Abstract
Background
Glycated hemoglobin has been a popular investigation to access the glycemic status. It is a marker for intracellular glycation, and hence, an investigation which can comply with both intracellular and extracellular glycation statuses is preferred.
Methodology
In this regard, fructosaminated HbA1c (FHbA1c), predicted HbA1c (PHbA1c) and glycation gap (GG) were evaluated in 57 cases of diabetes mellitus (DM) without complication and having a normal serum protein and albumin levels. Fifty controls were also evaluated. FHbA1c, PHbA1c and post-prandial predicted HbA1c (PPHbA1c) were plotted using population linear regression equation and calculated individually against each subject. The statistical calculation was evaluated using SPSS version 21.
Results
FHbA1c, PHbA1c, PPHbA1c and GG were found to be significantly elevated in cases (p value < 0.001). FHbA1c and GG show significant correlation with the glycemic indices in cases compared to controls. The correlation with FBS and PPBS increases as we move from controls to cases. Area under curve (AUC) in case of FHbA1c is 96.8%, and cut-off level of 5.85% can result in sensitivity of 88.2% and specificity of 90% for the diagnosis of DM.
Conclusion
FHbA1c can be used as an additional investigation in cases of DM. Along with GG, it is increased in DM and correlates with the glycemic indices. It has a decent AUC on plotting ROC. Thus, FHbA1c and GG can be used as a part of glyco-metabolic profile and can provide insight into the individualised glycation tendency of the cell.
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References
Atlas D. International diabetes federation. IDF Diabetes Atlas, 7th edn. International Diabetes Federation.: Brussels; 2015.
Nayak AU, Holland MR, Macdonald DR, Nevill A, Singh BM. Evidence for consistency of the glycation gap in diabetes. Diab Care. 2011;DC_101767.
Yudkin JS, Forrest RD, Jackson CA, Ryle AJ, Davie SJ, Gould BJ. Unexplained variability of glycated hemoglobin in nondiabetic subjects not related to glycemia. Diabetologia. 1990;33:208–15.
Shimizu I, Kohzuma T, Koga M. A proposed glycemic control marker for the future: glycated albumin. J Lab Precis Med. 2019;19:4.
Cosson E, Banu I, Cussac-Pillegand C, Chen Q, Chiheb S, Jaber Y, Nguyen MT, Charnaux N, Valensi P. Glycation gap is associated with macroproteinuria but not with other complications in patients with type 2 diabetes. Diab Care. 2013;DC_121780.
Danese E, Montagnana M, Nouvenne A, Lippi G. Advantages and pitfalls of fructosamine and glycated albumin in the diagnosis and treatment of diabetes. J Diabetes Sci Technol. 2015;9(2):169–76.
Cohen RM, Holmes YR, Chenier TC, Joiner CH. Discordance between HbA1c and fructosamine: evidence for a glycosylation gap and its relation to diabetic nephropathy. Diabetes Care. 2003;26:163–7.
Clark VL, Kruse JA. Clinical methods: the history, physical, and laboratory examinations. JAMA. 1990;264(21):2808–9.
Carl AB, Edward RA, David EB. Tietz textbook of clinical chemistry and molecular diagnostics. 5th ed. Philadelphia: Saunders; 2012.
Howley JEA, Browning MCK, Fraser CG. Assay of serum fructosamine that minimizes standardization and matrix problems: Use to assess components of biological variation. Clin Chem. 1987;33:269–72.
Burtis CA, Ashwood ER, Sauders WB, Tietz NW. Textb Clin Chem. 1999;477–530.
Tietz NW. Clinical guide to laboratory tests, 4th edn. 2006, p. 916–21
Doumas BT, Watson WA, Biggs HG. Albumin standards and the measurement of albumin with bromocresol green. Clin Chim Acta. 1971;31:87–95.
Fabiny DL, Ertingshausen G. Automated Reaction-Rate Method for Determination of Serum Creatinine with the CentrifiChem. Clin Chem. 1971;17:696–700.
Dziedzic M, Petkowicz B, Michalak M, Solski J. Level of glycation gap in a healthy subject. Ann Agric Environ Med. 2012;19(4)
Snieder H, Sawtell PA, Ross L, Walker J, Spector TD, Leslie RD. HbA1c levels are genetically determined even in type 1 diabetes: evidence from healthy and diabetic twins. Diabetes. 2001;50(12):2858–63.
Rodríguez-Segade S, Rodríguez J, Casanueva FF, Camiña F. Progression of nephropathy in type 2 diabetes: the glycation gap is a significant predictor after adjustment for glycohemoglobin (HbA1c). Clin Chem. 2011;57(2):264–71.
Malmström H, Walldius G, Grill V, Jungner I, Gudbjörnsdottir S, Hammar N. Fructosamine is a useful indicator of hyperglycemia and glucose control in clinical and epidemiological studies–cross-sectional and longitudinal experience from the AMORIS cohort. PLoS One. 2014;9(10):e111463.
Neelofar K, Ahmad J. Glycosylation gap in patients with diabetes with chronic kidney disease and healthy participants: a comparative study. Indian J Endocrinol Metab. 2017;21(3):410–4.
Kikkawa R, Koya D, Haneda M. Progression of diabetic nephropathy. Am J Kidney Dis. 2003;41(3 Suppl 1):S19–21.
Zafon C, Ciudin A, Valladares S, Mesa J, Simo R. Variables involved in the discordance between HbA1c and fructosamine: the glycation gap revisited. PLoS One. 2013;8(6):e66696.
Nayak AU, Singh BM, Dunmore SJ. Potential clinical error arising from use of HbA1c in diabetes: effects of the Glycation Gap. Endocr Rev. 2019;40(4):988–99.
Nayak AU, Nevill AM, Bassett P, Singh BM. Association of glycation gap with mortality and vascular complications in diabetes. Diabetes Care. 2013;36(10):3247–53.
Acknowledgment
We are thankful to ICMR for approving the project as part of short term studentship project. We acknowledge the support of all laboratory technicians and staff of the Department of Biochemistry, AIIMS Mangalagiri.
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The present study was approved by the Institutional Ethics Committee, AIIMS Mangalagiri, Andhra Pradesh, India, with reference no. AIIMS/MG/IEC/2019-20/03 dated 28-08-2019.
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Key messages
Fructosaminated HbA1c and glycation gap can be used as a part of glyco-metabolic profile in diabetes mellitus.
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Chandrasekhar, K., Chakraborty, M., Sripad, V.D. et al. Predicted HbA1c and fructosaminated HbA1c: evaluating their role as an indicator of glycemic status in diabetes mellitus: a hospital based cross-sectional study. Int J Diabetes Dev Ctries 41, 607–613 (2021). https://doi.org/10.1007/s13410-021-00942-8
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DOI: https://doi.org/10.1007/s13410-021-00942-8