Advantages and Pitfalls of Fructosamine and Glycated Albumin in the Diagnosis and Treatment of Diabetes

Abstract

Diabetes is one of the most severe and frequent human disorders. According to recent statistics, this condition afflicts as many as 382 million persons around the globe, with an estimated prevalence of approximately 8.3% in 2013. At variance with other frequent pathologies such as cardiovascular disease and bacterial infections, the trend toward an increased prevalence is not expected to soon reverse. Worldwide, as many as 592 million individuals may be affected by diabetes in 2035, a remarkable 55% increase in prevalence over the next 2 decades. 1 Due to its high global prevalence and severe, frequently life-threatening complications (eg, retinopathy, nephropathy, neuropathy, cardiovascular disease), diabetes must be regarded as a serious and increasing global health burden. The most recent Standards of Medical Care in Diabetes published by the American Diabetes Association (ADA) emphasize that early diagnosis and monitoring are critical for preventing or delaying the onset of acute complications and lowering the risk of long-term complications of diabetes. 2 The current diagnostic criteria for this condition are based on the presence of (1) glycated hemoglobin (HbA1c) value ≥6.5% (ie, ≥48 mmol/mol), (2) fasting plasma glucose (FPG) ≥126 mg/dL (ie, ≥7.0 mmol/L), (3) 2-hour plasma glucose ≥200 mg/dL (ie, ≥11.1 mmol/L) during an oral glucose tolerance test (OGTT) using a 75 g glucose load, or (4) random plasma glucose ≥200 mg/dL (ie, ≥11.1 mmol/L). An increased risk of diabetes (ie, prediabetes) is defined in the presence of (1) HbA1c value between 5.7-6.4% (ie, 39-46 mmol/mol), (2) FPG between 100-126 mg/dL (ie, 5.6-6.9 mmol/L), (3) 2-hour plasma glucose between 140-199 mg/ dL (ie, 7.8-11.0 mmol/L) during an OGTT. With regard to diabetes monitoring, the glycemic targets for nonpregnant adults with diabetes include HbA1c value <7.0% (ie, <53 mmol/mol), preprandial capillary plasma glucose between 567227D STXXX10.

Glycated albumin: a potential biomarker in diabetes

“…This feature enhances GA sensitivity to the rapid alterations in glucose levels, which may not be efficiently identified with an isolated measure of plasma glucose (13,19).…”

“…It is the main plasma protein, representing about 60% of the total proteins in the blood, with concentrations between 3.0 and 5.0 g/dL and a half-life of 14 to 20 days (18,19). Albumin structure makes it easier to perform its physiological functions, such as maintaining pH and blood osmotic pressure.…”

“…Compared to A1C, GA is more suitable to monitor the beginning of drug therapy in DM (55), and also to control the dose and change of medication (51), since its levels diminish faster than A1C in intensive treatment (19). Paroni and cols.…”

“…By definition, glycation is a non-enzymatic spontaneous reaction in which a reducing sugar is added to a free amino group, typically lysine or arginine present within proteins, also called as Maillard reaction (Figure 1) (18)(19)(20). The first step of this reaction involves the formation of an unstable and reversible product known as Schiff base, formed by the bonding of a carbonyl group of an acyclic carbohydrate with the N-terminal amino acid (19). This intermediate product can suffer a change in its conformation and result in a stable and irreversible ketamine, known as the Amadori product (22).…”

Optical and structural properties of biological tissues under diabetes mellitus

“…Since the high level of blood glucose leads to the growth of its content in the interstitial fluid, the glycation affects not only the blood proteins, such as albumin and hemoglobin [70,129,135,138,155], but also other proteins of the organism tissues. For example, in Refs.…”