Potential of New Tests in Long-Term Diabetes Complications

Glucose levels in diabetic patients should be constantly monitored, but the standard Hemoglobin A1c (HbA1c) test is not valid for everyone. The test, which is also used to diagnose diabetes, reflects exposure to glucose in the blood over the previous 2–3 months. However, it will not work in patients with anemia, kidney disease, hemoglobinopathies, human immunodeficiency virus (HIV), and certain other conditions.

Scientists at Johns Hopkins University (Baltimore, MD, USA), the University of Wisconsin (UW; Madison, WI, USA), and the University of Minnesota (Minneapolis, MN, USA) measured HbA1c, fructosamine, and glycated albumin in blood samples from over 12,000 participants in the Atherosclerosis Risk in Communities (ARIC) Study. (The ARIC Study is a community-based cohort of persons from Washington County, MD; Jackson, MS; Forsyth County, NC; and suburban Minneapolis, MN who have been followed for clinical outcomes since 1987).

The investigators discovered that fructosamine tests and a novel assay for glycated albumin could be useful for predicting complications related to diabetes. The results of the study suggest that fructosamine and glycated albumin should be useful substitutes for monitoring glucose control in patients with diabetes when HbA1c is not available or not valid. Because fructosamine and glycated albumin are measures of short-term (2–4 week) glucose control and change more rapidly than HbA1c, they could also be useful for monitoring changes in diabetes treatments.

Fructosamine is approved for clinical use in the United States but rarely used. The glycated albumin test is widely used in Japan but not approved for use in the United States. A major barrier to using these nontraditional markers is that they have not been related to the clinical outcomes of diabetes or compared to HbA1c.

The study appears in the January 15, 2014, online addition of Lancet Diabetes & Endocrinology.

Elizabeth Selvin, PhD, MPH, associate professor, Johns Hopkins Bloomberg School of Public Health and senior author on the study remarked, “We compared the associations of HbA1c, fructosamine, and glycated albumin with two of the most important clinical outcomes related to diabetes: retinopathy and kidney disease. We found that fructosamine and glycated albumin were strongly associated with retinopathy and kidney disease. These associations were similar to those observed for HbA1c with these outcomes.”

However, Prof. Selvin added, “Further studies are needed to understand the value of these tests in the clinic.”

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Johns Hopkins University
University of Wisconsin
University of Minnesota