625033" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0040" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glycated Hemoglobin Levels in Patients with Decompensated Cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Nadelson J." 1 => "Satapathy S.K." 2 => "Nair S." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Endocri-nol" "fecha" => "2016" "volumen" => "2016" "paginaInicial" => "8390210" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0045" "etiqueta" => "8." 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