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Evaluation of glycation gap for clinical use in diabetes management

Background-aim. Alternative glycemic markers have recently re-gained interest in diabetes research and clinical care. Considering a substantial interindividual variability assessment of glycemia based exclusively on HbA1c may be insufficient in various clinical circumstances. The concept of glycation gap (GG), defined as the difference between the measured and fructosamine-based predicted HbA1c was proposed as an aid to the assessment of both glycemic control and risk stratification for diabetic complications. The aim of this study was to evaluate fructosamine and GG within HbA1c-based clinical targets in a large cohort of diabetic patients without proteinuria. Methods. Venus blood was collected from 547 consecutive outpatient diabetic patients at their regular checkup. HbA1c and fructosamine were measured with automated immunoturbidimetric and nitrobluetetrazolium colorimetric procedures, respectively (Integra 400Plus, Roche Diagnostics, USA), serum glucose and protein levels with routine methods (AU680 Beckman Coulter, USA). GG was calculated with a previously validated population-derived equation according to Cohen. Patients were divided into three categories of glycemic control according to HbA1c levels: excellent, fair and poor (b49, 49 to 65 and N65 mmol/mol, respectively). Results. A total of 202 patients within the first category had mean fructosamine level 248±30, 78 μmol/L and GG of -4 (95% CI: -6 to -3), those in the second category (N=232) had mean fructosamine 278 ±36, 25 μmol/L and GG was 1 (95% CI: 0 to 3). Patients with poor glycemic control (N=113) had fructosamine level of 342±53, 92 μmol/L while GG was 5 (95% CI: 5 to 9). One-way ANOVA showed a significant increaseof GG values acrosscategories of glycemic control (Pb0, 001). HbA1c and fructosamine were identified as significant determinants of GG (r=0, 4321and -0, 3126, Pb0, 0001) while noinfluence was shown for glucose and protein levels with multiple regression analysis. Conclusions. Poor glycemic control is associated with an increased levels of GG indicating not only high level of blood glucose, but also a disturbed kinetics of glycation. Further studies are needed to evaluate the relationship of GG with clinically established risk factors of diabetic complications.

glycation gap ; diabetes management

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