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Chen F, Wang P, Dai F, Zhang Q, Ying R, Ai L, Chen Y. Correlation Between Blood Glucose Fluctuations and Osteoporosis in Type 2 Diabetes Mellitus. Int J Endocrinol 2025; 2025:8889420. [PMID: 39949568 PMCID: PMC11824305 DOI: 10.1155/ije/8889420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 01/08/2025] [Indexed: 02/16/2025] Open
Abstract
The purpose of this review is to investigate the impacts of blood glucose fluctuations on diabetic osteoporosis, a complication of Type 2 diabetes mellitus (T2DM) that remains poorly understood. We reviewed the current evidence of the relationship between blood glucose fluctuations and diabetic osteoporosis in patients with T2DM. The findings indicate that blood glucose fluctuations may contribute to inhibiting the processes of bone formation and resorption, promoting diabetic osteoporosis and fractures in T2DM. Mechanistic studies, both in vitro and in vivo, reveal that these effects are largely mediated by oxidative stress, advanced glycation end products, inflammatory mediators, and multiple pathways inducing cell apoptosis or autophagy. Thus, maintaining the long-term stability of blood glucose levels emerges as a target to be pursued in clinical practice in order to safely reduce mean blood glucose and for its direct effects on osteoporosis and fractures in T2DM.
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Affiliation(s)
- Fuhua Chen
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ping Wang
- Department of Endocrinology, The 2nd People's Hospital of Anhui, Hefei, Anhui, China
| | - Fang Dai
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qiu Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ruixue Ying
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Liya Ai
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yiqing Chen
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Sakane S, Kato K, Hata S, Nishimura E, Araki R, kouyama K, Hatao M, Matoba Y, Matsushita Y, Domichi M, Suganuma A, Murata T, Wu FL, Sakane N. Association of hypoglycemia problem-solving abilities with severe hypoglycemia in adults with type 1 diabetes: a Poisson regression analysis. Diabetol Int 2024; 15:777-785. [PMID: 39469565 PMCID: PMC11512935 DOI: 10.1007/s13340-024-00733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/18/2024] [Indexed: 10/30/2024]
Abstract
Background Severe hypoglycemia (SH) poses a significant challenge in the management of type 1 diabetes (T1D); however, the factors that offer protection other than diabetes technologies are under-studied. The primary objective of this study was to examine the association between hypoglycemia problem-solving (HPS) abilities and severe hypoglycemic events in adults with T1D using Poisson regression analysis. Methods In this cross-sectional study, 287 adults with T1D (mean age: 50.3 ± 14.5 years, male: 36.2%, diabetes duration: 17.5 ± 11.2 years, mean HbA1c: 7.7 ± 0.9%) were included and categorized into two groups: non-SH (n = 262) and SH (n = 25). Data on diabetic complications, the hypoglycemia problem-solving scale (HPSS), and treatment details were collected. Impaired awareness of hypoglycemia (IAH) was evaluated using Gold's method. Univariate and multivariable Poisson regression models were used for the analysis, and the findings were presented as incidence rate ratios (IRRs) at 95% confidence interval (CI). Results The incidence of SH was 16.7 (95% CI 7.5-26.0) per 100 person-years. In the univariate Poisson regression analysis, findings revealed associations between IAH, diabetic peripheral neuropathy (DPN), and HPSS1. On the other hand, the multivariate Poisson regression analysis, utilizing stepwise variable selection, identified DPN (IRR: 4.65, 95% CI 1.96-11.04; P < 0.001) and HPSS1 score (IRR: 0.51, 95% CI 0.34, 0.76; P = 0.001) as factors significantly associated with SH. Conclusion We identified HPS abilities, in addition to DPN, were associated with SH in adults with T1D. Trial registration University Hospital Medical Information Network (UMIN) Center: UMIN000039475), approval date: February 13, 2020.
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Affiliation(s)
- Seiko Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Ken Kato
- Diabetes Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006 Japan
| | - Sonyun Hata
- Diabetes Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006 Japan
| | - Erika Nishimura
- Diabetes Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006 Japan
| | - Rika Araki
- Department of Diabetes and Endocrinology, National Hospital Organization Mie National Hospital, Mie Japan 357 Ozatokubota-cho, Tsu, Mie 514-0125 Japan
| | - Kunichi kouyama
- Department of Diabetes and Metabolism, National Hospital Organization Hyogo-Chuo National Hospital, 1314Ohara, Sanda, Hyogo 669-1515 Japan
| | - Masako Hatao
- Department of Diabetes and Endocrinology, National Hospital Organization Himeji Medical Center, 68 Honmachi, Himeji, Hyogo 670-0012 Japan
| | - Yuka Matoba
- Department of Diabetes, Endocrinology and Metabolism, National Hospital Organization Kokura Medical Center, 10-1 Harugaoka, Kokuraminami-ku, Kitakyushu, Fukuoka, 802-0803 Japan
| | - Yuichi Matsushita
- Department of Diabetology and Metabolism, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Okayama Kita-ku, Okayama, 701-1154 Japan
| | - Masayuki Domichi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Takashi Murata
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-Cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-Cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Fei Ling Wu
- Department of Nursing, Chang Gung University of Science and Technology, No. 261, Wenhua 1St Rd, Guishan District, Taoyuan, Taiwan 333
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
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Takebayashi K, Yamauchi M, Hara K, Tsuchiya T, Hashimoto K. Association of the Ratio of Glycoalbumin to Hemoglobin A1c With Season Change and the COVID-19 Pandemic in Patients With Type 2 Diabetes Mellitus. Cureus 2024; 16:e64444. [PMID: 39007025 PMCID: PMC11245681 DOI: 10.7759/cureus.64444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 07/16/2024] Open
Abstract
AIM The main purpose of the current study was to investigate the effect of season change and the influence of the COVID-19 pandemic on the ratio of glycoalbumin to hemoglobin A1c (GA/HbA1c) in patients with type 2 diabetes. PATIENTS AND METHODS A total of 267 patients in whom both HbA1c and GA were measured at baseline were included in this retrospective study. GA/HbA1c was investigated for three years, 2018, 2019, and 2020 (COVID-19 pandemic period). RESULTS The mean values for GA/HbA1c per year in 2018, 2019, and 2020 were 2.64±0.35, 2.61±0.35, 2.64±0.39, respectively. There were no significant differences in GA/HbA1c during these years. There was a tendency toward seasonal variation in GA/HbA1c (i.e., higher in summer or autumn and lower in spring or winter). CONCLUSION In patients with type 2 diabetes, GA/HbA1c tended to show seasonal variation, which was not influenced by the COVID-19 pandemic.
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Affiliation(s)
- Kohzo Takebayashi
- Department of Diabetes, Endocrinology and Hematology, Dokkyo Medical University Saitama Medical Center, Koshigaya, JPN
| | - Mototaka Yamauchi
- Department of Diabetes, Endocrinology and Hematology, Dokkyo Medical University Saitama Medical Center, Koshigaya, JPN
| | - Kenji Hara
- Department of Diabetes, Endocrinology and Hematology, Dokkyo Medical University Saitama Medical Center, Koshigaya, JPN
| | - Takafumi Tsuchiya
- Department of Diabetes, Endocrinology and Hematology, Dokkyo Medical University Saitama Medical Center, Koshigaya, JPN
| | - Koshi Hashimoto
- Department of Diabetes, Endocrinology and Hematology, Dokkyo Medical University Saitama Medical Center, Koshigaya, JPN
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Zhang Z, Wang H, Chen M, Chen Y. L-shaped association between the GA/HbA1c ratio and all-cause mortality in U.S. adults with NAFLD: a cross-sectional study from the NHANES 1999-2004. BMC Endocr Disord 2024; 24:35. [PMID: 38468235 PMCID: PMC10926622 DOI: 10.1186/s12902-024-01568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/05/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE It is currently unclear whether there is a relationship between the ratio of glycated albumin to hemoglobin A1c (GA/HbA1c) and mortality in individuals diagnosed with nonalcoholic fatty liver disease (NAFLD). The primary objective of the study was to investigate the relationship between the GA/HbA1c ratio and all-cause mortality in adults with NAFLD in the U.S. METHODS The investigation included a total of 5,295 individuals aged ≥ 18 years who were diagnosed with NAFLD, these individuals were selected from the National Health and Nutrition Examination Survey conducted between 1999 and 2004. To evaluate the outcomes of death, the researchers relied on National Death Index (NDI) records up to December 31, 2019. To better understand the nonlinear relationship between the GA/HbA1c ratio and mortality among individuals with NAFLD, this study employed both subgroup and sensitivity analyses. Furthermore, Cox proportional hazards models and two-part Cox proportional hazards model were utilized. RESULTS The study included a total of 5,295 adult patients with NAFLD in the U.S. During a median follow-up period of 16.9 years, there were 1,471 recorded deaths, including 419 cardiovascular deaths. After accounting for various factors, a higher GA/HbA1c ratio exhibited a positive and nonlinear association with an increased risk of all-cause mortality in patients with NAFLD. Furthermore, the study revealed an L-shaped relationship between the GA/HbA1c ratio and all-cause mortality, with the inflection point occurring at a GA/HbA1c ratio of 2.21. When the GA/HbA1c ratio exceeded 2.21, each 1-unit increase in the ratio was associated with a 33% increase in the adjusted hazard ratio (HR 1.33; 95% CI 1.14, 1.60) for all-cause mortality. CONCLUSIONS A nonlinear correlation between the ratio of GA to HbA1c and all-cause mortality was observed in U.S. adults with NAFLD. In addition, an elevated GA/HbA1c ratio was linked to an increased risk of all-cause mortality in these patients.
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Affiliation(s)
- Zhaofu Zhang
- Department of Infectious Diseases, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China
| | - Hao Wang
- Department of Infectious Diseases, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China
| | - Mingyu Chen
- Department of Infectious Diseases, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China
| | - Youpeng Chen
- Department of Infectious Diseases, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China.
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Choi YJ, Lee NY, Ahn MB, Kim SH, Cho WK, Cho KS, Jung MH, Suh BK. Usefulness of glycated albumin level as a glycemic index complementing glycosylated hemoglobin in diabetic children and adolescents. Ann Pediatr Endocrinol Metab 2023; 28:289-295. [PMID: 38173383 PMCID: PMC10765020 DOI: 10.6065/apem.2244202.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 01/05/2024] Open
Abstract
PURPOSE Glycated albumin (GA) is a glycemic marker reflecting the average serum glucose of the previous 2 weeks. This study aimed to evaluate the usefulness of GA as a glycemic index to complement glycosylated hemoglobin (HbA1c) in children and adolescents. METHODS Fifty-four children and adolescents with diabetes mellitus (DM) and 97 children and adolescents without DM (NDM) were enrolled. The correlation between mean blood glucose (MG) and GA compared to HbA1c was investigated in the DM group. The correlation between fasting glucose (FG) and GA compared to HbA1c was investigated in the NDM group. Factors affecting GA, HbA1c, and GA/HbA1c were analyzed. RESULTS In the DM group, positive correlations were observed between MG and GA (P=0.003), between MG and HbA1c (P=0.001), and between GA and HbA1c (P<0.001). The correlation coefficient between MG and GA did not differ from that between MG and HbA1c in the DM group (P=0.811). Among patients with DM, those whose standardized body mass index standard deviation score (BMI SDS) was ≥2 had a lower GA/HbA1c compared with those whose BMI SDS was <2 (P=0.001). In the NDM group, there were no significant correlations between FG and GA, between FG and HbA1c, or between GA and HbA1c. The NDM subjects whose BMI SDS was ≥2 had a lower GA/HbA1c than did the NDM subjects whose BMI SDS was <2 (P=0.003). CONCLUSION GA is comparable with HbA1c in reflecting glycemic control in children and adolescents with DM. GA is affected by obesity in children and adolescents with or without DM.
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Affiliation(s)
- Young Ju Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na Yeong Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Bae Ahn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shin Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Kyoung Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Soon Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ho Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Kyu Suh
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Sakane N, Kato K, Hata S, Nishimura E, Araki R, Kouyama K, Hatao M, Matoba Y, Matsushita Y, Domichi M, Suganuma A, Sakane S, Murata T, Wu FL. Protective and risk factors of impaired awareness of hypoglycemia in patients with type 1 diabetes: a cross-sectional analysis of baseline data from the PR-IAH study. Diabetol Metab Syndr 2023; 15:79. [PMID: 37095537 PMCID: PMC10127054 DOI: 10.1186/s13098-023-01024-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/11/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Hypoglycemia in type 1 diabetes (T1D) is associated with mortality and morbidity, especially when awareness of hypoglycemia is impaired. This study aimed to investigate the protective and risk factors for impaired awareness of hypoglycemia (IAH) in adults with T1D. METHODS This cross-sectional study enrolled 288 adults with T1D (mean age, 50.4 ± 14.6 years; male, 36.5%; diabetes duration, 17.6 ± 11.2 years; mean HbA1c level, 7.7 ± 0.9%), who were divided into IAH and non-IAH (control) groups. A survey was conducted to assess hypoglycemia awareness using the Clarke questionnaire. Diabetes histories, complications, fear of hypoglycemia, diabetes distress, hypoglycemia problem-solving abilities, and treatment data were collected. RESULTS The prevalence of IAH was 19.1%. Diabetic peripheral neuropathy was associated with an increased risk of IAH (odds ratio [OR] 2.63; 95% confidence interval [CI] 1.13-5.91; P = 0.014), while treatment with continuous subcutaneous insulin infusion and hypoglycemia problem-solving perception scores were associated with a decreased risk of IAH (OR, 0.48; 95% CI, 0.22-0.96; P = 0.030; and OR, 0.54; 95% CI, 0.37-0.78; P = 0.001, respectively). There was no difference in continuous glucose monitoring use between the groups. CONCLUSION We identified protective factors in addition to risk factors for IAH in adults with T1D. This information may help manage problematic hypoglycemia. TRIAL REGISTRATION University hospital Medical Information Network (UMIN) Center: UMIN000039475). Approval date 13 February 2020.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, 612-8555, Kyoto, Japan.
| | - Ken Kato
- Diabetes center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, 540-0006, Osaka, Japan
| | - Sonyun Hata
- Diabetes center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, 540-0006, Osaka, Japan
| | - Erika Nishimura
- Diabetes center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, 540-0006, Osaka, Japan
| | - Rika Araki
- Department of Diabetes and Endocrinology, National Hospital Organization Mie National Hospital, 357 Ozatokubota-cho, 514-0125, Tsu, Mie, Japan
| | - Kunichi Kouyama
- Department of Diabetes and Metabolism, National Hospital Organization Hyogo-Chuo National Hospital, 1314Ohara, 669-1515, Sanda, Hyogo, Japan
| | - Masako Hatao
- Department of Diabetes and Endocrinology, National Hospital Organization Himeji Medical Center, 68 Honmachi, 670-0012, Himeji, Hyogo, Japan
| | - Yuka Matoba
- Department of Diabetes, Endocrinology and Metabolism, National Hospital Organization Kokura Medical Center, 10-1 Harugaoka, Kitakyushu Kokuraminami-ku, 802-0803, Fukuoka, Japan
| | - Yuichi Matsushita
- Department of Diabetology and Metabolism, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Okayama Kita-ku, 701-1192, Okayama, Japan
| | - Masayuki Domichi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, 612-8555, Kyoto, Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, 612-8555, Kyoto, Japan
| | - Seiko Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, 612-8555, Kyoto, Japan
| | - Takashi Murata
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, 612-8555, Kyoto, Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, 612-8555, Kyoto, Japan
| | - Fei Ling Wu
- Department of Nursing, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Rd, Guishan District, 333, Taoyuan City, Taiwan
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Sakane N, Hirota Y, Yamamoto A, Miura J, Takaike H, Hoshina S, Toyoda M, Saito N, Hosoda K, Matsubara M, Tone A, Kawashima S, Sawaki H, Matsuda T, Domichi M, Suganuma A, Sakane S, Murata T. Factors associated with hemoglobin glycation index in adults with type 1 diabetes mellitus: The FGM-Japan study. J Diabetes Investig 2023; 14:582-590. [PMID: 36789495 PMCID: PMC10034957 DOI: 10.1111/jdi.13973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 02/16/2023] Open
Abstract
AIMS/INTRODUCTION The discrepancy between HbA1c and glucose exposure may have significant clinical implications; however, the association between the hemoglobin glycation index (HGI) and clinical parameters in type 1 diabetes remains controversial. This study aimed to find the factors associated with HGI (laboratory HbA1c - predicted HbA1c derived from the continuous glucose monitoring [CGM]). MATERIALS AND METHODS We conducted a cross-sectional study of adults with type 1 diabetes (n = 211, age 50.9 ± 15.2 years old, female sex = 59.2%, duration of CGM use = 2.1 ± 1.0 years). All subjects wore the CGM for 90 days before HbA1c measurement. Data derived from the FreeStyle Libre sensor were used to calculate the glucose management indicator (GMI) and glycemic variability (GV) parameters. HGI was defined as the difference between the GMI and the laboratory HbA1c levels. The participants were divided into three groups according to the HGI tertile (low, moderate, and high). Multivariate regression analyses were performed. RESULTS The female sex ratio, HbA1c, and % coefficient of variation (%CV) significantly increased over the HGI tertile, while eGFR and Hb decreased over the HGI tertile. In multivariate analysis, the factors associated with HGI were %CV and eGFR, after adjusting for HbA1c level and sex (R2 = 0.44). CONCLUSIONS This study demonstrated that HGI is associated with female sex, eGFR, and some glycemic variability indices, independently of HbA1c. Minimizing glycemic fluctuations might reduce HGI. This information provides diabetic health professionals and patients with personalized diabetes management for adults with type 1 diabetes.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Akane Yamamoto
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hiroko Takaike
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Sari Hoshina
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Nobumichi Saito
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masaki Matsubara
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of General Medicine, Nara Medical University, Nara, Japan
| | - Atsuhito Tone
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | | | - Hideaki Sawaki
- Sawaki Internal Medicine and Diabetes Clinic, Osaka, Japan
| | | | - Masayuki Domichi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Seiko Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Murata
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Wang S, Gu L, Zhu J, Shan T, Sun J, Jiang Q, Wang H, Zhao D, Wang Q, Wang L. Association of glycated albumin to hemoglobin A1c ratio with all-cause and cardiovascular mortality among US adults: A population-based cohort study. Diabetes Res Clin Pract 2022; 193:110116. [PMID: 36240956 DOI: 10.1016/j.diabres.2022.110116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022]
Abstract
AIMS To investigate the association of glycated albumin to hemoglobin A1c (GA/HbA1c) ratio, an indicator of blood glucose fluctuations, with all-cause and cardiovascular mortality among US adults. METHODS This cohort study used data from the National Health and Nutrition Examination Survey 1999-2004. Participants were linked to National Death Index mortality data through December 31, 2015. Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), and restricted cubic spline (RCS) regression was conducted. RESULTS A total of 11,508 US adults (weighted mean age, 43.9 years; 5748 males [weighted, 48.9 %]) were included. During a median follow‑up of 13.6 years, 1963 total deaths occurred, including 383 cardiovascular deaths. After multivariable adjustments, a higher GA/HbA1c ratio was associated with a higher risk of all-cause (tertiles: P for trend < 0.001; continuous: HR 1.49 [95 % CI 1.32-1.69]) and cardiovascular (tertiles: P for trend = 0.048; continuous: HR 1.65 [95 % CI 1.27-2.14]) mortality. RCS revealed a linear relationship of GA/HbA1c ratio to mortality. CONCLUSIONS In the nationally representative cohort of US adults, GA/HbA1c ratio was significantly associated with the risk of all-cause and cardiovascular mortality. These findings suggest that GA/HbA1c ratio may serve as an effective indicator for identifying high-risk individuals.
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Affiliation(s)
- Sibo Wang
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China
| | - Lingfeng Gu
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China
| | - Jun Zhu
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China; Department of Cardiology, Geriatrics Hospital of Jiangsu Province, Nanjing 210024, China
| | - Tiankai Shan
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China
| | - Jiateng Sun
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China
| | - Qiqi Jiang
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China
| | - Hao Wang
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China
| | - Di Zhao
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China
| | - Qiming Wang
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China.
| | - Liansheng Wang
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing 210029, China.
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Shimizu N, Ogawa A, Hayashi A, Shichiri M. Discordance in the reduction rate between glycated albumin and glycated hemoglobin levels in type 2 diabetes patients receiving SGLT2 inhibitors. J Diabetes Complications 2022; 36:108225. [PMID: 35690574 DOI: 10.1016/j.jdiacomp.2022.108225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
AIMS Although the difference in HbA1c reduction between sodium-glucose cotransporter 2 (SGLT2) inhibitors and other oral glucose-lowering agents is relatively small, SGLT2 inhibitors exhibit beneficial cardiorenal protection. This study was based on the hypothesis that changes of HbA1c in patients treated with SGLT2 inhibitors may not accurately reflect an improved glycemic profile. METHODS Two studies were conducted: 1) a retrospective cohort study of 3039 patients administered with either an SGLT2 or a dipeptidyl peptidase-4 (DPP4) inhibitor for 12 months comparing the changes in glycated albumin (GA) and HbA1c levels and 2) a pilot study of 10 patients whose glycemic dynamics were evaluated using flash glucose monitoring at baseline and 2 months after treatment with an SGLT2 inhibitor. RESULTS SGLT2 inhibitors reduced GA more markedly than HbA1c in both studies. DPP4 inhibitors decreased both GA and HbA1c to a comparable degree. The mean glucose levels and glycemic standard deviation were significantly reduced after treatment with an SGLT2 inhibitor, in concordance with GA decline, although the lowering of HbA1c was marginal. CONCLUSIONS Changes in HbA1c levels underestimated the glucose-lowering effect and the diminished glycemic fluctuation induced by SGLT2 inhibitors. Thus, the distinct biomarker roles of GA and HbA1c should be reevaluated.
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Affiliation(s)
- Naoya Shimizu
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Akifumi Ogawa
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Akinori Hayashi
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan; Tokyo Kyosai Hospital, 2-3-8 Nakameguro, Meguro-ku, Tokyo 153-8934, Japan.
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10
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Taguchi T, Suzuki A, Takano K. Increased glycated albumin levels in patients with acromegaly related to glucose fluctuation caused by growth hormone excess but not albumin metabolism. Endocr J 2022; 69:225-233. [PMID: 34588387 DOI: 10.1507/endocrj.ej21-0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Acromegaly is often complicated by impaired glucose tolerance. The accuracy of glycated hemoglobin (HbA1c) and glycated albumin (GA) levels in representing glycemic profiles in patients with endocrine disorders, such as acromegaly, is unclear. This retrospective study reviewed data from patients whose GA levels had been recorded. 14 patients with acromegaly without diabetes mellitus (DM) (the acromegaly group), 15 patients with severe adult GH deficiency without DM (the growth hormone deficiency (GHD) group), and 55 nondiabetic patients (the control group) were included in this study. GA levels were significantly increased in the acromegaly group compared with the control and GHD groups, but no significant differences were observed between the control and GHD groups. The three groups were matched using propensity score matching (13 patients with acromegaly, 13 with GHD, and 13 control patients). Nonetheless, the results after matching were the same as those before matching. GA levels in the acromegaly group were significantly associated with plasma glucose (PG) levels at 0, 30, and 120 min after a 75-g oral glucose tolerance test (OGTT). Further, GH levels at 120 min after a 75-g OGTT in the acromegaly group were significantly correlated with GA levels and the difference in PG levels at baseline and 30 min. Our findings suggest that increases in PG levels attributable to excess GH after glucose loading are related to increases in GA levels in patients with acromegaly without DM. Hence, both HbA1c and GA should be checked to accurately assess impaired glucose tolerance in patients with acromegaly.
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Affiliation(s)
- Tomomi Taguchi
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Agena Suzuki
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Koji Takano
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
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11
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Takeuchi T, Hirota Y, Nakagawa Y, Matsuoka A, Hamaguchi T, Okada Y, Sakaguchi K, Ogawa W, Koga M. Glycated albumin (GA) and the GA/HbA1c ratio are higher in diabetic patients positive for insulin antibodies with high binding capacity and low affinity. Diabetol Int 2021; 13:226-231. [DOI: 10.1007/s13340-021-00528-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022]
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12
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Sakai T, Aoyama K, Inazumi K, Kikuchi R, Sato Y, Tada A, Hirata T, Morimoto J. Time in range correlates glycated albumin measured immediately after 2 weeks of continuous glucose monitoring. J Diabetes Complications 2021; 35:107962. [PMID: 34059411 DOI: 10.1016/j.jdiacomp.2021.107962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/17/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Abstract
AIMS Time in range (TIR), an index of glycemic control and also blood glucose fluctuation, obtained from continuous glucose monitoring (CGM), has been increasing its importance along with the spread of CGM in recent years. For a while, glycated albumin (GA) has been also used as a glycemic control index during about 2-weeks in routine clinical practice. It has not yet been confirmed under optimal condition whether TIR and GA correlates. Clarification of the correlation between TIR and GA, which was measured immediately after 2-weeks of CGM, might be a finding that further supports the utility of TIR. METHODS GA was measured at the conclusion of 2-week CGM in 71 diabetes outpatients at our hospital, and the correlation between GA and indices such as TIR obtained from CGM was statistically analyzed. RESULTS It was found that TIR and time above range (TAR) were significantly correlated with GA. Upon performing multiple regression analysis, TIR, TAR and BMI. indicated a significant regression coefficient with respect to GA. CONCLUSIONS These findings further support the utility of TIR as a marker of glycemic control that it might also be correlated with GA, and also suggest a relation between GA and blood glucose fluctuation.
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Affiliation(s)
- Takeru Sakai
- Department of Internal Medicine, Saitama Medical Center, Japan Community Healthcare Organization, 4-9-3 Kitaurawa, Urawa-ku, Saitama 330-0074, Japan
| | - Kazuki Aoyama
- Department of Internal Medicine, Saitama Medical Center, Japan Community Healthcare Organization, 4-9-3 Kitaurawa, Urawa-ku, Saitama 330-0074, Japan
| | - Koji Inazumi
- Department of Internal Medicine, Saitama Medical Center, Japan Community Healthcare Organization, 4-9-3 Kitaurawa, Urawa-ku, Saitama 330-0074, Japan
| | - Rieko Kikuchi
- Department of Internal Medicine, Saitama Medical Center, Japan Community Healthcare Organization, 4-9-3 Kitaurawa, Urawa-ku, Saitama 330-0074, Japan
| | - Yuki Sato
- Department of Internal Medicine, Saitama Medical Center, Japan Community Healthcare Organization, 4-9-3 Kitaurawa, Urawa-ku, Saitama 330-0074, Japan
| | - Ai Tada
- Department of Internal Medicine, Saitama Medical Center, Japan Community Healthcare Organization, 4-9-3 Kitaurawa, Urawa-ku, Saitama 330-0074, Japan
| | - Takumi Hirata
- Department of Public Health, Hokkaido University, Faculty of Medicine, Address: 15-7 Kita-ku, Sapporo-city, Hokkai-do 060-8638, Japan.
| | - Jiro Morimoto
- Department of Internal Medicine, Saitama Medical Center, Japan Community Healthcare Organization, 4-9-3 Kitaurawa, Urawa-ku, Saitama 330-0074, Japan.
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13
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Hayashi A, Shimizu N, Suzuki A, Matoba K, Momozono A, Masaki T, Ogawa A, Moriguchi I, Takano K, Kobayashi N, Shichiri M. Hemodialysis-Related Glycemic Disarray Proven by Continuous Glucose Monitoring; Glycemic Markers and Hypoglycemia. Diabetes Care 2021; 44:1647-1656. [PMID: 34045240 DOI: 10.2337/dc21-0269] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There is a high risk of asymptomatic hypoglycemia associated with hemodialysis (HD) using glucose-free dialysate; therefore, the inclusion of glucose in the dialysate is believed to prevent intradialytic hypoglycemia. However, the exact glycemic fluctuation profiles and frequency of asymptomatic hypoglycemia using dialysates containing >100 mg/dL glucose have not been determined. RESEARCH DESIGN AND METHODS We evaluated the glycemic profiles of 98 patients, 68 of whom were men, with type 2 diabetes undergoing HD (HbA1c 6.4 ± 1.2%; glycated albumin 20.8 ± 6.8%) with a dialysate containing 100, 125, or 150 mg/dL glucose using continuous glucose monitoring. RESULTS Sensor glucose level (SGL) showed a sustained decrease during HD, irrespective of the dialysate glucose concentration, and reached a nadir that was lower than the dialysate glucose concentration in 49 participants (50%). Twenty-one participants (21%) presented with HD-related hypoglycemia, defined by an SGL <70 mg/dL during HD and/or between the end of HD and their next meal. All these hypoglycemic episodes were asymptomatic. Measures of glycemic variability calculated using the SGL data (SD, coefficient of variation, and range of SGL) were higher and time below range (<70 mg/dL) was lower in participants who experienced HD-related hypoglycemia than in those who did not, whereas time in range between 70 and 180 mg/dL, time above range (>180 mg/dL), HbA1c, and glycated albumin of the two groups were similar. CONCLUSIONS Despite the use of dialysate containing 100-150 mg/dL glucose, patients with diabetes undergoing HD experienced HD-related hypoglycemia unawareness frequently. SGL may fall well below the dialysate glucose concentration toward the end of HD.
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Affiliation(s)
- Akinori Hayashi
- Department of Laboratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan .,Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | - Naoya Shimizu
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | - Agena Suzuki
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenta Matoba
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | - Akari Momozono
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tsuguto Masaki
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | - Akifumi Ogawa
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | | | - Koji Takano
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | | | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
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14
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Correlations Between Glycemic Parameters Obtained from Continuous Glucose Monitoring and Hemoglobin A1c and Glycoalbumin Levels in Type 2 Diabetes Mellitus. J UOEH 2021; 42:299-306. [PMID: 33268606 DOI: 10.7888/juoeh.42.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It is difficult to detect glycemic excursions using CGM in daily clinical practice. We retrospectively analyzed CGM data in type T2DM to define the correlations between HbA1c and GA levels at admission and the parameters representing glycemic excursions measured by CGM, including the mean amplitude of glycemic excursions (MAGE) and standard deviation (SD). The MAGE correlated significantly with GA and HbA1c, but not with the GA/HbA1c ratio. The SD correlated significantly with GA, HbA1c, and GA/HbA1c. Multivariate analysis identified the GA value to be the most reflective of MAGE. Patients were divided into 2 groups using a MAGE cutoff value of 75 mg/dl, which reflects stable diabetes. There was a significant difference in GA, but not HbA1c, between the groups with low and high mean amplitudes of glycemic excursions. Receiver operating characteristic curve analysis indicated that the cutoff for GA for identifying patients with MAGE of ≤75 mg/dl was 18.1%. Our study identified GA to be the most reflective of glycemic excursions in patients with T2DM. GA can be a useful index of glycemic excursions and treatment optimization to prevent arteriosclerosis.
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15
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Sun J, Xu B, Zhang X, He Z, Liu Z, Liu R, Nan G. The Mechanisms of Type 2 Diabetes-Related White Matter Intensities: A Review. Front Public Health 2020; 8:498056. [PMID: 33282807 PMCID: PMC7705244 DOI: 10.3389/fpubh.2020.498056] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Abstract
The continually increasing number of patients with type 2 diabetes is a worldwide health problem, and the incidence of microvascular complications is closely related to type 2 diabetes. Structural brain abnormalities are considered an important pathway through which type 2 diabetes causes brain diseases. In fact, there is considerable evidence that type 2 diabetes is associated with an increased risk of structural brain abnormalities such as lacunar infarcts (LIs), white matter hyperintensities (WMHs), and brain atrophy. WMHs are a common cerebral small-vessel disease in elderly adults, and it is characterized histologically by demyelination, loss of oligodendrocytes, and vacuolization as a result of small-vessel ischemia in the white matter. An increasing number of studies have found that diabetes is closely related to WMHs. However, the exact mechanism by which type 2 diabetes causes WMHs is not fully understood. This article reviews the mechanisms of type 2 diabetes-related WMHs to better understand the disease and provide help for better clinical treatment.
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Affiliation(s)
- Jing Sun
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Baofeng Xu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xuejiao Zhang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhidong He
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ziwei Liu
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Rui Liu
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guangxian Nan
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
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16
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Bergman M, Abdul-Ghani M, DeFronzo RA, Manco M, Sesti G, Fiorentino TV, Ceriello A, Rhee M, Phillips LS, Chung S, Cravalho C, Jagannathan R, Monnier L, Colette C, Owens D, Bianchi C, Del Prato S, Monteiro MP, Neves JS, Medina JL, Macedo MP, Ribeiro RT, Filipe Raposo J, Dorcely B, Ibrahim N, Buysschaert M. Review of methods for detecting glycemic disorders. Diabetes Res Clin Pract 2020; 165:108233. [PMID: 32497744 PMCID: PMC7977482 DOI: 10.1016/j.diabres.2020.108233] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023]
Abstract
Prediabetes (intermediate hyperglycemia) consists of two abnormalities, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) detected by a standardized 75-gram oral glucose tolerance test (OGTT). Individuals with isolated IGT or combined IFG and IGT have increased risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Diagnosing prediabetes early and accurately is critical in order to refer high-risk individuals for intensive lifestyle modification. However, there is currently no international consensus for diagnosing prediabetes with HbA1c or glucose measurements based upon American Diabetes Association (ADA) and the World Health Organization (WHO) criteria that identify different populations at risk for progressing to diabetes. Various caveats affecting the accuracy of interpreting the HbA1c including genetics complicate this further. This review describes established methods for detecting glucose disorders based upon glucose and HbA1c parameters as well as novel approaches including the 1-hour plasma glucose (1-h PG), glucose challenge test (GCT), shape of the glucose curve, genetics, continuous glucose monitoring (CGM), measures of insulin secretion and sensitivity, metabolomics, and ancillary tools such as fructosamine, glycated albumin (GA), 1,5- anhydroglucitol (1,5-AG). Of the approaches considered, the 1-h PG has considerable potential as a biomarker for detecting glucose disorders if confirmed by additional data including health economic analysis. Whether the 1-h OGTT is superior to genetics and omics in providing greater precision for individualized treatment requires further investigation. These methods will need to demonstrate substantially superiority to simpler tools for detecting glucose disorders to justify their cost and complexity.
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Affiliation(s)
- Michael Bergman
- NYU School of Medicine, NYU Diabetes Prevention Program, Endocrinology, Diabetes, Metabolism, VA New York Harbor Healthcare System, Manhattan Campus, 423 East 23rd Street, Room 16049C, NY, NY 10010, USA.
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
| | - Melania Manco
- Research Area for Multifactorial Diseases, Bambino Gesù Children Hospital, Rome, Italy.
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome 00161, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro 88100, Italy.
| | - Antonio Ceriello
- Department of Cardiovascular and Metabolic Diseases, Istituto Ricerca Cura Carattere Scientifico Multimedica, Sesto, San Giovanni (MI), Italy.
| | - Mary Rhee
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta VA Health Care System, Atlanta, GA 30322, USA.
| | - Lawrence S Phillips
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta VA Health Care System, Atlanta, GA 30322, USA.
| | - Stephanie Chung
- Diabetes Endocrinology and Obesity Branch, National Institutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Celeste Cravalho
- Diabetes Endocrinology and Obesity Branch, National Institutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Ram Jagannathan
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta VA Health Care System, Atlanta, GA 30322, USA.
| | - Louis Monnier
- Institute of Clinical Research, University of Montpellier, Montpellier, France.
| | - Claude Colette
- Institute of Clinical Research, University of Montpellier, Montpellier, France.
| | - David Owens
- Diabetes Research Group, Institute of Life Science, Swansea University, Wales, UK.
| | - Cristina Bianchi
- University Hospital of Pisa, Section of Metabolic Diseases and Diabetes, University Hospital, University of Pisa, Pisa, Italy.
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Mariana P Monteiro
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal; Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
| | - João Sérgio Neves
- Department of Surgery and Physiology, Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Endocrinology, Diabetes and Metabolism, São João University Hospital Center, Porto, Portugal.
| | | | - Maria Paula Macedo
- CEDOC-Centro de Estudos de Doenças Crónicas, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal; APDP-Diabetes Portugal, Education and Research Center (APDP-ERC), Lisboa, Portugal.
| | - Rogério Tavares Ribeiro
- Institute for Biomedicine, Department of Medical Sciences, University of Aveiro, APDP Diabetes Portugal, Education and Research Center (APDP-ERC), Aveiro, Portugal.
| | - João Filipe Raposo
- CEDOC-Centro de Estudos de Doenças Crónicas, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal; APDP-Diabetes Portugal, Education and Research Center (APDP-ERC), Lisboa, Portugal.
| | - Brenda Dorcely
- NYU School of Medicine, Division of Endocrinology, Diabetes, Metabolism, NY, NY 10016, USA.
| | - Nouran Ibrahim
- NYU School of Medicine, Division of Endocrinology, Diabetes, Metabolism, NY, NY 10016, USA.
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University Clinic Saint-Luc, Brussels, Belgium.
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17
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Ohara T, Furuta Y, Hirabayashi N, Hata J, Hirakawa Y, Honda T, Yoshida D, Shibata M, Kitazono T, Ninomiya T. Elevated serum glycated albumin and glycated albumin : hemoglobin A 1c ratio were associated with hippocampal atrophy in a general elderly population of Japanese: The Hisayama Study. J Diabetes Investig 2020; 11:971-979. [PMID: 31999889 PMCID: PMC7378434 DOI: 10.1111/jdi.13220] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/07/2020] [Accepted: 01/26/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS/INTRODUCTION To investigate the association of alternative glycemic measures - namely, serum glycated albumin (GA), hemoglobin A1c (HbA1c ) and the GA : HbA1c ratio - with global brain and hippocampal atrophy in a general elderly Japanese population. MATERIALS AND METHODS A total of 1,278 Japanese individuals aged ≥65 years in a community participated in brain magnetic resonance imaging scanning and screening examination of health status in 2012. We measured total brain volume (TBV), hippocampal volume (HV) and intracranial volume (ICV) using the data from the magnetic resonance imaging examination. The association of each glycemic measure with the ratios of TBV : ICV (an indicator of global brain atrophy) and HV : ICV (an indicator of hippocampal atrophy) was examined by analysis of covariance. RESULTS The mean values of the TBV : ICV and HV : ICV ratios decreased significantly with elevating serum GA levels and GA : HbA1c ratio levels (all P for trend < 0.05), but not with higher HbA1c levels, after adjusting for age, sex, low education, systolic blood pressure, antihypertensive medication, diabetes mellitus, serum total cholesterol, electrocardiogram abnormalities, body mass index, smoking habits, alcohol drinking habits and regular exercise. These significant associations were still observed in the sensitivity analysis after excluding individuals with mild cognitive impairment and dementia. In addition, increased serum GA levels and the GA : HbA1c ratio levels, but not HbA1c , were closely associated with lower mean values of the TBV : ICV and HV : ICV ratios, irrespective of the presence or absence of diabetes mellitus. CONCLUSIONS The present study suggests that higher serum GA and higher GA : HbA1c ratio are significantly associated with global brain and hippocampal atrophy.
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Grants
- JP19dk0207025 Japan Agency for Medical Research and Development
- JP19ek0210080 Japan Agency for Medical Research and Development
- JP19ek0210082 Japan Agency for Medical Research and Development
- JP19ek0210083 Japan Agency for Medical Research and Development
- JP19fk0108075 Japan Agency for Medical Research and Development
- JP19km0405202 Japan Agency for Medical Research and Development
- H29-Junkankitou-Ippan-003 Health and Labour Sciences Research Grants of the Ministry of Health, Labour and Welfare of Japan
- H30-Shokuhin-[Sitei]-005 Health and Labour Sciences Research Grants of the Ministry of Health, Labour and Welfare of Japan
- JP16H02692 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP16H05850 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP17H04126 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP17K01853 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP17K09113 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP17K09114 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP18H02737 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP18K07565 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP18K09412 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP18K17382 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP18K17925 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- JP19K07890 Grants-in-Aid for Scientific Research of the Ministry of Education, Culture, Sports, Science and Technology of Japan
- Japan Agency for Medical Research and Development
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Affiliation(s)
- Tomoyuki Ohara
- Department of NeuropsychiatryGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yoshihiko Furuta
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Medicine and Clinical ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Naoki Hirabayashi
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Psychosomatic MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Jun Hata
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Medicine and Clinical ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Center for Cohort StudiesGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yoichiro Hirakawa
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Medicine and Clinical ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Takanori Honda
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Daigo Yoshida
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Mao Shibata
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Psychosomatic MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Center for Cohort StudiesGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Takanari Kitazono
- Department of Medicine and Clinical ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Center for Cohort StudiesGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public HealthGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Center for Cohort StudiesGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
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18
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Hayashi A, Shichiri M. Use of Noncontact Infrared Skin Thermometer for Peripheral Arterial Disease Screening in Patients With and Without Diabetes. Angiology 2020; 71:650-657. [DOI: 10.1177/0003319720920162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Peripheral arterial disease (PAD) poses a threat of limb amputation and cardiovascular events. However, PAD diagnostic procedure requiring time, cost, and technical skills preclude its application as a screening test in the general population. Although PAD tends to be associated with lower foot skin temperature, none has yet to appreciate its usefulness for diagnosis/screening. We measured foot skin temperatures at the first and fifth metatarsal head and heel areas using noncontact infrared thermometer at the time of ankle brachial pressure index (ABI) measurement and limb arterial ultrasonography in 176 patients (345 legs) in participants. Foot skin temperatures correlated with ABI and showed distinctly lower levels in legs with ultrasound-confirmed arterial stenosis/occlusion and in those with ABI ≤0.90. Receiver operating characteristics analyses revealed that the lowest temperature value of the 3-foot locations had a higher sensitivity than every single location in detecting lower extremity PAD. Diagnostic efficiency for the ABI cutoff of 0.90 showed sensitivity/specificity of 41%/94%, while that for the lowest skin temperature cutoff of 30.8°C showed sensitivity/specificity of 60%/64%. In conclusion, an accurate skin temperature measurement using noncontact handheld infrared skin thermometer could serve as a new, cost-effective screening strategy for earlier diagnosis of PAD.
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Affiliation(s)
- Akinori Hayashi
- The Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Masayoshi Shichiri
- The Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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19
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Livingstone R, Boyle JG, Petrie JR. How tightly controlled do fluctuations in blood glucose levels need to be to reduce the risk of developing complications in people with Type 1 diabetes? Diabet Med 2020; 37:513-521. [PMID: 30697804 DOI: 10.1111/dme.13911] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 12/12/2022]
Abstract
In 2011, the James Lind Alliance published a 'top 10' list of priorities for Type 1 diabetes research based on a structured consultation process. Whether reducing fluctuations in blood glucose can prevent long-term microvascular and macrovascular complications was one of these. In this narrative review, 8 years on, we have assessed the updated evidence for the assertion that increased glucose variability plays an independent and clinically important role in the complications of Type 1 diabetes, over and above mean blood glucose and the effects of hypoglycaemia: the 'glucose variability hypothesis'. Although studies in cultured cells and ex vivo vessels have been suggestive, most studies in Type 1 diabetes have been small and/or cross-sectional, and based on 'finger-prick' glucose measurements that capture glucose variability only in waking hours and are affected by missing data. A recent analysis of the Diabetes Control and Complications Trial that formally imputed missing data found no independent effect of short-term glucose variability on long-term complications. Few other high-quality longitudinal studies have directly addressed the glucose variability hypothesis in Type 1 diabetes. We conclude that there is little substantial evidence to date to support this hypothesis in Type 1 diabetes, although increasing use of continuous glucose monitoring provides an opportunity to test it more definitively. In the meantime, we recommend that control of glycaemia in Type 1 diabetes should continue to focus on the sustained achievement of target HbA1c and avoidance of hypoglycaemia.
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Affiliation(s)
- R Livingstone
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - J G Boyle
- School of Medicine, University of Glasgow, Glasgow, UK
- Glasgow Royal Infirmary, Glasgow, UK
| | - J R Petrie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
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20
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Kobayashi Y, Suzuki R, Yasukawa K, Oba K, Yamauchi T, Yatomi Y, Kadowaki T. Oxidized albumin in blood reflects the severity of multiple vascular complications in diabetes mellitus. Metabol Open 2020; 6:100032. [PMID: 32812907 PMCID: PMC7424782 DOI: 10.1016/j.metop.2020.100032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023] Open
Abstract
Albumin has an oxidized form, known as non-mercaptalbumin (HNA), which reflects systemic oxidative stress. The association between serum HNA levels and diabetic complications are yet to be reported. In this cross-sectional study, we investigated 164 diabetic subjects to assess the correlation between HNA% (the proportion in the total albumin) and various clinical parameters. HNA% was significantly associated with the severity of multiple complications including neuropathy (23.3 ± 4.1% vs 26.2 ± 5.1%) and nephropathy (24.1 ± 3.9%, 24.6 ± 4.2%, 28.5 ± 6.1%, 31.3 ± 5.7%, 37.8 ± 2.9%, stage 1/2/3/4/5, respectively). These findings highlight the universal importance of oxidative stress, indicating HNA% potential as a versatile marker of the severity of diabetic complications.
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Affiliation(s)
- Yuka Kobayashi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Suzuki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Diabetes, Metabolism and Endocrinololy, Tokyo Medical University, Tokyo, Japan
| | - Keiko Yasukawa
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Koji Oba
- Graduate School of Interdisciplinary Information Studies, Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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21
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Kohata Y, Ohara M, Nagaike H, Fujikawa T, Osaka N, Goto S, Fukase A, Kushima H, Hiromura M, Terasaki M, Mori Y, Fukui T, Ouchi M, Suzuki T, Hirano T, Yamagishi SI. Association of Hemoglobin A1c, 1,5-Anhydro-D-Glucitol and Glycated Albumin with Oxidative Stress in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study. Diabetes Ther 2020; 11:655-665. [PMID: 31997224 PMCID: PMC7048877 DOI: 10.1007/s13300-020-00772-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Oxidative stress plays a central role in the development and progression of vascular complications in patients with type 2 diabetes mellitus (T2DM). We have previously shown that markers of glucose variability evaluated by continuous glucose monitoring (CGM) are positively associated with oxidative stress in patients with T2DM. However, the evaluation of the glycemic variability by CGM remains a time- and money-consuming procedure. Therefore, this study investigated the independent correlates of oxidative stress among various other clinical markers routinely measured in primary care. METHODS This was a retrospective cross-sectional study with 234 T2DM patients to examine which clinical variables, including 1,5-anhydro-D-glucitol (1,5-AG) and glycated albumin (GA), were independently associated with oxidative stress. Oxidative stress was measured using the diacron-reactive oxygen metabolites (d-ROMs) test. The relationships between d-ROMs and clinical factors, such as blood glucose, glycated hemoglobin (HbA1c), 1,5-AG, GA, lipid parameters, and blood pressure, were examined. RESULTS Multiple stepwise regression analysis revealed that 1,5-AG (inversely), GA, triglycerides, use of metformin and being female were independently associated with d-ROMs. When patients with T2DM were stratified into two groups with HbA1c < 8.0% and HbA1c ≥ 8.0%, 1,5-AG (inversely), HbA1c, use of metformin and being female were independently associated with d-ROMs in diabetes patients with HbA1c < 8.0%, whereas GA, fasting plasma glucose and being female were independently associated with d-ROMs in patients with HbA1c ≥ 8.0%. CONCLUSION Our present study suggests that 1,5-AG and GA are the strongest correlates of oxidative stress in patients with well and poorly controlled T2DM, respectively.
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Affiliation(s)
- Yo Kohata
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Makoto Ohara
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan.
| | - Hiroe Nagaike
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Tomoki Fujikawa
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Naoya Osaka
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Goto
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Ayako Fukase
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Hideki Kushima
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Munenori Hiromura
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Michishige Terasaki
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Yusaku Mori
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Tomoyasu Fukui
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Motoshi Ouchi
- Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Tatsuya Suzuki
- Division of Geriatric Medicine, Nippon Medical School, Tokyo, Japan
| | - Tsutomu Hirano
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
- Diabetes Center, Ebina General Hospital, Ebina, Japan
| | - Sho-Ichi Yamagishi
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
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22
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Lv W, Wang X, Xu Q, Lu W. Mechanisms and Characteristics of Sulfonylureas and Glinides. Curr Top Med Chem 2020; 20:37-56. [PMID: 31884929 DOI: 10.2174/1568026620666191224141617] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/30/2019] [Accepted: 09/22/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus is a complex progressive endocrine disease characterized by hyperglycemia and life-threatening complications. It is the most common disorder of pancreatic cell function that causes insulin deficiency. Sulfonylurea is a class of oral hypoglycemic drugs. Over the past half century, these drugs, together with the subsequent non-sulfonylureas (glinides), have been the main oral drugs for insulin secretion. OBJECTIVE Through in-depth study, the medical profession considers it as an important drug for improving blood sugar control. METHODS The mechanism, characteristics, efficacy and side effects of sulfonylureas and glinides were reviewed in detail. RESULTS Sulfonylureas and glinides not only stimulated the release of insulin from pancreatic cells, but also had many extrapanular hypoglycemic effect, such as reducing the clearance rate of insulin in liver, reducing the secretion of glucagon, and enhancing the sensitivity of peripheral tissues to insulin in type 2 diabetes mellitus. CONCLUSION Sulfonylureas and glinides are effective first-line drugs for the treatment of diabetes mellitus. Although they have the risk of hypoglycemia, weight gain and cardiovascular disease, their clinical practicability and safety can be guaranteed as long as they are reasonably used.
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Affiliation(s)
- Wei Lv
- School of Materials Science and Engineering, Shanghai University, Shanghai, China.,Shanghai Huayi Resins Co., Ltd., Shanghai, China
| | - Xianqing Wang
- Charles Institute of Dermatology, University College Dublin, Dublin D04 V1W8, Ireland
| | - Qian Xu
- Charles Institute of Dermatology, University College Dublin, Dublin D04 V1W8, Ireland
| | - Wencong Lu
- School of Materials Science and Engineering, Shanghai University, Shanghai, China
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23
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Momozono A, Kodera Y, Sasaki S, Nakagawa Y, Konno R, Shichiri M. Oxidised Met 147 of human serum albumin is a biomarker of oxidative stress, reflecting glycaemic fluctuations and hypoglycaemia in diabetes. Sci Rep 2020; 10:268. [PMID: 31937809 PMCID: PMC6959251 DOI: 10.1038/s41598-019-57095-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022] Open
Abstract
Oxidative stress has been linked to a number of chronic diseases, and this has aroused interest in the identification of clinical biomarkers that can accurately assess its severity. We used liquid chromatography-high resolution mass spectrometry (LC-MS) to show that oxidised and non-oxidised Met residues at position 147 of human serum albumin (Met147) can be accurately and reproducibly quantified with stable isotope-labelled peptides. Met147 oxidation was significantly higher in patients with diabetes than in controls. Least square multivariate analysis revealed that glycated haemoglobin (HbA1c) and glycated albumin (GA) did not significantly influence Met147 oxidation, but the GA/HbA1c ratio, which reflects glycaemic excursions, independently affected Met147 oxidation status. Continuous glucose monitoring revealed that Met147 oxidation strongly correlates with the standard deviation of sensor glucose concentrations and the time spent with hypoglycaemia or hyperglycaemia each day. Thus, glycaemic variability and hypoglycaemia in diabetes may be associated with greater oxidation of Met147. Renal function, high-density lipoprotein-cholesterol and serum bilirubin were also associated with the oxidation status of Met147. In conclusion, the quantification of oxidised and non-oxidised Met147 in serum albumin using our LC-MS methodology could be used to assess the degree of intravascular oxidative stress induced by hypoglycaemia and glycaemic fluctuations in diabetes.
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Affiliation(s)
- Akari Momozono
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.,Department of Physics and Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.,Center for Disease Proteomics, Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Yoshio Kodera
- Department of Physics and Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.,Center for Disease Proteomics, Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Sayaka Sasaki
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.,Department of Physics and Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.,Center for Disease Proteomics, Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Yuzuru Nakagawa
- Department of Physics and Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Ryo Konno
- Department of Physics and Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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24
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Yoshino S, Fujimoto K, Takada T, Kawamura S, Ogawa J, Kamata Y, Kodera Y, Shichiri M. Molecular form and concentration of serum α 2-macroglobulin in diabetes. Sci Rep 2019; 9:12927. [PMID: 31506491 PMCID: PMC6736885 DOI: 10.1038/s41598-019-49144-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 08/08/2019] [Indexed: 01/17/2023] Open
Abstract
α2-Macroglobulin is a highly abundant serum protein involved in the development of atherosclerosis and cardiac hypertrophy. However, its circulating molecular form and exact concentrations in human health/diseases are not known. Blue native-polyacrylamide gel electrophoresis of human serum was used to confirm the native conformation of α2-macroglobulin. We created an enzyme-linked immunosorbent assay suitable for quantifying its circulating molecular form and undertook a cross-sectional study to measure its serum levels in 248 patients with diabetes mellitus and 59 healthy volunteers. The predominant circulating molecular form of α2-macroglobulin was the tetramer, whereas its dimer was detectable in patients with high serum levels of α2-macroglobulin. The serum α2-macroglobulin concentration was not associated with glycated hemoglobin or any other glycemic variable as evaluated from 48-h continuous glucose monitoring, but showed close correlation with left ventricular posterior wall thickness, carotid artery intima-media thickness, urinary albumin:creatinine ratio (ACR) and brachial–ankle pulse wave velocity (baPWV). Multivariate analysis revealed only the ACR and baPWV to be independent variables influencing serum levels of α2-macroglobulin. Thus, an increased ACR and baPWV are associated with higher serum concentrations of α2-macroglobulin, and the latter may contribute to the mechanism by which albuminuria increases the risk of developing cardiovascular diseases.
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Affiliation(s)
- Sonomi Yoshino
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kazumi Fujimoto
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.,Laboratory of Biomolecular Physics, Department of Physics, & Center for Disease Proteomics, Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Tesshu Takada
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.,Department of Endocrinology, Diabetes and Metabolism, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan
| | - Sayuki Kawamura
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Junro Ogawa
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan
| | - Yuji Kamata
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yoshio Kodera
- Laboratory of Biomolecular Physics, Department of Physics, & Center for Disease Proteomics, Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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25
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Omori K, Nomoto H, Nakamura A, Takase T, Cho KY, Ono K, Manda N, Kurihara Y, Aoki S, Atsumi T, Miyoshi H. Reduction in glucose fluctuations in elderly patients with type 2 diabetes using repaglinide: A randomized controlled trial of repaglinide vs sulfonylurea. J Diabetes Investig 2019; 10:367-374. [PMID: 29963781 PMCID: PMC6400204 DOI: 10.1111/jdi.12889] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/07/2018] [Accepted: 06/19/2018] [Indexed: 01/01/2023] Open
Abstract
AIMS/INTRODUCTION Glinides are antidiabetic drugs that enhance the early phase of insulin secretion, but have been considered to be less effective at lowering blood glucose than sulfonylureas. However, glinides show a lower risk of hypoglycemia and a greater effect on postprandial hyperglycemia, and are particularly recommended for use in elderly patients with type 2 diabetes. We investigated the efficacy and safety of repaglinide compared with sulfonylurea for the treatment of elderly patients. MATERIALS AND METHODS In the present multicenter, prospective, randomized, open-label, controlled trial, 57 elderly lean patients with type 2 diabetes who were being treated with sulfonylureas were studied. They were either switched to repaglinide (Repa group) or continued a sulfonylurea (SU group) for 12 weeks. The primary outcome comprised the change in glycemic control, and among the secondary outcomes was the presence of hypoglycemia and drug compliance. RESULTS Although glycated hemoglobin (HbA1c) was not significantly different between the two groups (SU +0.02% vs Repa -0.07%), greater improvements in the glycated albumin (GA) and GA to HbA1c ratio (GA/HbA1c) were observed in the Repa group (ΔGA, SU +0.12% vs Repa -1.15%; ΔGA/HbA1c, SU +0.01 vs Repa -0.13; each P < 0.01) without increasing hypoglycemia. When the Repa group was subdivided according to whether GA improved, the SU dose before switching to repaglinide was significantly smaller and the homeostatic model assessment of β-cell function was significantly higher in the GA improvement subgroup. CONCLUSIONS Switching from SU to Repa improved GA and GA/HbA1c, and had favorable effects on glucose fluctuation in elderly patients with type 2 diabetes.
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Affiliation(s)
- Kazuno Omori
- Department of Rheumatology, Endocrinology and NephrologyFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Hiroshi Nomoto
- Department of Rheumatology, Endocrinology and NephrologyFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
- Kuriyama Red Cross HospitalKuriyamaJapan
| | - Akinobu Nakamura
- Department of Rheumatology, Endocrinology and NephrologyFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Takahiro Takase
- Department of Rheumatology, Endocrinology and NephrologyFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Kyu Yong Cho
- Department of Rheumatology, Endocrinology and NephrologyFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
- Oki Medical ClinicTomakomaiJapan
| | - Kota Ono
- Clinical Research and Medical Innovation CenterHokkaido University HospitalSapporoJapan
| | | | | | | | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and NephrologyFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Hideaki Miyoshi
- Department of Rheumatology, Endocrinology and NephrologyFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
- Division of Diabetes and ObesityFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
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26
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Takai M, Anno T, Kawasaki F, Kimura T, Hirukawa H, Mune T, Okimoto N, Kaku K, Kaneto H. Association of the Glycemic Fluctuation as well as Glycemic Control with the Pancreatic β-cell Function in Japanese Subjects with Type 2 Diabetes Mellitus. Intern Med 2019; 58:167-173. [PMID: 30146574 PMCID: PMC6378157 DOI: 10.2169/internalmedicine.1053-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective It is important to preserve the pancreatic β-cell function in order to maintain good glycemic control for a long period. The aim of this study was to examine which factors are associated with the β-cell function in subjects with type 2 diabetes mellitus. Methods A total of 372 subjects with type 2 diabetes who had been hospitalized for the amelioration of their glycemic control and/or education about diabetes in Kawasaki Medical School Hospital were included in this study. We evaluated the remnant β-cell function as the HOMA-%β using the computer software program HOMA2 and estimated the glycemic fluctuation with the glycoalbumin (GA)/hemoglobin A1c (HbA1c) ratio. In addition, we divided the subjects into a relatively young group (<65 years old) (n=210) and an elderly group (≥65 years old) (n=162) and performed several analyses in each group. Results The GA/HbA1c ratio, GA and HbA1c were independent determinant factors for the HOMA-%β regardless of age. We obtained almost the same results even after excluding those subjects using insulin secretagogues. These data suggest that the glycemic fluctuation and glycemic control are associated with the remnant β-cell function in Japanese subjects with type 2 diabetes. Conclusion It is very important to reduce glycemic fluctuation as well as to maintain good glycemic control in order to preserve β-cell function in subjects with type 2 diabetes.
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Affiliation(s)
- Maiko Takai
- Department of General Internal Medicine 1, Kawasaki Medical School, Japan
| | - Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, Japan
| | - Fumiko Kawasaki
- Department of General Internal Medicine 1, Kawasaki Medical School, Japan
| | - Tomohiko Kimura
- Department of Diabete, Metabolism and Endocrinology, Kawasaki Medical School, Japan
| | - Hidenori Hirukawa
- Department of Diabete, Metabolism and Endocrinology, Kawasaki Medical School, Japan
| | - Tomoatsu Mune
- Department of Diabete, Metabolism and Endocrinology, Kawasaki Medical School, Japan
| | - Niro Okimoto
- Department of General Internal Medicine 1, Kawasaki Medical School, Japan
| | - Kohei Kaku
- Department of General Internal Medicine 1, Kawasaki Medical School, Japan
| | - Hideaki Kaneto
- Department of Diabete, Metabolism and Endocrinology, Kawasaki Medical School, Japan
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27
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Gan T, Liao B, Xu G. The clinical usefulness of glycated albumin in patients with diabetes and chronic kidney disease: Progress and challenges. J Diabetes Complications 2018; 32:876-884. [PMID: 30049445 DOI: 10.1016/j.jdiacomp.2018.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/25/2018] [Accepted: 07/07/2018] [Indexed: 12/12/2022]
Abstract
Prolonged hyperglycemia leads to a non-enzymatic glycation of proteins, and produces Amadori products, such as glycated albumin (GA) and glycated hemoglobin (HbA1c). The utility of HbA1c in the setting of chronic kidney disease (CKD) may be problematic since altered lifespan of red blood cells, use of iron and/or erythropoietin therapy, uremia and so on. Therefore, as an alternative marker, GA has been suggested as a more reliable and sensitive glycemic index in patients with CKD. In addition to the mean plasma glucose concentration, GA also reflects postprandial plasma glucose and glycemic excursion. Besides, with a half-life of approximately 2-3 weeks, GA may reflect the status of blood glucose more rapidly than HbA1c. GA is also an early precursor of advanced glycation end products (AGEs), which cause alterations in various cellular proteins and organelles. Thus, high GA levels may correlate with adverse outcomes of patients with CKD. In this review, the clinical usefulness of GA was discussed, including a comparison of GA with HbA1c, the utility and limitations of GA as a glycemic index, its potential role in pathogenesis of diabetic nephropathy and the correlations between GA levels and outcomes, specifically in patients with diabetes and CKD.
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Affiliation(s)
- Ting Gan
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Grade 2014, the First Clinical Medical College of Nanchang University, Nanchang, China
| | - Baoying Liao
- Grade 2014, the First Clinical Medical College of Nanchang University, Nanchang, China
| | - Gaosi Xu
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
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Elevated urinary N-acetyl-β-D-glucosaminidase is associated with high glycoalbumin-to-hemoglobin A1c ratio in type 1 diabetes patients with early diabetic kidney disease. Sci Rep 2018; 8:6710. [PMID: 29712934 PMCID: PMC5928247 DOI: 10.1038/s41598-018-25023-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/12/2018] [Indexed: 01/23/2023] Open
Abstract
Urinary N-acetyl-β-D-glucosaminidase (uNAG) predicted the progression of diabetic kidney disease (DKD) prior to development of albuminuria in diabetes patients. We sought whether uNAG level is associated with glycoalbumin-to-hemoglobin A1c ratio (G/A ratio), a marker of postprandial hyperglycemia and glycemic excursion, independent of albuminuria and kidney function. The association between uNAG excretion and G/A ratio was assessed in 204 consecutive subjects with type 1 diabetes (T1D) (mean age 43.9 years; 49.0% men). uNAG excretion level increased along with older age, hyperglycemia, and degree of albuminuria, but was not correlated with body mass index or estimated glomerular filtration rate (eGFR). Elevated uNAG showed robust association with higher G/A ratio (adjusted β = 0.103, P = 0.020) after adjustment for age, sex, body mass index, duration of diabetes, uACR, angiotensin blockers use, fasting plasma glucose, and hemoglobin level. uNAG showed better discriminatory performance for individuals with high G/A ratio than albuminuria (AUC 0.613 vs. 0.518, P = 0.038). Measurement of uNAG improved AUC for high G/A ratio from 0.699 to 0.748 (P = 0.043) when added to conventional risk factors (cutoff 5.24 U/g creatinine; sensitivity 62.5% and specificity 58.0%). In conclusion, Elevated uNAG was found to be associated with high G/A ratio in patients with T1D with early stage DKD, independent of age and albuminuria.
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Bellia C, Zaninotto M, Cosma C, Agnello L, Bivona G, Marinova M, Lo Sasso B, Plebani M, Ciaccio M. Clinical usefulness of Glycated Albumin in the diagnosis of diabetes: Results from an Italian study. Clin Biochem 2018; 54:68-72. [PMID: 29486186 DOI: 10.1016/j.clinbiochem.2018.02.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/15/2018] [Accepted: 02/24/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Glycated Albumin (GA) has been proposed as a screening marker for diabetes in Asian countries in the last years. Nevertheless, few studies have been conducted in Caucasian population. The aim of this study is to evaluate the clinical usefulness of GA in diabetes diagnosis in Caucasian asymptomatic subjects considered at risk of diabetes based on medical history and Fasting Plasma Glucose (FPG). DESIGN AND METHODS Three hundred and thirty-four Caucasian subjects having one or more risk factor for diabetes, and/or FPG ranging from 5.6 mmol/L to 6.9 mmol/L with no symptoms for diabetes were enrolled in this study. Plasma GA was measured by an enzymatic method (quantILab Glycated Albumin) on ILab Taurus instrument (Instrumentation Laboratory - A Werfen Company). RESULTS GA median levels were 13.2% (IQR:12.2-14.4). Eighteen subjects (5.4%) were classified as diabetics based on their HbA1c. According to the ROC curve analysis, GA identified subjects with diabetes with a sensitivity of 72.2% (95% CI: 46.5-90.3) and a specificity of 71.8% (95% CI: 66.5-76.7) (AUC: 0.80; 95% CI: 0.75-0.84; P < 0.0001) at the cut-off of 14%. The cut-off of 13.5% was associated to a higher sensitivity 88.9% (95%CI: 65.3-98.6) and a specificity of 60.4% (95%CI, 54.8-65.9). CONCLUSIONS This study confirms the clinical usefulness of GA for the diagnosis of diabetes in Caucasian subjects at risk for diabetes. More studies are required to clarify the role of GA in relation to the other diagnostic criteria for diabetes.
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Affiliation(s)
- Chiara Bellia
- Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, University of Palermo, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital, Padova, Italy
| | - Chiara Cosma
- Department of Laboratory Medicine, University-Hospital, Padova, Italy
| | - Luisa Agnello
- Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, University of Palermo, Italy
| | - Giulia Bivona
- Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, University of Palermo, Italy
| | - Mariela Marinova
- Department of Laboratory Medicine, University-Hospital, Padova, Italy
| | - Bruna Lo Sasso
- Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, University of Palermo, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital, Padova, Italy
| | - Marcello Ciaccio
- Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, University of Palermo, Italy; Department of Laboratory Medicine, University-Hospital, Palermo, Italy.
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Shohat N, Tarabichi M, Tischler EH, Jabbour S, Parvizi J. Serum Fructosamine: A Simple and Inexpensive Test for Assessing Preoperative Glycemic Control. J Bone Joint Surg Am 2017; 99:1900-1907. [PMID: 29135663 DOI: 10.2106/jbjs.17.00075] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the medical community acknowledges the importance of preoperative glycemic control, the literature is inconclusive and the proper metric for assessment of glycemic control remains unclear. Serum fructosamine reflects the mean glycemic control in a shorter time period compared with glycated hemoglobin (HbA1c). Our aim was to examine its role in predicting adverse outcomes following total joint arthroplasty. METHODS Between 2012 and 2013, we screened all patients undergoing total joint arthroplasty preoperatively using serum HbA1c, fructosamine, and blood glucose levels. On the basis of the recommendations of the American Diabetes Association, 7% was chosen as the cutoff for HbA1c being indicative of poor glycemic control. This threshold correlated with a fructosamine level of 292 μmol/L. All patients were followed and total joint arthroplasty complications were evaluated. We were particularly interested in retrieving details on surgical-site infection (superficial and deep). Patients with fructosamine levels of ≥292 μmol/L were compared with those with fructosamine levels of <292 μmol/L. Complications were evaluated in a univariate analysis followed by a stepwise logistic regression analysis. RESULTS A total of 829 patients undergoing primary total joint arthroplasty were included in the present study. There were 119 patients (14.4%) with a history of diabetes and 308 patients (37.2%) with HbA1c levels in the prediabetic range. Overall, 51 patients had fructosamine levels of ≥292 μmol/L. Twenty patients (39.2%) had a fructosamine level of ≥292 μmol/L but did not have an HbA1c level of ≥7%. Patients with fructosamine levels of ≥292 μmol/L had a significantly higher risk for deep infection (adjusted odds ratio [OR], 6.2 [95% confidence interval (CI), 1.6 to 24.0]; p = 0.009), readmission (adjusted OR, 3.0 [95% CI, 1.1 to 8.1]; p = 0.03), and reoperation (adjusted OR, 3.4 [95% CI, 1.2 to 9.2]; p = 0.02). In the current study with the given sample size, HbA1c levels of ≥7% failed to show any significant correlation with deep infection (p = 0.14), readmission (p = 1.0), or reoperation (p = 0.7). CONCLUSIONS Serum fructosamine is a simple and inexpensive test that appears to be a good predictor of adverse outcome in patients with known diabetes and those with unrecognized diabetes or hyperglycemia. Our findings suggest that fructosamine can serve as an alternative to HbA1c in the setting of preoperative glycemic assessment. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Noam Shohat
- 1The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania 2Tel Aviv University, Tel Aviv, Israel 3Department of Endocrinology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Fujimoto K, Hayashi A, Kodera Y, Saito T, Toki T, Ogawa A, Kamata Y, Takano K, Katakami H, Shichiri M. Identification and quantification of plasma free salusin-β, an endogenous parasympathomimetic peptide. Sci Rep 2017; 7:8275. [PMID: 28811505 PMCID: PMC5557946 DOI: 10.1038/s41598-017-08288-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
Salusin-β is an endogenous parasympathomimetic proatherosclerotic peptide. Salusin-β was initially predicted from bioinformatic analyses and later immunologically detected in human biofluids. However, elucidation of salusin-β bioactivity has faced enormous challenges because of its unique physicochemical characteristics that cause it to strongly adhere to laboratory apparatus materials. In the strictest sense, the discovery of bioactive peptides is not complete until their exact native sequences have been confirmed in the peripheral circulation. In this study, we determined the plasma molecular form and levels of free salusin-β to determine its pathophysiological significance. Ultra-high-yield enrichment and preseparation of non-tryptic human plasma was followed by LC-MS/MS, and full-length salusin-β and seven different endogenous fragment sequences were identified. We established a new ELISA that specifically detects plasma free salusin-β without cross-reacting with any of its identified endogenous fragments. Free salusin-β levels exhibited a profound early morning nadir and rapidly decreased in response to parasympathetic nervous augmentation. Our technical advance in plasma native peptide analysis successfully identified a hard-to-detect bioactive peptide, salusin-β, together with its formerly unrecognized fragments, and further suggests that conventional immunological measurements of target peptides may not be fully representative.
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Affiliation(s)
- Kazumi Fujimoto
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Akinori Hayashi
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yoshio Kodera
- Department of Physics, Laboratory of Biophysics, Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.,Center for Disease Proteomics, Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Tatsuya Saito
- Department of Physics, Laboratory of Biophysics, Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.,Center for Disease Proteomics, Kitasato University School of Science, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Takuya Toki
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Akifumi Ogawa
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yuji Kamata
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Koji Takano
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hideki Katakami
- Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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Mukai N, Ohara T, Hata J, Hirakawa Y, Yoshida D, Kishimoto H, Koga M, Nakamura U, Kitazono T, Kiyohara Y, Ninomiya T. Alternative Measures of Hyperglycemia and Risk of Alzheimer's Disease in the Community: The Hisayama Study. J Clin Endocrinol Metab 2017; 102:3002-3010. [PMID: 28605542 DOI: 10.1210/jc.2017-00439] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/05/2017] [Indexed: 02/05/2023]
Abstract
CONTEXT AND OBJECTIVE We investigated the associations of hemoglobin A1c (HbA1c), glycated albumin (GA), GA/HbA1c ratio, and 1,5-anhydroglucitol (1,5-AG) with the development of Alzheimer's disease (AD). DESIGN AND PARTICIPANTS A total of 1187 community-dwelling Japanese subjects aged ≥65 years without dementia were followed up for an average of 4.8 years. RESULTS The age- and sex-adjusted incidence of AD increased significantly with higher quartiles of GA/HbA1c ratio, and a similar tendency was seen for GA, whereas no such association was observed for HbA1c and 1,5-AG. After adjusting for potential confounding factors, positive association of GA/HbA1c ratio with the risk of AD remained significant: the multivariable-adjusted hazard ratio (HR) was significantly higher in the third [HR = 2.11, 95% confidence interval (CI) = 1.16 to 3.82] and fourth (HR = 2.01, 95% CI = 1.09 to 3.68) quartile than in the first quartile. Among subjects with normal glucose tolerance, those with high GA/HbA1c ratio had a higher risk of AD than those with low GA/HbA1c ratio (HR = 1.82, 95% CI = 1.05 to 3.16), and a similar tendency was found in those with glucose intolerance (HR = 1.73, 95% CI = 0.96 to 3.13). No such associations were observed for HbA1c, GA, and 1,5-AG, regardless of glucose tolerance status. CONCLUSIONS Our findings suggest that elevated GA/HbA1c ratio-but not HbA1c, GA, or 1,5-AG level-is significantly associated with the risk of AD in subjects both with and without glucose intolerance. GA/HbA1c ratio may be a useful biomarker for predicting incident AD.
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Affiliation(s)
- Naoko Mukai
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Tomoyuki Ohara
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Jun Hata
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yoichiro Hirakawa
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Daigo Yoshida
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hiro Kishimoto
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masafumi Koga
- Department of Internal Medicine, Hakuhokai Central Hospital, Hyogo 661-0953, Japan
| | - Udai Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Takanari Kitazono
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yutaka Kiyohara
- Hisayama Research Institute for Lifestyle Diseases, Fukuoka 812-8582, Japan
| | - Toshiharu Ninomiya
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Tamura Y, Kimbara Y, Yamaoka T, Sato K, Tsuboi Y, Kodera R, Chiba Y, Mori S, Fujiwara Y, Tokumaru AM, Ito H, Sakurai T, Araki A. White Matter Hyperintensity in Elderly Patients with Diabetes Mellitus Is Associated with Cognitive Impairment, Functional Disability, and a High Glycoalbumin/Glycohemoglobin Ratio. Front Aging Neurosci 2017; 9:220. [PMID: 28729834 PMCID: PMC5498506 DOI: 10.3389/fnagi.2017.00220] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/23/2017] [Indexed: 01/07/2023] Open
Abstract
Aims: Although evidence has accumulated that white matter hyperintensity (WMH) is associated with the deterioration of cognitive function and impairment of activities of daily living (ADL), the clinical relevance of WMH in elderly patients with diabetes mellitus (DM) is not still clear. The aim of this study was to examine whether WMH volume is associated with ADL and cognitive function and whether glucose control and glucose variability can affect WMH volume in these patients. Methods: This cross-sectional study investigated the associations of WMH with cognitive function and instrumental ADL (IADL), as well as metabolic and vascular risk factors in a total of 178 elderly patients with diabetes. The study assessed WMH volumes and the functional status of cognition and IADL. WMH volumes were evaluated by obtaining axial T2-weighted and fluid-attenuated inversion recovery sequence images on brain magnetic resonance imaging and assessing the images using Software for Neuro-Image Processing in Experimental Research. Results: We found a significant association between WMH volumes and Mini-Mental State Examination (MMSE) scores (p = 0.039) and between WMH and IADL status (p = 0.006). Furthermore, we found significant relations of large WMH volumes with a high glycoalbumin/glycohemoglobin ratio (GA/HbA1c) (p < 0.001). Large WMH volumes were also found to be associated with a low body mass index (p = 0.014) and a low diastolic blood pressure (p = 0.024), but not with HbA1c. Multiple regression analysis showed that high GA/HbA1c, which reflects high glucose variability, was a significant determining factor for large WMH volumes. We also found that GA/HbA1c was negatively associated with both MMSE (p = 0.036) and IADL (p < 0.001). Conclusion: GA/HbA1c, which is a marker of glucose variability, was independently associated with WMH volumes, which could lead to the decline of cognition and IADL in elderly patients with DM.
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Affiliation(s)
- Yoshiaki Tamura
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Yoshiyuki Kimbara
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Takuya Yamaoka
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Ken Sato
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Yuki Tsuboi
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Remi Kodera
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Yuko Chiba
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Seijiro Mori
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of GerontologyTokyo, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Hideki Ito
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and GerontologyAichi, Japan
| | - Atsushi Araki
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
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Association of glycated albumin to HbA1c ratio with diabetic retinopathy but not diabetic nephropathy in patients with type 2 diabetes. Clin Biochem 2017; 50:270-273. [DOI: 10.1016/j.clinbiochem.2016.11.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 11/26/2016] [Accepted: 11/28/2016] [Indexed: 11/20/2022]
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Wang N, Xu Z, Han P, Li T. Glycated albumin and ratio of glycated albumin to glycated hemoglobin are good indicators of diabetic nephropathy in type 2 diabetes mellitus. Diabetes Metab Res Rev 2017; 33. [PMID: 27537245 DOI: 10.1002/dmrr.2843] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 06/26/2016] [Accepted: 08/15/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND We investigated the association between serum levels of glycated albumin (GA), glycated hemoglobin (HbA1c ), and GA:HbA1c ratio and the presence of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). METHODS Two hundred six consecutive patients with T2DM were enrolled from the endocrinology ward at Shengjing Hospital of China Medical University and classified into 2 groups: DN group (n = 71) and non-diabetic nephropathy (non-DN) group (n = 135). RESULTS The DN group showed significantly higher GA and GA:HbA1c values compared with the non-DN group. After univariate logistic regression, GA, GA:HbA1c , HbA1c , age, T2DM duration, systolic blood pressure, diastolic blood pressure, triglycerides, mean blood glucose (from 7 blood glucose checks), and presence of retinopathy were selected for advanced analysis. A multivariate logistic regression analysis was performed to examine the association between the presence of DN and these variables. Glycated albumin, GA:HbA1c , duration, systolic blood pressure, mean blood glucose, and retinopathy (but not HbA1c ) were identified as independent variables that predicted the presence of DN. We then fitted the areas under the curve of GA:HbA1c and GA (0.811 and 0.754, respectively) separately using a receiver operating characteristic curve analysis. Both were better than HbA1c (0.580). We defined the cutoff value of GA:HbA1c as 2.71 (sensitivity 0.676, specificity 0.778) and that of GA as 17.5% (sensitivity 0.761, specificity 0.644) for the prediction of DN in patients with T2DM. CONCLUSIONS The GA:HbA1c ratio and GA may be superior to HbA1c associated with the presence of DN.
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Affiliation(s)
- Nana Wang
- Endocrinology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhen Xu
- Laboratory Medicine Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ping Han
- Endocrinology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tiegang Li
- Emergency Department, Shengjing Hospital of China Medical University, Shenyang, China
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Methionine sulfoxides in serum proteins as potential clinical biomarkers of oxidative stress. Sci Rep 2016; 6:38299. [PMID: 27929071 PMCID: PMC5144094 DOI: 10.1038/srep38299] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/07/2016] [Indexed: 02/02/2023] Open
Abstract
Oxidative stress contributes to the pathophysiology of a variety of diseases, and circulating biomarkers of its severity remains a topic of great interest for researchers. Our peptidomic strategy enables accurate and reproducible analysis of circulating proteins/peptides with or without post-translational modifications. Conventional wisdom holds that hydrophobic methionines exposed to an aqueous environment or experimental handling procedures are vulnerable to oxidation. However, we show that the mass spectra intensity ratio of oxidized to non-oxidized methionine residues in serum tryptic proteins can be accurately quantified using a single drop of human serum and give stable and reproducible results. Our data demonstrate that two methionine residues in serum albumin (Met-111 and Met-147) are highly oxidized to methionine sulfoxide in patients with diabetes and renal failure and in healthy smokers versus non-smoker controls. This label-free mass spectrometry approach to quantify redox changes in methionine residues should facilitate the identification of additional circulating biomarkers suitable for predicting the development or progression of human diseases.
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Masumoto N, Otsuki H, Iwakawa S, Inada S, Goya K, Sho H, Suzuki S, Kurebayashi S, Hashimoto K, Koga M. Effects of alogliptin on the ratio of glycated albumin to HbA1c in patients with type 2 diabetes mellitus. Diabetol Int 2016; 8:212-217. [PMID: 30603324 DOI: 10.1007/s13340-016-0298-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/13/2016] [Indexed: 01/29/2023]
Abstract
The ratio of glycated albumin (GA) to HbA1c (the GA/HbA1c ratio) has been used as a glycemic control indicator that reflects postprandial plasma glucose levels or glycemic variability. In this study, we investigated the effects of alogliptin, a DPP-4 inhibitor, on the GA/HbA1c ratio in patients with type 2 diabetes mellitus. Thirty-eight patients with type 2 diabetes mellitus whose glycemic control was stable were enrolled, and alogliptin (12.5 or 25 mg/day) was then administered to them for 24 weeks. HbA1c and GA levels both significantly decreased after 24 weeks (P < 0.0001), whereas the GA/HbA1c ratio did not (P = 0.129). No correlation was observed between the change in the GA/HbA1c ratio (the ΔGA/HbA1c ratio) and HbA1c or GA level before the administration of alogliptin; however, a negative correlation was found between the ΔGA/HbA1c ratio and the GA/HbA1c ratio before the administration of alogliptin (R = -0.322, P = 0.049). Although the GA/HbA1c ratio in the low-value group (<2.80) was not significantly affected by the administration of alogliptin, that in the high-value group (≥2.80) significantly decreased (P = 0.008). The administration of alogliptin significantly decreased the GA/HbA1c ratio in the high-value group after 24 weeks. Alogliptin may be more useful for patients with high postprandial plasma glucose levels than in those with low postplandial plasma glucose levels.
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Affiliation(s)
- Norio Masumoto
- Department of Pharmacy, Kawanishi City Hospital, 5-21-1, Higashiuneno, Kawanishi, Hyogo 666-0195 Japan
| | - Hiroaki Otsuki
- Department of Pharmacy, Kawanishi City Hospital, 5-21-1, Higashiuneno, Kawanishi, Hyogo 666-0195 Japan
| | - Seigo Iwakawa
- 2Department of Pharmaceutics, Kobe Pharmaceutical University, Kobe, Japan
| | - Shinya Inada
- Department of Internal Medicine, Kawanishi City Hospital, Kawanishi, Hyogo Japan
| | - Kayoko Goya
- Department of Internal Medicine, Nishinomiya Municipal Hospital, Nishinomiya, Hyogo Japan
| | - Hiroyuki Sho
- 5Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan
| | - Satoko Suzuki
- 5Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan
| | - Shogo Kurebayashi
- Department of Internal Medicine, Nishinomiya Municipal Hospital, Nishinomiya, Hyogo Japan
| | | | - Masafumi Koga
- Department of Internal Medicine, Hakuhokai Central Hospital, Amagasaki, Hyogo Japan
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Koga M, Inada S, Taniguchi J, Nakatani Y, Yoshino H, Yoshino G, Okauchi Y, Mineo I. High glycated albumin (GA) levels and the GA/HbA1c ratio in patients with insulin autoimmune syndrome. Diabetol Int 2016; 8:199-204. [PMID: 30603322 DOI: 10.1007/s13340-016-0294-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 10/23/2016] [Indexed: 11/26/2022]
Abstract
Insulin autoimmune syndrome (IAS) involves not only fasting hypoglycemia, but also postprandial hyperglycemia. In the present study, we hypothesized that glycated albumin (GA) levels and the GA/HbA1c ratio, which reflect fluctuations in plasma glucose levels, are elevated in IAS patients. Four IAS patients were enrolled in the present study. Thirty-two non-diabetic subjects matched for gender, age, and BMI were used as the control group. The fasting plasma glucose levels in the IAS patients were significantly lower than in the control group. However, the oral glucose tolerance test (OGTT) revealed impaired glucose tolerance or diabetes mellitus in all the IAS patients, and thus the OGTT 2-h plasma glucose levels were significantly higher than in the control group. The GA levels and the GA/HbA1c ratio in the IAS patients were significantly higher than in the control group, despite no significant difference in the HbA1c levels between the two groups. In one case in which IAS spontaneously went into remission, there was a significant correlation between anti-insulin antibodies and GA, but not HbA1c. Improvement in glucose fluctuations was observed by continuous glucose monitoring in another patient along with improvement in the clinical symptoms. Furthermore, anti-insulin antibodies, GA, and the GA/HbA1c ratio decreased, but HbA1c did not change significantly in three IAS patients along with the improvement in clinical symptoms. These results suggest that GA and the GA/HbA1c ratio are useful indicators for determining the level of disease activity in IAS patients.
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Affiliation(s)
- Masafumi Koga
- Department of Internal Medicine, Hakuhokai Central Hospital, 4-23-1 Higashisonodacho, Amagasaki, Hyogo 661-0953 Japan
| | - Shinya Inada
- Department of Internal Medicine, Kawanishi City Hospital, Hyogo, Japan
| | - Jun Taniguchi
- 3Department of Diabetes, Tokeidai Memorial Hospital, Sapporo, Japan
| | - Yuki Nakatani
- 4Department of Diabetes & Endocrinology, Dokkyo Medical University Nikko Medical Center, Tochigi, Japan
| | - Hiroshi Yoshino
- 5Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Gen Yoshino
- Center for Diabetes, Shin-Suma General Hospital, Kobe, Japan
| | | | - Ikuo Mineo
- 7Diabetes Center, Toyonaka Municipal Hospital, Osaka, Japan
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Hayashi A, Takano K, Masaki T, Yoshino S, Ogawa A, Shichiri M. Distinct biomarker roles for HbA 1c and glycated albumin in patients with type 2 diabetes on hemodialysis. J Diabetes Complications 2016; 30:1494-1499. [PMID: 27614726 DOI: 10.1016/j.jdiacomp.2016.08.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
AIMS HbA1c and glycated albumin (GA) are used to monitor glycemia, but their accuracy to represent glycemic profiles in hemodialysis remains controversial. METHODS Continuous glucose monitoring in 97 patients with type 2 diabetes (41 on hemodialysis [HD] and 56 without nephropathy) was analyzed to evaluate whether HbA1c and/or GA serve as appropriate glycemic profile markers. RESULTS The average glucose significantly correlated with HbA1c in both HD group and group without nephropathy (r=0.59, P<0.0001; r=0.40, P<0.005). The slopes of linear regression lines were statistically indistinguishable (F=0.30, P=0.744), while the y-intercepts were significantly different (F=57.86, P<0.0001). GA showed strong correlation with the glycemic standard deviation (r=0.68, P<0.0001), and with the average glucose (r=0.42, P<0.001). Least square analysis revealed that only HbA1c, but not GA, was significantly associated with the average glucose (F=10.20, P<0.0005; F=0.38, P=0.5427), while only GA was significantly associated with the glycemic variability in HD group. CONCLUSIONS In HD participants, HbA1c correlates with the average glucose more than GA, but underestimates it, and a correction formula of HbA1c can be developed as an appreciable marker. GA value itself reflects the average glucose, but less accurately than HbA1c, while it could serve as an indicator for hyperglycemia/hypoglycemia excursion.
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Affiliation(s)
- Akinori Hayashi
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Koji Takano
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tsuguto Masaki
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | - Sonomi Yoshino
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | - Akifumi Ogawa
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa, Japan
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Kinoshita T, Shimoda M, Sanada J, Fushimi Y, Hirata Y, Irie S, Tanabe A, Obata A, Kimura T, Hirukawa H, Kohara K, Tatsumi F, Kamei S, Nakanishi S, Mune T, Kaku K, Kaneto H. Association of GA/HbA1c ratio and cognitive impairment in subjects with type 2 diabetes mellitus. J Diabetes Complications 2016; 30:1452-1455. [PMID: 27591029 DOI: 10.1016/j.jdiacomp.2016.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to search for factors influencing cognitive impairment and to clarify the association between the fluctuation of blood glucose levels and cognitive impairment in elderly Japanese subjects with type 2 diabetes. METHODS We recruited 88 relatively elderly subjects (≥65years old) with type 2 diabetes who were hospitalized in Kawasaki Medical School from January 2014 to December 2015. We evaluated the fluctuation of blood glucose levels with glycoalbumin (GA)/hemoglobin A1c (HbA1c) ratio, and estimated cognitive impairment with Hasegawa dementia scale-revised (HDS-R) score and mini mental state examination (MMSE) score. RESULTS Multivariate analyses showed that GA/HbA1c ratio and urinary albumin excretion, but not hypoglycemia, were independent determinant factors for cognitive impairment in elderly Japanese subjects with type 2 diabetes. CONCLUSIONS The fluctuation of blood glucose levels per se is closely associated with cognitive impairment in elderly subjects with type 2 diabetes even when hypoglycemia is not accompanied. Since it is very easy to calculate GA/HbA1c ratio, we should check this ratio so that we can reduce the fluctuation of blood glucose levels especially in elderly subjects with type 2 diabetes.
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Affiliation(s)
- Tomoe Kinoshita
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Masashi Shimoda
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Junpei Sanada
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Yoshiro Fushimi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Yurie Hirata
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Shintaro Irie
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Akihito Tanabe
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Atsushi Obata
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Tomohiko Kimura
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Hidenori Hirukawa
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Kenji Kohara
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Fuminori Tatsumi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Shinji Kamei
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Shuhei Nakanishi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Tomoatsu Mune
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Kohei Kaku
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School.
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Pramodkumar TA, Jayashri R, Gokulakrishnan K, Velmurugan K, Pradeepa R, Anjana RM, Mohan V. Relationship of glycemic control markers - 1,5 anhydroglucitol, fructosamine, and glycated hemoglobin among Asian Indians with different degrees of glucose intolerance. Indian J Endocrinol Metab 2016; 20:690-695. [PMID: 27730082 PMCID: PMC5040052 DOI: 10.4103/2230-8210.190559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE 1,5 anhydroglucitol (1,5 AG) is emerging as a marker of short-term glycemic control. We measured levels of 1,5 AG, fructosamine (FA), and glycated hemoglobin (HbA1c) in Asian Indians with different degrees of glucose intolerance. MATERIALS AND METHODS We recruited 210 individuals with normal glucose tolerance (NGT; n = 60), impaired glucose tolerance (IGT; n = 50), and Type 2 diabetes mellitus (T2DM; n = 100) from a large tertiary diabetes center in Chennai in Southern India. Anthropometric measurements were obtained using standardized techniques. Serum 1,5 AG (enzymatic colorimetric assay), FA (NBT/kinetic), and HbA1c (high-performance liquid chromatography) estimations were performed. RESULTS 1,5 AG levels were significantly lower in the T2DM followed by IGT compared with the NGT group (7.9 vs. 18.8 vs. 21.8 µg/ml, P < 0.05). FA and HbA1c were higher in T2DM and IGT compared with NGT individuals (313 vs. 237 vs. 200 µmol/L, P < 0.001) (8.3 vs. 5.8 vs. 5.3%, P < 0.001).1,5 AG showed a significant negative correlation with FA (r = -0.618, P < 0.001) and HbA1c (r = -0.700, P < 0.001). 1,5 AG decreased with increasing quartiles of postprandial glucose (P for trend <0.001). However, even among individuals with HbA1c ≤7%, 27% individuals had decreased 1,5 AG plasma level (<10 µg/ml). CONCLUSION Circulatory levels of 1,5 AG correlate negatively with FA and HbA1c, and may provide an additional marker to assess glycemic control in patients with Type 2 diabetes.
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Affiliation(s)
| | - Ramamoorthy Jayashri
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Gopalapuram, Chennai, Tamil Nadu, India
| | - Kuppan Gokulakrishnan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Gopalapuram, Chennai, Tamil Nadu, India
| | - Kaliyaperumal Velmurugan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Gopalapuram, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Gopalapuram, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Gopalapuram, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Gopalapuram, Chennai, Tamil Nadu, India
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Yoneda C, Tashima-Horie K, Fukushima S, Saito S, Tanaka S, Haruki T, Ogino J, Suzuki Y, Hashimoto N. Association of morning fasting blood glucose variability with insulin antibodies and clinical factors in type 1 diabetes. Endocr J 2016; 63:603-9. [PMID: 27170092 DOI: 10.1507/endocrj.ej15-0647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The fasting blood glucose concentration in type 1 diabetes may vary without being much affected by diet and exercise. This study aimed to identify association of morning fasting blood glucose concentration variability with insulin antibodies and clinical factors. The subjects in this study were 54 patients with type 1 diabetes who had high variation of fasting blood glucose. The insulin antibody level was measured, and correlations of glycemic variability with antibody levels, binding rates, and other clinical factors were investigated. The standard deviation (SD) of the 30-day morning self-monitored fasting blood glucose concentration (FBG SD) was evaluated as an index of glycemic variability. The mean glucose level was 159.8±42.1 mg/dL and the FBG SD was 47.5±22.0 mg/dL. Glycemic variability (FBG SD) was positively correlated with insulin antibody level, but not with insulin antibody binding rate, and had a negative correlation with C-peptide immunoreactivity/plasma glucose (CPR/PG) and positive correlations with diabetes duration, basal insulin dose and bolus insulin dose. Glycemic variability was not correlated with BMI, HbA1c or age. In multiple regression analysis of glycemic variability, CPR/PG was the only significant related factor. The results showed that glycemic variability was mainly influenced by endogenous insulin secretion capacity and was high in patients with high insulin antibody levels. In some patients with a high insulin antibody titer, the antibody may have an effect on the variability of the fasting glucose concentration in type 1 diabetes.
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Affiliation(s)
- Chihiro Yoneda
- Department of Diabetes, Endocrine and Metabolic Diseases, Tokyo Women's Medical University, Yachiyo Medical Center, Yachiyo 276-8524, Japan
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Usefulness of glycated albumin in decisions regarding the discontinuation of a diabetes drug and factors associated with poor glycemic control following discontinuation in patients with type 2 diabetes mellitus. Diabetol Int 2016; 8:39-44. [PMID: 30603305 DOI: 10.1007/s13340-016-0274-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
We studied the usefulness of glycated albumin (GA) for decisions regarding the discontinuation of a diabetes drug in type 2 diabetic patients with good glycemic control, and the factors associated with increases in GA following discontinuation of a diabetes drug in patients with type 2 diabetes mellitus. Sixteen patients (12 males and 4 females) were enrolled in the present study and discontinued one diabetes drug. When the change in GA was less than 1 % at 4 weeks after the discontinuation of the diabetes drug (ΔGA4w), discontinuation was continued (the continuous group, n = 10), but when the change in GA was more than a 1 %, the discontinued diabetes drug was resumed (the resume group, n = 6). In the continuous group, HbA1c at 12 weeks after discontinuation (6.2 ± 0.6 %) remained unchanged from its value at discontinuation (6.2 ± 0.7 %) , but it was significantly elevated at 12 weeks after discontinuation in the resume group (changing from 6.3 ± 0.1 to 7.0 ± 0.6 %). Age, duration of diabetes, and GA were significantly lower while body mass index (BMI) was significantly higher in the continuous group than in the resume group, but no significant difference in HbA1c was observed between the groups. The discontinuation of a diabetes drug in patients with low insulin secretion must be performed carefully because factors such as duration of diabetes, BMI, and GA showed significant differences between the continuous group and resume group in our study, and these indicators are known to be linked with insulin secretion.
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Park S, Lee W, Chung HS, Hong KS. Diagnostic Utility of Serum Glycated Albumin for Diabetes Mellitus and Its Correlation With Hyperlipidemia. Ann Lab Med 2016; 36:306-12. [PMID: 27139602 PMCID: PMC4855049 DOI: 10.3343/alm.2016.36.4.306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 01/27/2016] [Accepted: 03/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Glycated albumin (GA) is a better marker of short-term glycemic control than glycated hemoglobin (A1c). Dyslipidemia is the main cause of cardiovascular complications in diabetes mellitus (DM). Studies on the correlation of GA with lipid indices are sparse. We investigated the diagnostic utility of GA for DM and its relationship with serum lipid profiles compared with that of A1c. METHODS The GA enzymatic method was used to determine the diagnostic utility of GA for DM by using samples from 163 normal subjects (group 1) and 102 patients newly diagnosed with type 2 DM (T2DM; group 2). To analyze the lipid profiles, 263 patients with T2DM receiving treatment (group 3) were recruited. RESULTS GA correlated with A1c (r=0.934, P<0.0001). Linear regression analysis indicated that GA levels were about 2.48 folds those of A1c. In the ROC analysis for GA to diagnose DM, the areas under the curve (0.988, 95% confidence interval 0.972-1.004) was excellent. HDL levels were significantly lower in groups 2 and 3. In group 1, positive correlations were observed between A1c and triglyceride (TG), total cholesterol (TC), LDL, TG/HDL, TC/HDL, and LDL/HDL levels. A negative correlation was observed between HDL and A1c levels. In group 3, HDL levels (P=0.0124 and P=0.0141, respectively) were significantly higher and LDL levels tended to be lower, not statistically significant, in the well-controlled group categorized using the A1c and GA cut-off values. CONCLUSIONS GA is a potential diagnostic tool for DM. Compared with A1c, GA seems less relevant to dyslipidemia.
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Affiliation(s)
- Sholhui Park
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Wookeun Lee
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hae Sun Chung
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ki Sook Hong
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
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Mo Y, Ma X, Li H, Ran X, Yang W, Li Q, Peng Y, Li Y, Gao X, Luan X, Wang W, Xie Y, Zhou J, Jia W. Relationship between glycated albumin and glycated hemoglobin according to glucose tolerance status: A multicenter study. Diabetes Res Clin Pract 2016; 115:17-23. [PMID: 27242118 DOI: 10.1016/j.diabres.2016.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 11/13/2015] [Accepted: 03/01/2016] [Indexed: 02/05/2023]
Abstract
AIMS To determine the relationship between glycated albumin (GA) and glycated hemoglobin (HbA1c) and to explore the association of glycated albumin/glycated hemoglobin (GA/HbA1c) ratio with glucose indices in Chinese subjects with varying glucose tolerance status. METHODS This hospital-based, cross-sectional study involved 953 participants without known diabetes from 11 centers in China. Oral glucose tolerance test (OGTT) was used to identify three groups of subjects: normal glucose regulation (n=194), impaired glucose regulation (n=303) and newly diagnosed type 2 diabetes group (n=456). The GA, HbA1c and GA/HbA1c ratio were tested. RESULTS GA was positively correlated with HbA1c (r=0.832, P<0.001). After correcting for age, sex and BMI, the correlations remained significant (r=0.824, P<0.001). Linear regression analysis estimated that a 1% increase of HbA1c was associated with a 2.84% increase of GA (GA=2.843×HbA1c-0.203; R(2)=0.692, P<0.001). GA would be 18.3 (16.7-19.9)% and 19.7 (18.0-21.4)% with HbA1c of 6.5% (48mmol/mol) and 7.0% (53mmol/mol). The mean GA/HbA1c ratio was 2.81±0.38, and it significantly increased with the presence of glucose intolerance (all, P<0.05). In the total study population, GA/HbA1c was correlated with BMI, glucose levels and 30-min insulin during OGTT, the homeostatic model assessment of β-cell function (HOMA-β), and ΔI30/ΔG30 (all, P<0.05). Increased glucose at 30min (standardized β=0.221, P<0.001), and decreased BMI (standardized β=-0.114, P=0.008) were associated with elevated GA/HbA1c ratio by multiple linear regression (adjusted R(2)=0.045). CONCLUSIONS The relationship between GA and HbA1c was strong. The GA/HbA1c ratio was related to acute postprandial glucose fluctuation and BMI level.
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Affiliation(s)
- Yifei Mo
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Xiaojing Ma
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Hong Li
- Department of Endocrinology and Metabolism, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Wenying Yang
- Department of Endocrinology and Metabolism, China-Japan Friendship Hospital, Beijing, China
| | - Qiang Li
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yongde Peng
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai, China
| | - Yanbing Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Fudan University Affiliated Zhongshan Hospital, Shanghai, China
| | - Xiaojun Luan
- Department of Endocrinology and Metabolism, The First People's Hospital of Foshan, Foshan, China
| | - Weiqing Wang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xie
- Department of Diabetic Neurology, Metabolic Disease Hospital, Tianjin Medical University, Tianjin, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China; Department of Endocrinology and Metabolism, Kashgar Prefecture Second People's Hospital, Kashgar, Xinjiang, China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China.
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Kim MK, Yun KJ, Kwon HS, Baek KH, Song KH. Discordance in the levels of hemoglobin A1C and glycated albumin: Calculation of the glycation gap based on glycated albumin level. J Diabetes Complications 2016; 30:477-81. [PMID: 26803475 DOI: 10.1016/j.jdiacomp.2015.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/11/2015] [Accepted: 12/22/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The glycation gap (G-gap) is an empirical measure of the extent of the difference between HbA1C and fructosamine levels. Several studies have shown that the presence of a G-gap is linked to diabetic nephropathy, but possible artifacts caused by dependence of the fructosamine level on the extent of serum protein metabolism require careful consideration. We investigated the consistency of G-gaps measured by assaying glycated albumin (GA) levels to identify factors associated with G-gap variations. METHOD A total of 457 pairs of observations, like an HbA1c and GA measurement at the same clinic visit, were obtained from 170 Korean patients with type 2 diabetes. HbA1c and GA levels were measured simultaneously in two or three separate occasions. Each G-gap was calculated as the difference between the measured HbA1c level and that predicted by the GA level. All patients underwent abdominal computed tomography, and the areas of subcutaneous and visceral fat were measured. RESULTS The G-gaps were all significantly inter-correlated over time (γ=0.755, P<0.001).The direction of each G-gap was consistent. The body mass index (BMI), visceral fat area, and the estimated glomerular filtration rate (eGFR) increased linearly from the lowest to the highest G-gap quartile (all P values <0.05). Upon multivariate analysis, both visceral fat area and the eGFR were significantly associated with a G-gap. CONCLUSIONS A G-gap determined using GA measurements is consistent within an individual over time. The G-gap is associated with visceral fat and kidney function in patients with type 2 diabetes.
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Affiliation(s)
- Mee Kyoung Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Jin Yun
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Hyun Baek
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Ho Song
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
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Iizuka K, Kato T, Mizuno M, Takeda J. A discrepancy between plasma glycated albumin and HbA1c levels in a patient with steroid-induced diabetes mellitus. BMJ Case Rep 2016; 2016:bcr-2016-214788. [PMID: 26961565 DOI: 10.1136/bcr-2016-214788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A 57-year-old man was admitted for the treatment of steroid-induced diabetes mellitus (DM). He also had interstitial pneumonia and, to treat it, 20 mg prednisolone had been started in April 2014. Although glycated haemoglobin (HbA1c) level was 7.8% (62 mmol/mol), his glycated albumin (GA) level was normal (13.9%) and the ratio of GA to HbA1c (GA:HbA1c) was lower than that of normal participants and patients with type 2 DM. Plasma GA and GA:HbA1c levels became persistently lower. In September 2015, HbA1c levels measured by HPLC and immunoprecipitation methods were almost the same (6.8% (51 mmol/mol) and 6.7% (50 mmol/mol), respectively), but GA (10.2%) and GA:HbA1c (1.6) were much lower. We report the case of a patient with DM where steroid administration may have caused a decrease in plasma GA and GA:HbA1c levels via increased albumin turnover.
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Affiliation(s)
- Katsumi Iizuka
- Department of Diabetes and Endocrinology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | | | - Masami Mizuno
- Department of Diabetes and Endocrinology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Jun Takeda
- Department of Diabetes and Endocrinology, Graduate School of Medicine, Gifu University, Gifu, Japan
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Boutayeb W, Lamlili M, Ben El Mostafa S, Zitouni N, Boutayeb A. Seeking a low value of HbA1c may be dangerous under recurrent episodes of hypoglycaemia: A short report. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2015. [DOI: 10.3233/mnm-150045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- W. Boutayeb
- URAC04, LaMSD, Department of Mathematics and Informatics, Faculty of Sciences, University Mohamed Ist, Oujda, Morocco
| | - M. Lamlili
- URAC04, LaMSD, Department of Mathematics and Informatics, Faculty of Sciences, University Mohamed Ist, Oujda, Morocco
| | | | | | - A. Boutayeb
- URAC04, LaMSD, Department of Mathematics and Informatics, Faculty of Sciences, University Mohamed Ist, Oujda, Morocco
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Abstract
Chronic hyperglycemia is the primary risk factor for the development of complications in diabetes mellitus (DM); however, it is believed that frequent or large glucose fluctuations may independently contribute to diabetes-related complications. Postprandial spikes in blood glucose, as well as hypoglycemic events, are blamed for increased cardiovascular events in DM. Glycemic variability (GV) includes both of these events; hence, minimizing GV can prevent future cardiovascular events. Correcting GV emerges as a target to be pursued in clinical practice to safely reduce the mean blood glucose and to determine its direct effects on vascular complications in diabetes. Modern diabetes management modalities, including glucagon-related peptide-1-based therapy, newer insulins, modern insulin pumps and bariatric surgery, significantly reduce GV. However, defining GV remains a challenge primarily due to the difficulty of measuring it and the lack of consensus regarding the optimal approach for its management. The purpose of this manuscript was not only to review the most recent evidence on GV but also to help readers better understand the available measurement options and how the various definitions relate differently to the development of diabetic complications.
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Affiliation(s)
- Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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50
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Yoon HJ, Lee YH, Kim SR, Rim TH, Lee EY, Kang ES, Cha BS, Lee HC, Lee BW. Glycated albumin and the risk of micro- and macrovascular complications in subjects with type 1 diabetes. Cardiovasc Diabetol 2015; 14:53. [PMID: 25975731 PMCID: PMC4438622 DOI: 10.1186/s12933-015-0219-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/22/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We investigated the relationship between the glycemic indices glycated albumin (GA) and glycated hemoglobin (HbA1c) and the progression of diabetic vascular complications [diabetic nephropathy (DN) and carotid artery atherosclerosis (CAA)] in subjects with type 1 diabetes (T1D). METHODS A total of 154 participants with a median follow-up of 2.8 years were enrolled in this retrospective longitudinal study. We recruited T1D subjects who had regularly measured urine albumin-creatinine ratios and estimated glomerular filtration rates, as well as tested HbA1c and GA levels consecutively every 3 or 6 months. A subgroup of 54 subjects was measured repeated carotid intima-media thickness (IMT). RESULTS We classified subjects into the DN progression (Group I; n = 30) with either deteriorated stages of chronic kidney disease (n = 18) or albuminuria progression (n = 17), and the non-progression (Group II; n = 124). In multiple logistic regression analyses, baseline albuminuria (odds ratio [OR] = 2.64, 95 % confidence interval [CI] = 1.03-6.74), mean GA levels (OR = 2.03, 95 % CI = 1.27-3.26) were significantly associated with progression of DN. However, there was no association with mean HbA1c (OR = 0.98, 95 % CI = 0.62-1.54). In a subgroup analysis for follow-up measurements of carotid IMT, age was independently associated with the presence of plaque and the mean IMT. However glycemic indices were not significantly associated with CAA. CONCLUSIONS Mean GA levels were more closely associated with DN progression than mean HbA1c in subjects with T1D. However, they were not associated with the CAA.
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Affiliation(s)
- Hye-jin Yoon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Yong-ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - So Ra Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Tyler Hyungtaek Rim
- Severance Hospital, Seoul, Korea, , 120-752. .,Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea, , 120-752.
| | - Eun Young Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Bong-soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Hyun Chul Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
| | - Byung-wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Severance Hospital, Seoul, Korea, , 120-752.
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