Discordance Between Glycated Hemoglobin A 1 c and the Glucose Management Indicator in People With Diabetes and Chronic Kidney Disease

International audienceIntroduction: Assessment of glucose exposure via glycated hemoglobin A 1 c (HbA 1 c) has limitations for interpretation in individuals with diabetes and chronic kidney disease (CKD). The glucose management indicator (GMI) derived from continuous glucose monitoring (CGM) data could be an alternative. However, the concordance between HbA 1 c measured in laboratory and GMI (HbA 1 c-GMI) is uncertain in individuals with CKD. The purpose of this study is to analyze this discrepancy. Material and method: We performed a multicentric, retrospective, observational study. A group of individuals with diabetes and CKD (n = 170) was compared with a group of individuals with diabetes without CKD (n = 185). All individuals used an intermittently scanned continuous glucose monitoring (isCGM). A comparison of 14-day and 90-day glucose data recorded by the isCGM was performed to calculate GMI and the discordance between lab HbA 1 c and GMI was analyzed by a Bland-Altman method and linear regression. Results: HbA 1 c-GMI discordance was significantly higher in the CKD group versus without CKD group (0.78 ± 0.57 [0.66-0.90] vs 0.59 ± 0.44 [0.50-0.66]%, P 0.5% was found in 68.2% of individuals with CKD versus 42.2% of individuals without CKD. We suggest a new specific formula to estimate HbA 1 c from the linear regression between HbA 1 c and mean glucose CGM, namely CKD-GMI = 0.0261 × 90-day mean glucose (mg/L) + 3.5579 ( r 2 = 0.59). Conclusions: HbA1c-GMI discordance is frequent and usually in favor of an HbA1c level higher than the GMI value, which can lead to errors in changes in glucose-lowering therapy, especially for individuals with CKD. This latter population should benefit from the CGM to measure their glucose exposure more precisely