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Bernier E, Lachance A, Plante AS, Lemieux P, Mourabit Amari K, Weisnagel SJ, Gagnon C, Michaud A, Tchernof A, Morisset AS. Trimester-Specific Serum Fructosamine in Association with Abdominal Adiposity, Insulin Resistance, and Inflammation in Healthy Pregnant Individuals. Nutrients 2022; 14:nu14193999. [PMID: 36235652 PMCID: PMC9572673 DOI: 10.3390/nu14193999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to (1) characterize the variations in serum fructosamine across trimesters and according to pre-pregnancy BMI (ppBMI), and (2) examine associations between fructosamine and adiposity/metabolic markers (ppBMI, first-trimester adiposity, leptin, glucose homeostasis, and inflammation measurements) during pregnancy. Serum fructosamine, albumin, fasting glucose and insulin, leptin, adiponectin, interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations were measured at each trimester. In the first trimester, subcutaneous (SAT) and visceral (VAT) adipose tissue thicknesses were estimated by ultrasound. In the 101 healthy pregnant individuals included (age: 32.2 ± 3.5 y.o.; ppBMI: 25.5 ± 5.5 kg/m2), fructosamine concentrations decreased during pregnancy whereas albumin-corrected fructosamine concentrations increased (p < 0.0001 for both). Notably, fructosamine concentrations were inversely associated with ppBMI, first-trimester SAT, VAT, and leptin (r = −0.55, r = −0.61, r = −0.48, r = −0.47, respectively; p < 0.0001 for all), first-trimester fasting insulin and HOMA-IR (r = −0.46, r = −0.46; p < 0.0001 for both), and first-trimester IL-6 (r = −0.38, p < 0.01). However, once corrected for albumin, most of the correlations lost strength. Once adjusted for ppBMI, fructosamine concentrations were positively associated with third-trimester fasting glucose and CRP (r = 0.24, r = 0.27; p < 0.05 for both). In conclusion, serum fructosamine is inversely associated with adiposity before and during pregnancy, with markers of glucose homeostasis and inflammation, but the latter associations are partially influenced by albumin concentrations and ppBMI.
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Affiliation(s)
- Emilie Bernier
- École de Nutrition, l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
| | - Amélie Lachance
- École de Nutrition, l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie, Québec-Université Laval, Québec, QC G1V 4G5, Canada
| | - Anne-Sophie Plante
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
| | - Patricia Lemieux
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
- Département de Médecine, l’Université Laval, Québec, QC G1V 0A6, Canada
| | - Karim Mourabit Amari
- Département de Médecine de Laboratoire, CHU de Québec-Université Laval, Québec, QC G1V 4G5, Canada
| | - S. John Weisnagel
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
- Département de Médecine, l’Université Laval, Québec, QC G1V 0A6, Canada
| | - Claudia Gagnon
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
- Département de Médecine, l’Université Laval, Québec, QC G1V 0A6, Canada
| | - Andréanne Michaud
- École de Nutrition, l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie, Québec-Université Laval, Québec, QC G1V 4G5, Canada
| | - André Tchernof
- École de Nutrition, l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie, Québec-Université Laval, Québec, QC G1V 4G5, Canada
| | - Anne-Sophie Morisset
- École de Nutrition, l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
- Correspondence: ; Tel.: +1-418-656-2131 (ext. 13982)
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Delanghe JR, Lambrecht S, Fiers T, Speeckaert MM. Labile glycated hemoglobin: an underestimated laboratory marker of short term glycemia. Clin Chem Lab Med 2022; 60:451-455. [PMID: 35041778 DOI: 10.1515/cclm-2021-1321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Diabetes mellitus is a major public health problem. Hemoglobin A1c (HbA1c) is a key laboratory parameter in the management of diabetes patients. However, in diabetes monitoring, interpretation of HbA1c results is hampered by the important interindividual variation in red blood cell (RBC) life span. Furthermore, HbA1c only slowly responds to changes in glucose metabolism. Besides HbA1c, there exists a labile HbA1c fraction (l-HbA1c), exhibiting much faster kinetics. As both HbA1c and l-HbA1c are measured by modern standard chromatography, we explored the possibilities of using the l-HbA1c fraction for monitoring glycemia. METHODS l-HbA1c and HbA1c fractions were simultaneously assayed on a Tosoh G8 analyzer and expressed as %. l-HbA1c results were compared with serum glucose and HbA1c. Concomitantly, RBC distribution width (RDW) was determined on a Sysmex SN analyzer as a marker for erythrocyte life span. RESULTS l-HbA1c could be measured with between-run coefficient of variations (CVs) between 2.2 and 2.3%. l-HbA1c correlated with both glycemia (r=0.80) and HbA1c results (r=0.73). In a multiple regression model (r2=0.752), glycemia and HbA1c were the most determining factors. To a lesser extent, RDW correlated with l-HbA1c (r=0.158). Furthermore, the l-HbA1c/HbA1c ratio weakly positively correlated with RDW (r=0.247). CONCLUSIONS L-HBA1c represents an additional marker for monitoring the rapid occurrence of glycemic disorders that escape detection when using only HbA1c and blood glucose. RDW can be used as an indicator of atypical RBCs life span, in which the l-HbA1c fraction may be helpful.
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Affiliation(s)
- Joris R Delanghe
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | - Stijn Lambrecht
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | - Tom Fiers
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | - Marijn M Speeckaert
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.,Research Foundation-Flanders (FWO), Brussels, Belgium
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Peer N, George J, Lombard C, Levitt N, Kengne AP. Associations of glycated albumin and fructosamine with glycaemic status in urban black South Africans. Clin Chim Acta 2021; 519:291-297. [PMID: 34022245 DOI: 10.1016/j.cca.2021.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The associations of glycated albumin (GA) and fructosamine (FA) as alternate tests for diabetes screening in South Africans were examined to overcome shortcomings with oral glucose tolerance tests (OGTTs). METHODS Based on OGTTs, glycaemic status included 1) normal glucose, 2) dysglycaemia (impaired fasting glucose, impaired glucose tolerance, newly diagnosed diabetes), and 3) known diabetes. RESULTS Among 1092 participants, >21 years, mean GA (16.9%) and FA (230.2 μmol/l) increased significantly by age and worsening glycaemic status and were significantly higher in women vs. men and BMI (kg/m2) ≥ 30 vs. <30. For dysglycaemia, correlations of GA and FA with fasting and 2-hour glucose levels were higher in obese (0.576 to 0.688) vs. non-obese (-0.010 to 0.522). Optimal GA threshold to identify dysglycaemia was 15.35% and comparable, but with lower sensitivity (0.54) and specificity (0.55), to Asian studies. For FA, the optimal cut-point of 227.0 μmol/l approximated that described in the literature. Dysglycaemia and known diabetes were associated with GA, while only known diabetes was related to FA, in models adjusted for age, gender and obesity. CONCLUSIONS Potential exists for GA and/or FA as alternative measures of dysglycaemia in clinical practice in Africans, but longitudinal studies are required to clearly elucidate their utility.
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Affiliation(s)
- Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Jaya George
- Department of Chemical Pathology, University of the Witwatersrand, and National Health Laboratory Services, Johannesburg, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, UCT, Cape Town, South Africa
| | - Andre-Pascal Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
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Glycated serum proteins: High in pancreatic cancer and low in preeclampsia. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 162:321-333. [PMID: 30905460 DOI: 10.1016/bs.pmbts.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Glycated serum protein (GSP, measured as serum fructosamine concentration in μmol/L) is a product of glycation reaction between glucose and serum proteins in the blood circulation. GSP is used along with blood glucose, glycated hemoglobin (HbA1c), and glycated albumin as indicators of glycemic control for diabetic patients. However, a systematic comparison of the GSP levels in different types of human diseases has not been reported. In this study, 62,698 clinical lab test results of GSP levels in patients with 61 clinically defined diseases over the past 5 years in our hospital were retrieved and compared to that of 1861 clinical lab test results in healthy individuals. Based on the mean (SD), median, and p (-Log10p) values, we found that patients with type 2 diabetes, hepatic encephalopathy, pancreatic cancer, healthy individuals >65 years old, and cerebral arteriosclerosis had significantly (p<0.05, -Log10p>1.30) increased whereas patients with 49/61 diseases including preeclampsia, nephrotic syndrome, sepsis, lupus erythematous, and leukemia had significantly decreased GSP levels compared to that of healthy controls. Among the 61 diseases, type 2 diabetes and leukemia had the highest -Log10p values (>274) and lupus erythematous, nephrotic syndrome, and gastric cancer had -Log10p values >140. Revealing the molecular mechanisms especially those underlying the decreased GSP levels in most of human diseases might make GSP levels serve more clinical purposes in future.
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Pedrosa W, Sander Diniz MDFH, Barreto SM, Vidigal PG. Establishing a blood fructosamine reference range for the Brazilian population based on data from ELSA - Brasil. Pract Lab Med 2018; 13:e00111. [PMID: 30581949 PMCID: PMC6295605 DOI: 10.1016/j.plabm.2018.e00111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/07/2018] [Accepted: 11/29/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives The fructosamine test is used in the monitoring of diabetes mellitus, particularly in cases with restrictions on the use of glycated hemoglobin (mainly in the setting of altered red blood cell lifespan and interference by hemoglobin variants). It could also provide additional information on shorter-term glycemic control. The objective of the study is to establish the reference range of the fructosamine in the Brazilian population. Design and methods The reference interval was defined as suggested by the Clinical and Laboratory Standards Institute (CLSI). The study participants were from a Brazilian cohort (The Longitudinal Study of Adult Health – ELSA-Brasil) with baseline data collected between 2008 and 2010. A total of 466 subjects were selected after exclusion of diabetic individuals, and those with altered glycemic markers and renal function tests. Results The reference interval was 186–248 μmol/L for women and 196–269 μmol/L for men. Fructosamine levels were higher in men than in women (p = 0.006) and in the non-white population (p = 0.034) and had a negative correlation with the body mass index (r = −0.117; p = 0.011). Conclusions The reference intervals for fructosamine were affected by sex. Reference intervals stratified by sex would be more adequate in the interpretation of the fructosamine test. Reference intervals for fructosamine in serum. The reference intervals for fructosamine were affected by sex. The reference intervals for fructosamine are different for different population.
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Key Words
- 1, 5 AG, 1,5-anhydroglucitol
- 2-h PG, 2 h post glucose load
- A1c, Glycate hemoglobin
- BMI, Body mass index
- CLSI, Clinical and laboratory standard institute
- Diabetes mellitus
- FPG, Fasting plasma glucose
- Fructosamine
- IDF, International diabetes federation
- NBT, Nitroblue tetrazolium method
- OGTT, Oral glucose tolerance test
- Reference interval
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Affiliation(s)
- William Pedrosa
- Postgraduate Program in Pathology, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Hermes Pardini Laboratory, Belo Horizonte, Brazil
| | - Maria de Fátima Haueisen Sander Diniz
- Postgraduate Program in Ciências Aplicadas à Saúde do Adulto, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Department of Public Health, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Pedro Guatimosim Vidigal
- Department of Clinical Pathology, School of Medicine, Federal University of Minas Gerais, Av. Prof. Alfredo Balena 190, Room 403, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Corresponding author.
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Selvin E, Warren B, He X, Sacks DB, Saenger AK. Establishment of Community-Based Reference Intervals for Fructosamine, Glycated Albumin, and 1,5-Anhydroglucitol. Clin Chem 2018; 64:843-850. [PMID: 29436378 PMCID: PMC5924648 DOI: 10.1373/clinchem.2017.285742] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/18/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is growing interest in fructosamine, glycated albumin, and 1,5-anhydroglucitol (1,5-AG) as alternative measures of hyperglycemia, particularly for use in settings where traditional measures (glucose and HbA1c) are problematic or where intermediate (2-4 weeks) glycemic control is of interest. However, reference intervals for these alternative biomarkers are not established. METHODS We measured fructosamine, glycated albumin, and 1,5-AG in a community-based sample of US black and white adults who participated in the Atherosclerosis Risk in Communities (ARIC) Study. We calculated reference intervals, evaluated demographic differences, and derived cutoffs aligned with current diagnostic cutpoints for HbA1c and fasting glucose. RESULTS In a healthy reference population of 1799 individuals (mean age, 55 years; 51% women; 15% black), the 2.5 and 97.5 percentiles, respectively, were 194.8 and 258.0 μmol/L for fructosamine, 10.7% and 15.1% for glycated albumin, and 8.4 and 28.7 μg/mL for 1,5-AG. Distributions differed by race, sex, and body mass index. Equivalent concentrations of fructosamine and glycated albumin corresponding to an HbA1c of 6.5% (96.5 percentile) were 270.2 μmol/L and 15.6%, respectively. Equivalent concentrations of fructosamine and glycated albumin corresponding to a fasting glucose of 126 mg/dL (93.9 percentile) were 261.7 μmol/L and 15.0%, respectively. CONCLUSIONS The reference intervals for these biomarkers should inform their clinical use. Diagnostic cutpoint equivalents for fructosamine and glycated albumin could be useful to identify persons with hyperglycemia in settings where fasting glucose or HbA1c are not available or where the interpretation of these traditional measures is problematic.
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Affiliation(s)
- Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Bethany Warren
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Xintong He
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Amy K Saenger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
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Rodríguez-Segade S, Rodríguez J, Camiña F. Corrected Fructosamine improves both correlation with HbA1C and diagnostic performance. Clin Biochem 2017; 50:110-115. [DOI: 10.1016/j.clinbiochem.2016.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 12/13/2022]
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Joyeux-Faure M, Rossini E, Ribuot C, Faure P. Fructose-Fed Rat Hearts are Protected Against Ischemia-Reperfusion Injury. Exp Biol Med (Maywood) 2016; 231:456-62. [PMID: 16565441 DOI: 10.1177/153537020623100411] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
High fructose-fed (HFF) rat model is known to develop the insulin-resistant syndrome with a very similar metabolic profile to the human X syndrome. Such metabolic modifications have been associated with a high incidence of cardiovascular disease. The role of free radical attack in diabetes mellitus and its cardiovascular complications have been abundantly documented. The present study examined the susceptibility to myocardial ischemic injury and the involvement of free radical attack and/or protection in the metabolic disorders of high FF rats. Rats were divided into two experimental groups that received diet for 4 weeks: a control group (C, n = 28) receiving a standard diet and a HFF group (FF, n = 28), in which 58% of the total carbohydrate was fructose. The euglycemic clamp technique was performed to assess insulin resistance. For the ischemia-reperfusion procedure, rat hearts were isolated and perfused at constant pressure before they were subjected to a 30-min occlusion of the left coronary artery followed by 120 mins of reperfusion. Hemodynamic parameters were measured throughout the protocol. Infarct-to-risk ratio (I/R) was assessed at the end of the protocol by 2,3,4-triphenyltetrazolium chloride staining and planimetric analysis. Lipid peroxidation, antioxidant enzyme activity, level of vitamin E, and trace element status were measured in blood samples from both groups. Rats of the FF group developed an insulin resistance indicated by the glucose infusion rate, which was decreased by 47%. Infarct size was significantly reduced in rats from the FF group (19.9% ± 6.6%) compared to rats from the control group (34.6% ± 4.9%), and cardiac functional recovery at reperfusion was improved in the FF group. Lipid peroxidation and oxidative stress were higher in the FF group, as indicated by higher malonedialdehyde level, whereas plasma vitamin E/triacylglycerol ratio was also enhanced in this group. This study indicates that fructose feeding affords protection against in vitro ischemia-reperfusion injury, potentially implicating vitamin E.
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Affiliation(s)
- Marie Joyeux-Faure
- Laboratoire HP2, Hypoxie Physio-Pathologie Respiratoire et Cardiovasculaire, Faculté de Médecine-Pharmacie, Université Grenoble I, Domaine de la Merci, 38706 La Tronche, France.
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Alghothani N, Dungan KM. HbA1C An Inaccurate Measure of Glycemic Control in a Female with Hereditary Spherocytosis Despite Normal Hemoglobin Levels. AACE Clin Case Rep 2015. [DOI: 10.4158/ep14394.cr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Selvin E, Francis LMA, Ballantyne CM, Hoogeveen RC, Coresh J, Brancati FL, Steffes MW. Nontraditional markers of glycemia: associations with microvascular conditions. Diabetes Care 2011; 34:960-7. [PMID: 21335368 PMCID: PMC3064058 DOI: 10.2337/dc10-1945] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the associations of nontraditional (fructosamine, glycated albumin, 1,5-anhydroglucitol [1,5-AG]) and standard (fasting glucose, HbA(1c)) glycemic markers with common microvascular conditions associated with diabetes mellitus. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study of 1,600 participants (227 with a history of diabetes and 1,323 without) from the Atherosclerosis Risk in Communities (ARIC) Study, a community-based population. We conducted logistic regression analyses of the associations of diabetes-specific tertiles of fructosamine, glycated albumin, 1/(1,5-AG), fasting glucose, and HbA(1c) with prevalence of chronic kidney disease, albuminuria, and retinopathy after adjustment for demographic, clinical, and lifestyle variables. RESULTS We observed significant positive trends in the associations of each marker with albuminuria and retinopathy, even after accounting for demographic, clinical, and lifestyle factors (all P trends <0.05). The associations with chronic kidney disease were similar in direction but were only significant for higher glycated albumin (P trend = 0.005), fructosamine (P trend = 0.003), and HbA(1c) (P trend = 0.005) values. After further adjustment for HbA(1c), glycated albumin and fructosamine remained significantly or borderline significantly associated with the microvascular outcomes. CONCLUSIONS In cross-sectional analyses, two serum markers of glycemia-glycated albumin and fructosamine-are as, or more strongly, associated with microvascular conditions as HbA(1c). These markers may be useful in settings where whole blood is not available. Whether they might complement or outperform HbA(1c) in terms of long-term predictive value requires further investigation.
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Affiliation(s)
- Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore,Maryland, USA.
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Agarwal MM, Dhatt GS, Othman Y, Ljubisavljevic MR. Gestational diabetes: an evaluation of serum fructosamine as a screening test in a high-risk population. Gynecol Obstet Invest 2010; 71:207-12. [PMID: 21160150 DOI: 10.1159/000318705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 07/05/2010] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the value of serum fructosamine as a screening test for gestational diabetes mellitus (GDM). METHODS 849 pregnant women underwent the one-step 75 g oral glucose tolerance test (OGTT) for universal screening of GDM. The fasting serum fructosamine (cFruc) was assessed using the area under the receiver operating characteristic curve (AUC). The GDM diagnostic criteria used were those of the American Diabetes Association; however, the cFruc performance was also evaluated using criteria of the World Health Organization, Australian (ADIPS), European (EASD) and International Association of Diabetes and Pregnancy Study Groups (IADPSG). RESULTS 113 (13.3%) women had GDM. The AUC of the cFruc was 0.60 (95% CI 0.54-0.66). A cFruc threshold of 237 μmol/l achieved an acceptable sensitivity of 85.8% (95% CI 78.0-91.0%), but the associated specificity remained poor at 23.4% (95% CI 20.0-27.0%) with a positive predictive value of just 14.7%. Overall, over 4 out of 5 pregnant women, being over this cutoff, would need the confirmatory OGTT. No cFruc threshold reached acceptable likelihood ratios to rule-in or rule-out GDM. The AUC for cFruc remained unacceptable independent of the diagnostic criteria. CONCLUSIONS Despite all the advances in technology, serum fructosamine is a poor test to screen for GDM.
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Affiliation(s)
- Mukesh M Agarwal
- Department of Pathology, Faculty of Medicine, UAE University, Al Ain, United Arab Emirates.
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Home P, Chacra A, Chan J, Emslie-Smith A, Sorensen L, Crombrugge PV. Considerations on blood glucose management in Type 2 diabetes mellitus. Diabetes Metab Res Rev 2002; 18:273-85. [PMID: 12203943 DOI: 10.1002/dmrr.312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In recent years the benefits of more intensive management in preventing or delaying the development and progression of diabetic complications have been well documented. What is not as well documented is how to motivate the person with diabetes to manage the condition, how to set, assess and quantify glucose goals, and the glucose variables that should be routinely measured. This review discusses the importance of setting targets and communicating them in a way that the patient understands. When aiming for a glycaemia target, balance is required (1) between achieving reduction of complications and causing an increased degree of hypoglycaemia, and (2) between what is achievable and what degree of benefit is gained. Target values given in guidelines should be adapted by the clinician to take into account the patient's susceptibility to hypoglycaemia, stage and type of complications, age and life expectancy, co-morbidity, social environment, understanding of the steps required and level of commitment to the treatment. Several suggestions are given regarding possible improvements and amendments to existing guidelines for diabetes management in treating to glucose goal. For example, attention should be drawn to the need to individualize goals and to consider education, long-term support, patient needs and treatment outcome when formulating diabetes management plans. The relative properties of the different glucose variables-fasting plasma glucose (FPG), postprandial plasma glucose (PPG), glycated haemoglobin A(1c) (HbA(1c)), and glycated protein-in terms of their convenience of measurement, usefulness and relevance to the physician and patient are also evaluated. When prioritising the variables to be measured it is suggested that where feasible, HbA(1c) should be the standard measurement by which to gauge risk and treatment efficacy. Serial measurements should be made and, where possible, the use of blood glucose meters encouraged, in order to obtain a blood glucose profile for the patient.
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Reusch CE, Haberer B. Evaluation of fructosamine in dogs and cats with hypo- or hyperproteinaemia, azotaemia, hyperlipidaemia and hyperbilirubinaemia. Vet Rec 2001; 148:370-6. [PMID: 11321552 DOI: 10.1136/vr.148.12.370] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The influence of various pathological conditions on fructosamine levels in normoglycaemic dogs and cats was investigated. The most frequent and most pronounced deviations were found in animals with hypoproteinaemia, in which fructosamine was significantly lower than in the controls. In 66 per cent of the dogs and 67 per cent of the cats with hypoproteinaemia the levels were below the reference range. In the dogs the concentration of fructosamine was correlated with the level of albumin, but in the cats it was correlated with the level of total protein. Dogs with hyperlipidaemia and azotaemia also had significantly lower levels of fructosamine; 38 per cent of those with hyperlipidaemia and 47 per cent of those with azotaemia had fructosamine levels outside the reference range. No significant changes in fructosamine were detected in dogs or cats with hyperproteinaemia or hyperbilirubinaemia, or in cats with hyperlipidaemia or azotaemia.
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Affiliation(s)
- C E Reusch
- Clinic for Small Animal Internal Medicine, University of Zurich, Switzerland
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Austin GE, Wheaton R, Nanes MS, Rubin J, Mullins RE. Usefulness of fructosamine for monitoring outpatients with diabetes. Am J Med Sci 1999; 318:316-23. [PMID: 10555094 DOI: 10.1097/00000441-199911000-00006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Measurements of total glycohemoglobin (glycoHb) or hemoglobin A1c are routinely used to evaluate intermediate-to-long term glycemic control in patients with diabetes. However, despite the recent availability of more rapid methods for glycohemoglobin determination, it remains difficult in many institutions to obtain same-day glycoHb determinations in time to assist physicians with management of outpatients with diabetes. Hence, we investigated whether fructosamine, which reflects very recent (2 to 3 weeks) glycemic control and which can be assayed more rapidly in our laboratory, could serve as a useful adjunct to glycoHb for management of these patients. METHODS Diabetes control in outpatients managed using fructosamine, fasting serum glucose, and glycoHb (concentrations from the prior visit) was compared with that for outpatients monitored using fasting serum glucose and prior glycoHb alone. The relative usefulness of fructosamine, current and prior glycoHb, and "fasting" serum glucose for evaluation and management of outpatients with diabetes was compared. In addition, the acceptance of fructosamine by physicians was evaluated by a questionnaire. RESULTS Same-day fructosamine concentrations correlated better with current glycoHb than did either prior glycoHb or current fasting serum glucose concentrations. However, the availability of same-day fructosamine results did not objectively improve diabetes control compared with that obtained using only fasting serum glucose values and prior glycoHb concentrations. Nonetheless, most examining physicians stated that same-day fructosamine concentrations helped them significantly with diabetes management, primarily because many patients do not adequately monitor home blood glucose levels. CONCLUSIONS Fructosamine may be a useful adjunctive test for management of outpatients with diabetes in situations where it is not practical to obtain same-day glycoHb concentrations, for patients less compliant with home glucose monitoring, or where recent changes in insulin dose or clinical presentation might not be reflected in the glycoHb levels.
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Affiliation(s)
- G E Austin
- Department of Pathology and Laboratory Medicine, Veterans Affairs Medical Center, Decatur, Georgia 30033, USA.
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Faure P, Rossini E, Lafond JL, Richard MJ, Favier A, Halimi S. Vitamin E improves the free radical defense system potential and insulin sensitivity of rats fed high fructose diets. J Nutr 1997; 127:103-7. [PMID: 9040552 DOI: 10.1093/jn/127.1.103] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The purpose of this study was to investigate the effects of vitamin E in rats fed a high fructose diet which leads to insulin resistance, on some components of the free radical defense system and on insulin sensitivity. The rats (postweaning, 50 g) were divided into three groups: the control group (C, n = 16), which received a purified diet containing 60 g/100 g carbohydrates, the high fructose-fed group (FT, n = 16),fed a diet in which 56.8% of the carbohydrate as fructose, and a high fructose and vitamin E-fed group (FVE, n = 16), fed the FT diet supplemented with 3.4 g vitamin E/kg diet (vs. 0.17 g/kg in C and FT groups). The duration of the treatment was 6 wk. Insulin sensitivity was determined in half of the rats in each group using the euglycemic hyperinsulinic glucose clamp technique. The remaining rats were investigated for plasma glucose, insulin, triglyceride and fructosamine concentrations and for components of the free radical defense system. The FT group had a significantly lower insulin sensitivity than the C group. Basal glycemia was not different among the groups. In comparison with the C group, the FT group had a greater lipid peroxidation, as indicated by the higher concentrations of plasma thiobarbituric acid reactive substances (TBARS) and blood disulfide glutathione (GSSG) and the lower Cu-Zn superoxide dismutase (Cu-Zn SOD) activity. These markers approached the values of the controls after addition of vitamin E. Moreover, the FVE group had a higher insulin sensitivity than the FT group, but it remained lower than in the C group. These results show that a high fructose diet in rats leads to insulin resistance and a defect in the free radical defense system. Vitamin E supplementation improves insulin sensitivity in fructose-fed rats.
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Affiliation(s)
- P Faure
- Groupe de Recherche sur le Pathologis Oocydatives (GREPO), Domaine de la Merci, La Tronche, France
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