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Objective To establish an improved method for estimating the mean blood glucose by glycosylated hemoglobin(HbA1c) in diabetic patients with renal insufficiency. Methods The clinical data were retrospectively analyzed of 329 patients with type 2 diabetes mellitus who were hospitalized in the Department of Hypertension and Endocrinology of Daping Hospital of Army Medical Center of PLA from January 2018 to December 2021. All patients were divided into control group [estimated glomerular fraction rate, eGFR≥60 ml/(min.1.73 m2), n=165] and renal insufficiency group [eGFR<60 ml/(min.1.73 m2), n=164]based on their eGFR levels. The basic demographic data, oral glucose tolerance test (OGTT) 2 hours post plasma glucose, and other laboratory test results of the patients were collected. The HbA1c and OGTT models were adopted separately to estimate the 24-hour average blood glucose of the enrolled patients, and the gap glucose level of the two methods was calculated. The influencing factors of estimating blood glucose deviation with HbA1c in patients with renal insufficiency were analyzed, and a correction model of estimating average blood glucose with HbA1c was established. A total of 29 patients with type 2 diabetes mellitus and renal insufficiency hospitalized in the Department of Hypertension and Endocrinology of Daping Hospital of Army Medical Center of PLA from January to March 2022 were collected for external verification. Results Compared with control group, diabetic patients with renal insufficiency were relatively older (P=0.001), with longer course of diabetes (P<0.001), and had lower HbA1c (P=0.034),eGFR (P<0.001), Hb (P<0.001), and ALB (P<0.001) levels. The mean blood glucose of the two groups was estimated by HbA1c. The gap of estimated blood glucose was significantly higher in renal insufficiency group than in control group [(0.88±1.64) mmol/L vs.(–0.09±2.10) mmol/L, P<0.001], and was negatively correlated with the Hb level (r=–0.377, P<0.001), while with no relation with ALB level (P=0.551). A linear regression model was used to include HbA1c, Hb, age, diabetes course, eGFR and ALB into the analysis,and to establish an estimation model for estimating the daily mean blood glucose of diabetic patients with renal insufficiency: mean blood glucose (mmol/L) =4.539+0.95×HbA1c-0.016×Hb (adjusted R2=0.829, P<0.001). Using this model, the gap glucose level between the estimated mean blood glucose and the detected blood glucose were remarkably reduced in renal insufficiency group [(0.02±1.05) mmol/L vs. (0.88±1.64) mmol/L, P<0.001]. The goodness-of-fit index RNL=0.830 was obtained by external validation of 29 patients, indicating that the model obtained is highly feasible. Conclusions A correction model of estimating mean blood glucose by HbA1c for diabetic patients with renal insufficiency has been successfully established. It is of great significance to further develop individualized HbA1c control and improve the prognosis of diabetes patients.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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