Alternate glycemic markers reflect glycemic variability in continuous glucose monitoring in youth with prediabetes and type 2 diabetes

Abstract

Objective To determine whether the alternate glycemic markers, fructosamine (FA), glycated albumin (GA), and 1,5-anhydroglucitol (1,5AG), predict glycemic variability captured by continuous glucose monitoring (CGM) in obese youth with prediabetes and type 2 diabetes (T2D). Study Design Youth with BMI ≥85th%ile, 10-18 years, had collection of fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), FA, GA, and 1,5AG and 72 hours of CGM. Participants with HbA1c ≥5.7% were included. Relationships between glycemic markers and CGM variables were determined with Spearman correlation coefficients. Linear models were used to examine the association between alternate markers and CGM measures of glycemic variability – standard deviation (SD) and mean amplitude of glycemic excursions (MAGE) – after controlling for HbA1c. Results Total n=56; Median (25th%ile,75th%ile) age=14.3 yrs (12.5, 15.9), 32% male, 64% Hispanic, 20% black, 13% white, HbA1c=5.9% (5.8, 6.3), FA=211mmol/L (200, 226), GA=12% (11%, 12%), and 1,5AG=22mcg/ml (19,26). HbA1c correlated with average sensor glucose, AUC, SD, MAGE, and %time>140mg/dl. FA and GA correlated with average and peak sensor glucose, %time>140mg/dl and >200mg/dl, and MAGE. GA also correlated with SD and AUC180. 1,5AG correlated with peak glucose, AUC180, SD, and MAGE. After adjusting for HbA1c, all 3 markers independently predicted MAGE; FA and GA independently predicted SD. Conclusions Alternate glycemic markers predict glycemic variability as measured by CGM in youth with prediabetes and T2D. After adjusting for HbA1c, these alternate markers continued to predict components of glycemic variability detected by CGM.

Continuous subcutaneous insulin infusion combined with liraglutide reduced glycemic variability and oxidative stress in type 2 diabetes mellitus: a study based on the flash glucose monitoring system

“…1) showed that the addition of liraglutide improved glycemic control compared with CSII alone, manifested by decreased FBG and estimated HbA1c. As previous studies have shown, 1,5-AG is a new clinical marker for glycemic control in patients with type 2 diabetes [23,24]. In this study, we found that the serum 1,5-AG concentration in the CSII combined with liraglutide group was significantly higher than that in the CSII alone group (Table 2), which may further imply that glycemic control with CSII combined with liraglutide is better than with CSII.…”

Longitudinal follow up of dysglycemia in overweight and obese pediatric patients

“…Hemoglobin A1c, while a convenient method for diabetes screening in a community health setting does have significant variability, even within the standardization program. The use of A1c compared with other methods of diabetes screening such as fasting glucose or 2‐hour oral glucose tolerance testing may identify different populations of youth 18‐20 . An elevated A1c value repeated in a short time interval could lead to 2 different categories (LRPD, HRPD, or diabetes) simply based on the variability of the A1c measurement.…”

“…The use of A1c compared with other methods of diabetes screening such as fasting glucose or 2-hour oral glucose tolerance testing may identify different populations of youth. [18][19][20] An elevated A1c value repeated in a short time interval could lead to 2 different categories (LRPD, HRPD, or diabetes) simply based on the variability of the A1c measurement. This variability highlights the importance of repeat testing.…”

Hemoglobin A1c Accurately Predicts Continuous Glucose Monitoring–Derived Average Glucose in Youth and Young Adults With Cystic Fibrosis

“…Our group previously found that alternate glycemic markers correlate with multiple continuous glucose monitoring (CGM) variables (17) and that these markers are sensitive for detecting type 2 diabetes in obese youth with prediabetes (14). Therefore, we enrolled participants with CF and a group of healthy control subjects (HCs) into a studydthe Glycemic Monitoring in Cystic Fibrosis Study (GeM-CF)d aimed at characterizing free-living glucose patterns across the glycemic spectrum and have collected alternate markers of glycemia in this cohort.…”