Role of Glycated Proteins in the Diagnosis and Management of Diabetes: Research Gaps and Future Directions

Welsh, Kerry J.; Kirkman, M. Sue; Sacks, David B.

doi:10.2337/dc15-2727

Cited by 171 publications

(107 citation statements)

References 94 publications

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“…It has been known since at least the 1990 publication of Yudkin et al (5) and has been consistently demonstrated in numerous studies in individuals with prediabetes, type 1 diabetes, and type 2 diabetes (6–13), including the A1c-Derived Average Glucose (ADAG) study, which produced the widely used conversion table to estimate mean glucose for an HbA 1c level (14). …”

Section: Introductionmentioning

confidence: 99%

The Fallacy of Average: How Using HbA1c Alone to Assess Glycemic Control Can Be Misleading

et al. 2017

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HbA1c is a valuable metric for comparing treatment groups in a randomized trial, for assessing glycemic trends in a population over time, or for cross-sectional comparisons of glycemic control in different populations. However, what is not widely appreciated is that HbA1c may not be a good indicator of an individual patient’s glycemic control because of the wide range of mean glucose concentrations and glucose profiles that can be associated with a given HbA1c level. To illustrate this point, we plotted mean glucose measured with continuous glucose monitoring (CGM) versus central laboratory–measured HbA1c in 387 participants in three randomized trials, showing that not infrequently HbA1c may underestimate or overestimate mean glucose, sometimes substantially. Thus, if HbA1c is to be used to assess glycemic control, it is imperative to know the patient’s actual mean glucose to understand how well HbA1c is an indicator of the patient’s glycemic control. With knowledge of the mean glucose, an estimated HbA1c (eA1C) can be calculated with the formula provided in this article to compare with the measured HbA1c. Estimating glycemic control from HbA1c alone is in essence applying a population average to an individual, which can be misleading. Thus, a patient’s CGM glucose profile has considerable value for optimizing his or her diabetes management. In this era of personalized, precision medicine, there are few better examples with respect to the fallacy of applying a population average to a specific patient rather than using specific information about the patient to determine the optimal approach to treatment.

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Section: Introductionmentioning

confidence: 99%

The Fallacy of Average: How Using HbA1c Alone to Assess Glycemic Control Can Be Misleading

et al. 2017

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“…Several conditions alter glycated albumin independently of glucose. These include, among others, changes in albumin concentrations (e.g., nephrotic syndrome, protein losing enteropathy, malnutrition), cirrhosis, thyroid disease, hyperuricemia and smoking (13). Low albumin is of particular concern in the setting of ESRD.…”

mentioning

confidence: 99%

Monitoring Glycemic Control in End-Stage Renal Disease: What Should Be Measured?

Selvin

Sacks

2017

Clinical Chemistry

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“…The reason is that other proteins (e.g. LDL, myelin-proteins, collagen, myosin) become more pathogenic when they bind non-enzymatically to glucose (27).…”

Section: The Sars-cov-2 As New Human Coronavirusmentioning

confidence: 99%

“…The respiratory side is well known and managed, with poor results in the risk group, exactly the one that has more cardiometabolic alterations. Regarding this group of disorders, discussed in detail above, we do not know why they are always approached separately, when there are many advantages of their overall management, and it would have an unavoidable impact on morbidity, lethality and costs as demonstrated in patients followed up in outpatient clinic (27,28).…”

Section: Practical Aspects Of Covid-19 Regarding the Personalized Aspmentioning

confidence: 99%

COVID-19: A Personalized Cardiometabolic Approach for Reducing Complications and Costs. The Role of Aging beyond Topics

Sabán-Ruiz¹,

Ly-Pen²

2020

The Journal of nutrition, health and aging

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Role of Glycated Proteins in the Diagnosis and Management of Diabetes: Research Gaps and Future Directions

Cited by 171 publications

References 94 publications

The Fallacy of Average: How Using HbA1c Alone to Assess Glycemic Control Can Be Misleading

The Fallacy of Average: How Using HbA1c Alone to Assess Glycemic Control Can Be Misleading

Monitoring Glycemic Control in End-Stage Renal Disease: What Should Be Measured?

COVID-19: A Personalized Cardiometabolic Approach for Reducing Complications and Costs. The Role of Aging beyond Topics

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