CLD (chronic liver diseases)-HbA1C as a suitable indicator for estimation of mean plasma glucose in patients with chronic liver diseases

In patients with chronic liver diseases (CLD), turnover of erythrocytes is increased whereas that of serum albumin is decreased. Thus, glycated hemoglobin (HbA1C) and glycated albumin (GA) cannot be used as adequate indicators for chronic plasma glucose control in diabetic patients with CLD. In this investigation, we have proposed CLD-HbA1C, a novel long-term glycemic control marker by using measured HbA1C and GA. We studied 82 patients with CLD in whom glycemic control was regarded as to be stable. Daily plasma glucose profiles were monitored and estimated levels of HbA1C were calculated on the conversion formula established by Rohlfing et al. [C.L. Rohlfing, J.D. England, H.M. Wiedmeyer, A. Tennill, R.R. Little, D.E. Goldstein, Defining the relationship between plasma glucose and HbA1c, Diabetes Care 25 (2002) 275–278]. Cholinesterase (ChE) as an indicator for hepatic function was determined at the same time when HbA1C and GA levels were measured. CLD-HbA1C was defined as the average of measured HbA1C and GA/3, based upon the results that among healthy individuals, GA levels were roughly estimated at approximately threefold higher than HbA1C levels. While measured HbA1C levels in patients with CLD were generally lower than estimated HbA1C levels, GA/3 values were generally higher than estimated HbA1C levels. Such discrepancies lineally increased in accordance with a decrease in ChE levels. On the other hand, CLD-HbA1C levels were highly correlated with estimated HbA1C levels (R = 0.883), while no significant correlation between CLD-HbA1C and ChE was noted.In conclusion, CLD-HbA1C has been found a superior chronic glycemic control marker than HbA1C or GA in diabetic patients with chronic liver diseases.