Beyond self-monitored plasma glucose and HbA1c: the role of non-traditional glycaemic markers in gestational diabetes mellitus

Abstract

Strict glycaemic management is the cornerstone of metabolic control in gestational diabetes mellitus (GDM). Current monitoring standards involve self-monitoring plasma glucose (SMBG) and haemoglobin A1c (HbA1c). However, both have important limitations. SMBG only reflects instantaneous blood glucose and the inconvenience of self-collecting blood frequently results in poor compliance. HbA1c provides information on blood glucose levels from the previous 2 to 3 months and it is influenced by iron-deficient states, common during pregnancy. There is an urgent need for new shorter-term glycaemic markers, as glycated albumin, fructosamine or 1,5-anhydroglucitol. Glycated albumin seems especially interesting as it provides information on blood glucose levels over the foregoing 2-3 weeks and it is not influenced by iron deficiency or the dilutional anaemia of pregnancy. Fructosamine has a precise and inexpensive measurement and it is not affected by haemoglobin characteristics. This review further discusses the potential value of these non-traditional indicators of glycaemic control in patients with GDM, outlining their possible future applications.

Gestational Diabetes Mellitus—Innovative Approach to Prediction, Diagnosis, Management, and Prevention of Future NCD—Mother and Offspring

“…A variety of other markers of overall glycemia with shorter half-lives (thus more reflective of short term glycemia changes) including fructosamine (FA), glycated albumin (GA) and 1.5 anhydroglucitrol (1.5 AHG) have been evaluated ( 41 ). None of these markers are optimally suited to use in pregnancy.…”

Insulin Therapy in Gestational Diabetes

“…This marker was studied in GDM, but the cutoff limits are not precisely known with consideration of some population differences [38]. Molecules like fructosamine or 1,5-anhydroglucitol have not proven their utility [39][40][41].…”

Association between glycated albumin, fructosamine, and HbA1c with neonatal outcomes in a prospective cohort of women with gestational diabetes mellitus

“…Its association with adverse pregnancy outcomes has been previously reported . However, its use as a suitable marker during pregnancy has been increasingly questioned: HbA1c reflects average glycemia over the preceding 2–3 months (a long time frame) and appears to be affected by iron deficient states …”

“…Several authors suggest glycated albumin as a favorable alternative . It gives information regarding the previous 2–3 weeks, it is not affected by hemoglobin metabolism or iron deficient states, and it changes rapidly and markedly .…”