Hemoglobin A1c and Fructosamine Evaluated in Patients with Type 2 Diabetes Receiving Peritoneal Dialysis Using Long-Term Continuous Glucose Monitoring.

INTRODUCTION: Shortened erythrocyte life span and erythropoietin-stimulating agents may affect hemoglobin A1c (HbA1c) levels in patients receiving peritoneal dialysis (PD). We compared HbA1c with interstitial glucose measured by continuous glucose monitoring (CGM) in patients with type 2 diabetes receiving PD. METHODS: Fourteen days of CGM (Ipro2, Medtronic) were performed in 23 patients with type 2 diabetes receiving PD and in 23 controls with type 2 diabetes and an estimated glomerular filtration rate over 60 mL/min/1.73 m2. Patients were matched on gender and age (±5 years). HbA1c (mmol/mol), its derived estimate of mean plasma glucose (eMPGA1c) (mmol/L), and fructosamine (µmol/L) were measured at the end of the CGM period and compared with the mean sensor glucose (mmol/L) from CGM. RESULTS: In the PD group, mean sensor glucose was 0.98 (95% con-fidence interval (CI): 0.43-1.54) mmol/L higher than the eMPGA1c compared with the control group (p = 0.002) where glucose levels were nearly identical (-0.05 (95% CI: -0.35-0.25) mmol/L). A significant association was found between fructosamine and mean sensor glucose using linear regression with no difference between slopes (p = 0.89) or y-intercepts (p = 0.28). DISCUSSION/CONCLUSION: HbA1c underestimates mean plasma glucose levels in patients with type 2 diabetes receiving PD. However, the clinical significance of this finding is undetermined. Fructosamine seems to more accurately reflect glycemic status. CGM or fructosamine could complement HbA1c to increase the accuracy of glycemic monitoring in the PD population.

Readmittance rates within seven days are preferable in quality measuring of emergency departments.

INTRODUCTION: The objective of this article was to qualify and test the recommendations of a national Danish report. We conducted an investigation on the readmittance rate as well as reasons for readmittance in a patient cohort defined through the process of internal audit at the Emergency Department at Zealand University Hospital, Køge, Denmark. METHODS: A retrospective, descriptive study of admitted patients in November 2014, including a total of 1,440 patients. Data and parameters were obtained from electronic patient records. RESULTS: A total of 162 patients were readmitted within 30 days from their initial admission (11% of the cohort). Of this group, 139 (86%) readmittances were unpreventable or planned. Readmissions caused by missed diagnosis or insufficient treatment accounted for 8% and 6%, respectively. The median time until readmission in these cases were two and four and a half days, respectively. The median time to readmission for the unpreventable readmissions ranged from 13 to 18.5 days. CONCLUSION: In terms of patient safety, our data support a seven-day observation period for readmission rates when measuring or monitoring quality of care in emergency departments. FUNDING: none. TRIAL REGISTRATION: none.