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Is eGFR a better monitoring choice than HbA1c on liraglutide?

Asked 2 May 2024Modified 2.1 years agoViewed 29k times
17

Details up front: eGFR · HbA1c · liraglutide.

I want to know what the trade-off actually is rather than which option is fashionable.

I would rather have a defensible reason than a marginal improvement.

So which one, and on what grounds?

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askedunit_math6.2k152 May 2024
7Do you have a baseline from before you started, or is this the first panel? – Dr_Yusuf_Adeyemi 2 months ago
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2 Answers

Accepted answer first, then by votes
43

Accepted answer

The short version: a small, well-chosen panel with a baseline beats a large one without.

A twenty-analyte panel run on a healthy person will produce, on average, one out-of-range result purely from how reference intervals are constructed. That is arithmetic rather than pathology.

Relative to absolute, worked

QuantityValueDerivation
Control-arm event rate8.0 %From the trial table, not the abstract
Hazard ratio0.80Reported
Treated event rate6.4 %8.0 × 0.80
Absolute risk reduction1.6 pp8.0 − 6.4
Number needed to treat631 ÷ 0.016
Relative risk reduction20 %1 − 0.80

The last two rows describe the same finding. Only one of them is used in headlines.

Stated carefully, delta checks — comparing against your own previous value — are far more sensitive than comparing against a population interval, which is the argument for keeping a series rather than a snapshot.

Reference intervals are conventionally the central ninety-five per cent of a reference population, which is the direct cause of the one-in-twenty out-of-range rate on a healthy panel.

The caveat is that a panel is not a diagnosis and interpreting one is a clinician's job, particularly when several values move together.

Keep the full report, not the number. You will need the units and the interval later.

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answered · acceptedDr_Rosalind_Achebe69k14728 May 2024
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34

Before reacting to any single value, check whether it is outside the interval by an amount larger than the assay's own variation.

A sensible core for this population is a full blood count, renal function with electrolytes, liver enzymes with bilirubin, a fasting lipid panel with apolipoprotein B, HbA1c and thyroid-stimulating hormone.

Specifically, same laboratory, same method, same time of day, same fasting state. Between-laboratory differences on several common analytes are larger than the changes people are trying to detect.

External quality assurance schemes document between-laboratory differences on common analytes that routinely exceed the size of clinically interesting changes.

Research-use compounds are not approved for human use, and no panel makes that safer.

Same laboratory, same time, same fasting state, or the comparison is not a comparison.

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answeredlipid_panel_q36k1278 Jun 2024

Your answer

Ask PeptideStack is a static archive. Posting is closed, but the norms are worth stating: answer the question that was asked, show your working, cite the trial or the certificate, and say plainly where the evidence runs out.

Not medical advice. Research-use-only compounds are not approved for human use.