Association of glycated albumin, but not glycated hemoglobin, with calcaneus quantitative ultrasound in male hemodialysis patients with type 2 diabetes mellitus

Abstract 

Sustained high glucose impairs bone metabolism in patients with type 2 diabetes mellitus (T2DM). In this study, the relationship between glycemic control and bone metabolism was examined in male hemodialysis (HD) patients with T2DM. To avoid the effect of menstruation and the menstrual cycle, obesity, and glycosuria-induced hypercalciuria on bone metabolism, male anuric nonobese HD patients with T2DM (n = 42) were enrolled. Calcaneus stiffness index (SI) was determined using ultrasound after HD session. Casual plasma glucose (PG), glycated hemoglobin (HbA_1c), and glycated albumin (GA) were measured before the HD session. In simple regression analysis, log PG (r = −0.333, P < .05) and log GA (r = −0.350, P < .05), but not log HbA_1c (r = −0.134, P = .3985), exhibited significant and negative correlations with calcaneus SI. In multiple regression analysis including log BMI, log cCa × Pi product, and log PG, log PG was associated significantly in a negative manner with calcaneus SI, in addition to log cCa × Pi product. When log PG was replaced with log GA or log HbA_1c, log GA, but not log HbA_1c, emerged as a significant factor associated. The mechanism as to why HbA_1c failed to associate could be explained by its false reduction by erythropoietin injection. The present study supported the notion of GA as an appropriate indicator for glycemic control in HD patients with T2DM. Furthermore, it is suggested that poor glycemic control might be a significant factor toward decreasing calcaneus SI in T2DM HD patients.