Potential Clinical Error Arising From Use of HbA1c in Diabetes: Effects of the Glycation Gap

Nayak, Ananth; Singh, Baldev; Dunmore, Simon

doi:10.1210/er.2018-00284

Cited by 62 publications

(59 citation statements)

References 67 publications

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“…HGI, an indicator used to assess the inter-individual variation of HbA1c, reflects the difference in the degree of hemoglobin glycosylation at a given plasma glucose level [ 10 ]. In addition to being influenced by blood glucose concentrations, the individual differences of HbA1c may be also associated with biological factors that influence non-enzymatic protein glycation such as genetics, and the life cycle of red blood cells [ 21 ].Various studies have confirmed that there are consistent inconsistencies between HbA1c and other clinically used blood glucose homeostasis indicators, such as fructosamine and mean blood glucose [ 8 , 21 , 22 ]. An increasing amount of evidence shows that such inconsistencies may affect the accuracy of HbA1c in management of diabetes and its other applications.…”

Section: Discussionmentioning

confidence: 99%

Association of hemoglobin glycation index and its interaction with obesity/family history of hypertension on hypertension risk: a community-based cross-sectional survey

Song

Zhao

et al. 2020

BMC Cardiovasc Disord

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Background Hemoglobin glycation index (HGI) is considered to be a convenient measurable indicator to assess the inter-individual variation of HbA1c. In the present study, we tested the relationship between HGI and risk of hypertension, and further explored the possible interacting influences of HGI with other such factors on hypertension risk among Chinese individuals. Methods The eligible subjects were chosen from a community-based cross-sectional survey in China. We collected relevant data and clinical indicators for each participant. HGI was calculated as “measured HbA1c-predicted HbA1c” and divided into four categories according to quartile. The following indicators were used to assess interactive effects: (1) relative excess risk due to interaction (RERI); (2) attributable proportion due to interaction (AP); and (3) synergy index (SI). Statistical analysis was performed using R software. Results Specifically, 1777 eligible participants were selected in this cross-sectional survey. There were 433 subjects who were identified to have hypertension (24.4%). A significant increase in the prevalence of hypertension from Q1 to Q4 of HGI was observed (p < 0.001). Multivariable logistic model demonstrated that subjects at the highest HGI group had a substantially increased risk of being hypertensive than subjects in the first quartile of HGI, as indicated by the OR value of 1.87 (95% CI 1.26–2.78). Moreover, a significant interaction between family history of hypertension and HGI on hypertension risk was detected (RERI: 1.36, 95% CI 0.11–2.63; AP: 0.43, 95% CI 0.17–0.69; and SI:2.68, 95% CI 1.10–6.48). The interactive effect between HGI and abdominal obesity was also found to be significant, as estimated by the value of RERI (1.04, 95% CI 0.24–1.85), AP (0.33, 95% CI 0.11–0.56) and SI (1.96, 95% CI 1.01–3.79). However, in the analysis of the interaction between HGI and general obesity, only the AP value (0.28, 95% CI 0.01–0.54) was observed to be significant. Conclusion High HGI was independently associated with the risk of hypertension. Moreover, HGI significantly shared interactions with obesity and family history of hypertension that influenced the risk of hypertension.

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Section: Discussionmentioning

confidence: 99%

Association of hemoglobin glycation index and its interaction with obesity/family history of hypertension on hypertension risk: a community-based cross-sectional survey

Song

Zhao

et al. 2020

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…HGI, an indicator used to assess the inter-individual variation of HbA1c, re ects the difference in the degree of hemoglobin glycosylation at a given plasma glucose level [10]. In addition to being in uenced by blood glucose concentrations, the individual differences of HbA1c may be also associated with biological factors that in uence non-enzymatic protein glycation such as genetics, and the life cycle of red blood cells [21].Various studies have con rmed that there are consistent inconsistencies between HbA1c and other clinically used blood glucose homeostasis indicators, such as fructosamine and mean blood glucose [8,21,22]. An increasing amount of evidence shows that such inconsistencies may affect the accuracy of HbA1c in management of diabetes and its other applications.…”

Section: Discussionmentioning

confidence: 99%

Association of hemoglobin glycation index and its interaction with obesity /family history of hypertension on hypertension risk: a community-based cross-sectional survey

Song

Zhao

et al. 2020

Preprint

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Abstract Background: Hemoglobin glycation index (HGI) is considered to be a convenient measurable indicator to assess the inter-individual variation of HbA1c. In the present study, we tested the relationship between HGI and risk of hypertension, and further explored the possible interacting influences of HGI with other such factors on hypertension risk among Chinese individuals.Methods : The eligible subjects were chosen from a community-based cross-sectional survey in China. We collected relevant data and clinical indicators for each participant. HGI was calculated as “measured HbA1c-predicted HbA1c” and divided into four categories according to quartile. The following indicators were used to assess interactive effects：(1) relative excess risk due to interaction (RERI); (2) attributable proportion due to interaction (AP); and (3) synergy index (SI). Statistical analysis was performed using R software.Results: Specifically, 1777 eligible participants were selected in this cross-sectional survey. There were 433 subjects who were identified to have hypertension (24.4%). A significant increase in the prevalence of hypertension from Q1 to Q4 of HGI was observed (P<0.001). Multivariable logistic model demonstrated that subjects at the highest HGI group had a substantially increased risk of being hypertensive than subjects in the first quartile of HGI, as indicated by the OR value of 1.87(95%CI: 1.26-2.78). Moreover, a significant interaction between family history of hypertension and HGI on hypertension risk was detected (RERI:1.36,95%CI:0.11-2.63; AP: 0.43, 95%CI:0.17-0.69; and SI:2.68, 95% CI:1.10-6.48). The interactive effect between HGI and abdominal obesity was also found to be significant, as estimated by the value of RERI (1.04, 95%CI:0.24-1.85), AP (0.33, 95% CI: 0.11-0.56) and SI (1.96, 95%CI:1.01-3.79). However, in the analysis of the interaction between HGI and general obesity, only the AP value (0.28, 95%CI: 0.01-0.54) was observed to be significant.Conclusion: High HGI was independently associated with the risk of hypertension. Moreover, HGI significantly shared interactions with obesity and family history of hypertension that influenced the risk of hypertension.

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Section: Introductionmentioning

confidence: 99%

“…Discordances between glycated hemoglobin (HbA1c) levels and other markers of glycemic control are common in clinical practice [1]. Mismatches of actual HbA1c levels (i.e., higher or lower) with the expected mean blood glucose (MBG)-based HbA1c levels can limit the accuracy of HbA1c measurements for diabetes diagnosis and management [1]. Regardless of the presence of type 2 diabetes mellitus (T2DM), HbA1c has been reported to have interindividual variations that are caused by factors other than MBG levels, including genetic factors and differences in erythrocyte lifespan, mean erythrocyte age, and hemoglobin glycation rates [2].…”

Section: Introductionmentioning

confidence: 99%

“…Although FBG estimations correlate well with MBG levels, these can widely vary, and methodologies that use 6-or 8-point glucose profiles provide better representations of MBG levels. The availability of continuous glucose monitoring (CGM) with large data and better reflection of postprandial peaks could help in the calculation of MBG levels, but the potential of CGM for HGI calculation has not been explored [1].…”

Section: Introductionmentioning

confidence: 99%

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Consistency of the Glycation Gap with the Hemoglobin Glycation Index Derived from a Continuous Glucose Monitoring System

Joung¹,

Kwon²,

Baek³

et al. 2020

Endocrinol Metab

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Background: Discordances between glycated hemoglobin (HbA1c) levels and glycemic control are common in clinical practice. We aimed to investigate the consistency of the glycation gap with the hemoglobin glycation index (HGI). Methods: From 2016 to 2019, 36 patients with type 2 diabetes were enrolled. HbA1c, glycated albumin (GA), and fasting blood glucose levels were simultaneously measured and 72-hour continuous glucose monitoring (CGM) was performed on the same day. Repeated tests were performed at baseline and 1 month later, without changing patients' diabetes management. The HGI was calculated as the difference between the measured HbA1c and the predicted HbA1c that was derived from CGM. The glycation gap was calculated as the difference between the measured and GA-based predicted HbA1c levels. Results: Strong correlations were found between the mean blood glucose (MBG)-based HGI and the prebreakfast glucose-based HGI (r=0.867, P<0.001) and between the glycation gap and the MBG-based HGI (r=0.810, P<0.001). A close correlation was found between the MBG-based HGI at baseline and that after 1 month (r=0.729, P<0.001), with a y-intercept of 0 and a positive slope. Conclusion: The HGI and glycation gap were highly reproducible, and the magnitudes of repeated determinations were closely correlated. Patients with similar mean glucose levels may have significantly different HbA1c levels.

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Potential Clinical Error Arising From Use of HbA1c in Diabetes: Effects of the Glycation Gap

Cited by 62 publications

References 67 publications

Association of hemoglobin glycation index and its interaction with obesity/family history of hypertension on hypertension risk: a community-based cross-sectional survey

Association of hemoglobin glycation index and its interaction with obesity/family history of hypertension on hypertension risk: a community-based cross-sectional survey

Association of hemoglobin glycation index and its interaction with obesity /family history of hypertension on hypertension risk: a community-based cross-sectional survey

Consistency of the Glycation Gap with the Hemoglobin Glycation Index Derived from a Continuous Glucose Monitoring System

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