Associations of alternative markers of glycemia with hemoglobin A 1c and fasting glucose

Stephen P. Juraschek, Michael W Steffes, Elizabeth Selvin

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: 1,5-Anhydroglucitol (1,5-AG), fructosamine, and glycated albumin are of increasing interest as alternative measures of hyperglycemia. We characterize the associations of these nontraditional glycemic markers with hemoglobin A 1c (Hb A 1c ) and fasting glucose and assess their ability to identify people with diabetes. METHODS: We conducted a cross-sectional comparison of 1,5-AG, fructosamine, and glycated albumin with Hb A 1c and fasting glucose measurements in 1719 participants from the Atherosclerosis Risk in Communities Study. We evaluated nonlinear relationships using R 2 and F-statistics. Performance for identification of cases of diabetes was determined using the area under the curve (AUC). Diabetes was defined by Hb A 1c ≥6.5%, fasting glucose ≥126 mg/dL (≥6.99 mmol/L), and/or a self-reported history of diagnosed diabetes. RESULTS: Median values of Hb A 1c and fasting glucose were 5.8% and 109 mg/dL (6.05 mmol/L), respectively; 17.3% of the study population had diagnosed diabetes. Glycated albumin, fructosamine, and 1,5-AG were more strongly correlated with Hb A1c compared with fasting glucose (all P values <0.05). Nonlinear models provided the best fit for describing the relationships of the alternative markers to Hb A1c. When diabetes was defined by an Hb A 1c ≥6.5%, fructosamine (AUC 0.83; 95% CI, 0.79-0.87) and glycated albumin (AUC 0.87; 95% CI, 0.83-0.90) performed comparably to fasting glucose (AUC 0.83; 95% CI, 0.79-0.87), while 1,5-AG performed worse (AUC 0.74; 95% CI, 0.69-0.78) for identifying cases of undiagnosed diabetes. CONCLUSIONS: Fructosamine and glycated albumin may be useful adjuncts to Hb A 1c and fasting glucose. Future studies should examine these markers in situations in which fasting glucose or Hb A 1c measurements are invalid or not available.

Original languageEnglish (US)
Pages (from-to)1648-1655
Number of pages8
JournalClinical chemistry
Volume58
Issue number12
DOIs
StatePublished - Dec 1 2012

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Hemoglobin A
Medical problems
Fructosamine
Fasting
Glucose
Area Under Curve
Glycosylated Hemoglobin A
Aptitude
Nonlinear Dynamics
Hyperglycemia
Atherosclerosis
glycosylated serum albumin
Statistics
1,5-anhydroglucitol

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Associations of alternative markers of glycemia with hemoglobin A 1c and fasting glucose . / Juraschek, Stephen P.; Steffes, Michael W; Selvin, Elizabeth.

In: Clinical chemistry, Vol. 58, No. 12, 01.12.2012, p. 1648-1655.

Research output: Contribution to journalArticle

Juraschek, Stephen P. ; Steffes, Michael W ; Selvin, Elizabeth. / Associations of alternative markers of glycemia with hemoglobin A 1c and fasting glucose In: Clinical chemistry. 2012 ; Vol. 58, No. 12. pp. 1648-1655.
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abstract = "BACKGROUND: 1,5-Anhydroglucitol (1,5-AG), fructosamine, and glycated albumin are of increasing interest as alternative measures of hyperglycemia. We characterize the associations of these nontraditional glycemic markers with hemoglobin A 1c (Hb A 1c ) and fasting glucose and assess their ability to identify people with diabetes. METHODS: We conducted a cross-sectional comparison of 1,5-AG, fructosamine, and glycated albumin with Hb A 1c and fasting glucose measurements in 1719 participants from the Atherosclerosis Risk in Communities Study. We evaluated nonlinear relationships using R 2 and F-statistics. Performance for identification of cases of diabetes was determined using the area under the curve (AUC). Diabetes was defined by Hb A 1c ≥6.5{\%}, fasting glucose ≥126 mg/dL (≥6.99 mmol/L), and/or a self-reported history of diagnosed diabetes. RESULTS: Median values of Hb A 1c and fasting glucose were 5.8{\%} and 109 mg/dL (6.05 mmol/L), respectively; 17.3{\%} of the study population had diagnosed diabetes. Glycated albumin, fructosamine, and 1,5-AG were more strongly correlated with Hb A1c compared with fasting glucose (all P values <0.05). Nonlinear models provided the best fit for describing the relationships of the alternative markers to Hb A1c. When diabetes was defined by an Hb A 1c ≥6.5{\%}, fructosamine (AUC 0.83; 95{\%} CI, 0.79-0.87) and glycated albumin (AUC 0.87; 95{\%} CI, 0.83-0.90) performed comparably to fasting glucose (AUC 0.83; 95{\%} CI, 0.79-0.87), while 1,5-AG performed worse (AUC 0.74; 95{\%} CI, 0.69-0.78) for identifying cases of undiagnosed diabetes. CONCLUSIONS: Fructosamine and glycated albumin may be useful adjuncts to Hb A 1c and fasting glucose. Future studies should examine these markers in situations in which fasting glucose or Hb A 1c measurements are invalid or not available.",
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N2 - BACKGROUND: 1,5-Anhydroglucitol (1,5-AG), fructosamine, and glycated albumin are of increasing interest as alternative measures of hyperglycemia. We characterize the associations of these nontraditional glycemic markers with hemoglobin A 1c (Hb A 1c ) and fasting glucose and assess their ability to identify people with diabetes. METHODS: We conducted a cross-sectional comparison of 1,5-AG, fructosamine, and glycated albumin with Hb A 1c and fasting glucose measurements in 1719 participants from the Atherosclerosis Risk in Communities Study. We evaluated nonlinear relationships using R 2 and F-statistics. Performance for identification of cases of diabetes was determined using the area under the curve (AUC). Diabetes was defined by Hb A 1c ≥6.5%, fasting glucose ≥126 mg/dL (≥6.99 mmol/L), and/or a self-reported history of diagnosed diabetes. RESULTS: Median values of Hb A 1c and fasting glucose were 5.8% and 109 mg/dL (6.05 mmol/L), respectively; 17.3% of the study population had diagnosed diabetes. Glycated albumin, fructosamine, and 1,5-AG were more strongly correlated with Hb A1c compared with fasting glucose (all P values <0.05). Nonlinear models provided the best fit for describing the relationships of the alternative markers to Hb A1c. When diabetes was defined by an Hb A 1c ≥6.5%, fructosamine (AUC 0.83; 95% CI, 0.79-0.87) and glycated albumin (AUC 0.87; 95% CI, 0.83-0.90) performed comparably to fasting glucose (AUC 0.83; 95% CI, 0.79-0.87), while 1,5-AG performed worse (AUC 0.74; 95% CI, 0.69-0.78) for identifying cases of undiagnosed diabetes. CONCLUSIONS: Fructosamine and glycated albumin may be useful adjuncts to Hb A 1c and fasting glucose. Future studies should examine these markers in situations in which fasting glucose or Hb A 1c measurements are invalid or not available.

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