The Challenge of the Use of Glycemic Biomarkers in Diabetes: Reflecting on Hemoglobin A1C, 1,5-Anhydroglucitol, and the Glycated Proteins Fructosamine and Glycated Albumin

Wright, Lorena; Hirsch, Irl B.

doi:10.2337/diaspect.25.3.141

Cited by 36 publications

(41 citation statements)

References 68 publications

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“…Korelasi kuat antar-ketiga parameter kontrol glikemik tersebut telah dibuktikan di beberapa studi. [12][13][14][15][16] Penggunaan parameter GA di Indonesia, baik sebagai fungsi diagnostik maupun parameter pemantau keberhasilan terapi diabetes hingga saat ini masih terbatas dan belum dijadikan gold standard seperti HbA1C sesuai rekomendasi American Diabetes Association (ADA) maupun Perkumpulan Endokrinologi Indonesia (Perkeni). 6,17 Namun dalam mendeskripsikan nilai kontrol glikemik, nilai GA menjadi pilihan jika dibandingkan HbA1C terutama pada pasien dengan gangguan fungsi ginjal, atau pasien dengan kondisi penurunan masa hidup eritrosit seperti pada kasus anemia hemolitik.…”

Section: Pembahasanunclassified

Glycemic Control and Prevalence of Chronic Kidney Disease in Type‑2 Diabetes Mellitus Patients at Primary Healthcare Centers in Yogyakarta Province 2015

Ningrum

Ikawati

Sadewa

et al. 2017

Indones J Clin Pharm

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AbstrakPengendalian glikemik yang baik pada diabetes melitus tipe 2 (DMT2) terbukti dapat mencegah penyakit komplikasi akibat DMT2. Puskesmas sebagai sarana pelayanan kesehatan primer merupakan garda terdepan yang diharapkan dapat memberikan pelayanan pengelolaan DMT2 dengan baik untuk mencegah penyakit komplikasi seperti penyakit gagal ginjal kronik (GGK). Kejadian GGK yang seringkali tanpa gejala spesifik serta keterbatasan pemeriksaan diagnostik di puskesmas menyebabkan keterlambatan diagnosis GGK maupun pengelolaan terapi yang sub-optimal. Penelitian ini bertujuan menganalisis kontrol glikemik dan kejadian GGK pada pasien DMT2 di puskesmas serta faktor pasien yang memengaruhi kontrol glikemik dan kejadian GGK. Penelitian potong-lintang pada 6 puskesmas di Yogyakarta tahun 2015 ini melibatkan pasien DMT2 dewasa tanpa riwayat gagal hati kronik. Parameter kontrol glikemik menggunakan Glukosa-Darah-Puasa (GDP), Glycated-Albumin (GA), atau hemoglobin terglikasi (HbA1C), sedangkan nilai eLFG digunakan sebagai dasar klasifikasi GGK. Sebanyak 101 pasien dengan rata-rata usia 50,75±6,73 tahun terlibat dalam penelitian. Kontrol glikemik kategori baik ditemukan hanya pada 13,86% pasien, sedangkan 12,87% pasien mengalami GGK. Tidak ada faktor pasien yang memengaruhi kontrol glikemik. Sementara itu, usia dan durasi DMT2 berkorelasi dengan kejadian GGK (p<0,01). Berdasarkan penelitian ini, kontrol glikemik yang buruk dapat meningkatkan kemungkinan kejadian GGK sebesar 63,64%. Oleh karena itu, diperlukan strategi pengelolaan DMT2 maupun pencegahan GGK yang lebih baik termasuk penyediaan fasilitas pemeriksaan yang memadai untuk meminimalkan kejadian clinical inertia di puskesmas.Kata kunci: Faktor-pasien, gagal ginjal kronik, kontrol glikemik, puskesmas Glycemic Control and Prevalence of Chronic Kidney Disease in Type-2 Diabetes Mellitus Patients at Primary Healthcare Centers in Yogyakarta Province 2015 AbstractGood glycemic control in type-2 diabetes mellitus (T2DM) has proven to be able to prevent complications. Primary healthcare is at the forefront being expected to provide good services in T2DM management for preventing such complication as chronic kidney disease (CKD). The incidence of CKD that often shows no specific symptoms and the limitations in diagnostic examinations at primary healthcare centers has caused delay in diagnosis and suboptimal therapy management. This study aimed to determine glycemic controls and prevalence of CKD in patients with T2DM in primary healthcare centers as well as to assess patient's factors related to the glycemic controls and prevalence of CKD. This cross-sectional study in six primary healthcare centers in Yogyakarta in 2015 involved adult T2DM patients without a history of chronic liver disease. The glycemic control parameters comprised of Fasting-Blood-Glucose (FBG), Glycated-Albumin (GA), or glycated-hemoglobin (HbA1C), while the estimated GlomerularFiltration-Rate (eGFR) was used as the basis for CKD classification. A total of 101 patients with an average age of 50.75±6.73 years...

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Section: Pembahasanunclassified

Glycemic Control and Prevalence of Chronic Kidney Disease in Type‑2 Diabetes Mellitus Patients at Primary Healthcare Centers in Yogyakarta Province 2015

Ningrum

Ikawati

Sadewa

et al. 2017

Indones J Clin Pharm

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“…HbA1c is formed by the concentration-dependent nonenzymatic linkage of glucose to the N-terminal valine of the hemoglobin beta-chain (5). It is an excellent mark- Fig.…”

Section: Discussionmentioning

confidence: 99%

Use of Continuous Glucose Monitoring Leads to Diagnosis of Hemoglobin C Trait In a Patient with Discrepant Hemoglobin A1C and Self-Monitored Blood Glucose

Wright

Shajani-Yi

et al. 2019

AACE Clinical Case Reports

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Objective: Hemoglobin A1c (HbA1c) is a useful tool for the diagnosis and management of diabetes mellitus and generally an excellent marker of overall glycemic control for the preceding 8 to 12 weeks; however, the test is not without its pitfalls. A suspicion of falsely high or low HbA1c should prompt clinicians to evaluate for possible causes. Here, we present the novel use of continuous glucose monitoring (CGM) in a case of a 49-year-old African American woman with discrepant HbA1c and selfmonitored blood glucose (SMBG). CGM data suggested that the HbA1c values were falsely elevated, and subsequent evaluation led to a diagnosis of hemoglobin C (HbC) trait.Methods: Case identified is described. Point-of-care (POC) and central laboratory HbA1c were measured on the Bayer DCA 2000 and Bio-Rad Variant II Turbo ionexchange high-performance liquid chromatography platforms, respectively. Results:The patient had an elevated POC HbA1c of 10.8% (95 mmol/mol) and a central laboratory HbA1c of 9.2% (77 mmol/mol). The patient's glucose meter measured an average glucose of 138 mg/dL. The Freestyle LibrePro professional CGM was used to investigate the reliability of the patient's SMBG and showed an average glucose of 165 mg/dL. An investigation into potential causes for falsely elevated HbA1c revealed a previously undiagnosed HbC trait.Conclusion: CGM is a valuable tool to assess HbA1c and SMBG discordance and to guide subsequent diabetes management. Our results suggest that the HbA1c may have been overestimated in our patient due to HbC trait; therefore, results must be interpreted with caution. (AACE Clinical Case Rep. 2019;5:e31-e34) Abbreviations: CGM = continuous glucose monitoring; HbA1c = hemoglobin A1c; HbC = hemoglobin C; HPLC = highperformance liquid chromatography; POC = point-ofcare; SMBG = self-monitored blood glucose

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“…A number of studies have compared the existing assays for long-and short-term average glycemia, with each approach having advantages and disadvantages; [40][41][42][43][44][45] especially noteworthy is the inability of HbA1c to reflect intrinsic variability in glucose levels in individual patients and discrepancies in the average glucose levels derived from different measurements (the so-called glycation gap). 46 In this study, we describe our initial results evaluating an alternative parameter of glycemia (salivary protein glycosylation) that is potentially driven by cellular metabolism and that is discernible in saliva.…”

Section: Discussionmentioning

confidence: 99%

Salivary Protein Glycosylation as a Noninvasive Biomarker for Assessment of Glycemia

Rao

Laurie²,

Bean³

et al. 2014

J Diabetes Sci Technol

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Background: Assessment of short-term glycemic control can facilitate monitoring of diabetes development in at-risk individuals and monitoring response to lifestyle modification or medication. We evaluated salivary protein glycosylation levels as a novel, noninvasive, short-term glycemic index in comparison to hemoglobin A1c (HbA1c), fructosamine, 1,5-anhydroglucitol (1,5-AG), and continuous glucose monitoring (CGM). Methods:Ten subjects with type 2 diabetes were monitored by CGM and saliva and blood were collected at baseline and days 1, 7, 14, 21, and 28 for determination of salivary protein glycosylation, serum fructosamine, and serum 1,5-anhydroglucitol (1,5-AG) levels, as well as HbA1c (baseline and day 28). Weekly, 14-day, 21-day, and 28-day summary blood glucose measures from CGM were computed and matched to the time of each study visit.Results: Salivary protein glycosylation exhibited a moderate correlation with fructosamine (r = .65) and 1,5-AG (r = -.48) at baseline, and weak correlation with HbA1c (r = .3). Conclusions:Salivary protein glycosylation exhibited a stronger correlation than fructosamine and 1,5-AG with 7-, 14-, and 21-day average BG (r = .84, .84, and .69, respectively, and .00 [fructosamine] and .00,), maximum BG (r = .79, .76, and .53 vs -.09, -.21, and -.05 [fructosamine] and -.32, -.27, and -.52 [1,5-AG]), and percentage of time over 140 mg/dL (r = .87, .79, and .59 vs -.26, -.32, and .07 [fructosamine] and -.04, -.10, and -.50 [1,). Salivary protein glycosylation represents a promising noninvasive technology for monitoring short-term glycemic control.

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The Challenge of the Use of Glycemic Biomarkers in Diabetes: Reflecting on Hemoglobin A1C, 1,5-Anhydroglucitol, and the Glycated Proteins Fructosamine and Glycated Albumin

Cited by 36 publications

References 68 publications

Glycemic Control and Prevalence of Chronic Kidney Disease in Type‑2 Diabetes Mellitus Patients at Primary Healthcare Centers in Yogyakarta Province 2015

Glycemic Control and Prevalence of Chronic Kidney Disease in Type‑2 Diabetes Mellitus Patients at Primary Healthcare Centers in Yogyakarta Province 2015

Use of Continuous Glucose Monitoring Leads to Diagnosis of Hemoglobin C Trait In a Patient with Discrepant Hemoglobin A1C and Self-Monitored Blood Glucose

Salivary Protein Glycosylation as a Noninvasive Biomarker for Assessment of Glycemia

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