Alternative Biomarkers For Assessing Glycemic Control In Diabetes: Fructosamine, Glycated Albumin, And 1,5-anhydroglucitol
Alternative biomarkers for assessing glycemic control in diabetes: fructosamine, glycated albumin, and 1,5-anhydroglucitol Department of Pediatrics, Inha University Hospital, Inha University Graduate School of Medicine, Incheon, Korea. Address for correspondence: Ji-Eun Lee, MD, PhD. Department of Pediatrics, Inha University Hospital, Inha University Graduate School of medicine, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea. Tel: +82-32-890-3617, Fax: +82-32-890-3099, [email protected] Received 2015 Jun 26; Accepted 2015 Jun 26. Copyright 2015 Annals of Pediatric Endocrinology & Metabolism This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. The growing attention to alternative glycemic biomarkers including fructosamine, glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), is attributable to the limitations of the glycated hemoglobin (HbA1c) assay. It is important to recognize the conditions in which HbA1c levels may be difficult to interpret. Serum fructosamine and GA have been proposed useful tools for monitoring of short-term glycemic control. These biomarkers not only reflect well glycemic control in hematologic disorder, but also represent postprandial glucose fluctuation. Serum 1,5-AG may be useful for estimating within-day glucose variation. Use of these nontraditional tests can be more helpful in the management of diabetes as complement traditional measures. Further larger cohort studies are warranted to determine whether nontraditional biomarkers have potential utility for early diagnosis, management of Continue reading >>
Q. My Hba1c Is 7. 5. Should I Continue My Tablet For Diabetes?
Hello doctor, I am a 52 year old female. One year before I went to a diabetologist and took glucose tolerance test. Here is the result, fasting - 128 mg/dL, 1 hour - 340 mg/dL, 2 hour - 196 mg/dL. Doctor prescribed medicine for a month but after that I did not take any medication. Now I would like to know should I take any tablet. Here I have also attached my HbA1c report for your reference. Thank you doctor, Should I take the tablet before food or after food? Continue reading >>
Alternative Markers Of Glycemia: Fructosamine, Glycated Albumin, 1,5-ag
Fructosamine is the common name for 1-amino-1-deoxy-fructose, also called isoglucosamine, and was first synthesized in 1886. Fructosamine is a ketoamine formed from the joining of fructose to protein molecules (mostly albumin) through glycation, a nonenzymatic mechanism involving a labile Schiff base intermediate and the Amadori rearrangement. Glycated albumin is a ketoamine formed via a non-enzymatic glycation reaction of serum albumin Reflects mean glucose over the prior two to three weeks (i.e. extending beyond the half-life of albumin and some other serum proteins). 1,5-anhydroglucitol (1,5-AG), the 1-deoxy form of glucose, is a metabolically inert polyol composed of six-carbon chain monosaccharides derived mainly from food and well absorbed by the intestine. 1,5-AG competes with glucose for reabsorption into the kidneys. When glucose levels rise (>180 mg/dl), even transiently, urinary loss of 1,5-AG occurs, and circulating levels of 1,5-AG fall. GlycoMark is the automated assay for 1,5-AG approved for use in the U.S. 1,5-AG has been measured and used clinically in Japan for over a decade to monitor short-term glycemic control. Fructosamine: Multiple methods have been used to measure fructosamine, including the phenylhydrazine procedure, the furosine procedure, affinity chromatography, the 2-thiobarbituric acid colorimetric procedure, and the nitroblue tetrazolium colorimetric procedure. First generation fructosamine assays suffered from lack of specificity, lack of standardization among laboratories, susceptibility to interference by hyperlipidemia, and difficulty in calibrating the assay. However, second generation assays are rapid, inexpensive, highly specific, and free from interference by urates and triglycerides. The fructosamine assay commonly Continue reading >>
Print Overview The A1C test is a common blood test used to diagnose type 1 and type 2 diabetes and then to gauge how well you're managing your diabetes. The A1C test goes by many other names, including glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C and HbA1c. The A1C test result reflects your average blood sugar level for the past two to three months. Specifically, the A1C test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications. Why it's done An international committee of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation, recommend that the A1C test be the primary test used to diagnose prediabetes, type 1 diabetes and type 2 diabetes. After a diabetes diagnosis, the A1C test is used to monitor your diabetes treatment plan. Since the A1C test measures your average blood sugar level for the past two to three months instead of your blood sugar level at a specific point in time, it is a better reflection of how well your diabetes treatment plan is working overall. Your doctor will likely use the A1C test when you're first diagnosed with diabetes. This also helps establish a baseline A1C level. The test may then need to be repeated while you're learning to control your blood sugar. Later, how often you need the A1C test depends on the type of diabetes you have, your treatment plan and how well you're managing your blood sugar. For example, the A1C test may be recommended: Once every year if you have prediabetes, which indicates a high risk of developing diabetes Twice a year if Continue reading >>
HbA1c (%) Estimated Average (eAG) (mg/dL) Estimated Average (eAG) (mmol/l) 5 97 5.4 6 126 7.0 7 154 8.6 8 183 10.2 9 212 11.8 10 240 13.4 11 269 14.9 12 298 16.5 You can use the calculators on this page to convert HbA1c and estimated average blood sugars. You can also convert from mg/dL, the measurements used in the USA, and mmol which is used by most of the rest of the world. Convert Blood Sugar from US (mg/dl) to UK (mmol/L) The difference is that mg/dL is a measure of weight while mmol is a measure of volume. US: UK: (click on other box to calculate) Formulas US (mg/dl) is the UK (mmol/L) number multiplied by 18. UK (mmol/L) is the US (mg/dl) number divided by 18. Convert HbA1c to Average Blood Glucose Reading Enter HbA1c (Glycosylated Hemoglobin): % Avg. plasma blood glucose = mg/dl mmol/L Avg. whole blood glucose = mg/dl mmol/L Formulas Avg. Plasma Blood Glucose (mg/dl) = (HbA1c * 35.6) - 77.3 Avg. Plasma Blood Glucose (mmol/L) = (HbA1c * 1.98) - 4.29 Avg. whole blood glucose = Plasma Blood Glucose / 1.12 Continue reading >>
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What Is An Hba1c? What’s A Good Number?
If you have diabetes, you should be tracking your HbA1c. It’s the best measure that we have of your average blood sugars over the last three months. But what is an HbA1c?! Hemoglobin is the stuff that carries oxygen in your blood and gives it that red color. When you have extra sugar in your blood, some of it attaches to the homoglobin and forms a variant called hemoglobin A1c. It’s also called “glycated hemoglobin” – or HbA1c for short. Hemoglobin and its variations live for about 120 days. By measuring the percentage of HbA1c in your blood, we can tell about how high your blood sugars have been during that lifespan. How is an HbA1c test performed? The HbA1c test is done by drawing blood from a vein. You may feel a slight pinch when the needle in inserted. Blood can be sent away to a lab or measured on a machine in your doctor’s office or at a hospital. There are home HbA1c test kits available that cost about $15 per test. The home tests are less accurate but can give you a strong estimate. What is a normal HbA1c? In people without diabetes, the HbA1c is usually between 4% and 6%. From the Wikipedia page on glycated hemoglobin, here’s a chart showing how your HbA1c compares to your estimated average blood glucose during the prior months: HbA1c eAG (estimated average glucose) (%) (mmol/mol) (mmol/L) (mg/dL) 5 31 5.4 (4.2–6.7) 97 (76–120) 6 42 7.0 (5.5–8.5) 126 (100–152) 7 53 8.6 (6.8–10.3) 154 (123–185) 8 64 10.2 (8.1–12.1) 183 (147–217) 9 75 11.8 (9.4–13.9) 212 (170–249) 10 86 13.4 (10.7–15.7) 240 (193–282) 11 97 14.9 (12.0–17.5) 269 (217–314) 12 108 16.5 (13.3–19.3) 298 (240–347 What is a good HbA1c? Below are the 2011 guidelines for the major American standards bodies: The guidelines are based in part on the two largest s Continue reading >>
Hba1c 57-64% And Impaired Fasting Plasma Glucose For Diagnosis Of Prediabetesand Risk Of Progression To Diabetes In Japan (topics 3): A Longitudinal Cohortstudy.
1. Lancet. 2011 Jul 9;378(9786):147-55. doi: 10.1016/S0140-6736(11)60472-8. Epub2011 Jun 24. HbA1c 57-64% and impaired fasting plasma glucose for diagnosis of prediabetesand risk of progression to diabetes in Japan (TOPICS 3): a longitudinal cohortstudy. Heianza Y(1), Hara S, Arase Y, Saito K, Fujiwara K, Tsuji H, Kodama S, Hsieh SD, Mori Y, Shimano H, Yamada N, Kosaka K, Sone H. (1)Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan. Comment in Lancet. 2011 Jul 9;378(9786):104-6. BACKGROUND: The clinical relevance of the diagnostic criteria for prediabetes to prediction of progression to diabetes has been little studied. We aimed tocompare the prevalence of prediabetes when assessed by the new glycatedhaemoglobin A(1c) (HbA(1c)) 57-64% criterion or by impaired fasting glucose,and assessed differences in progression rate to diabetes between these twocriteria for prediabetes in a Japanese population.METHODS: Our longitudinal cohort study included 4670 men and 1571 women aged24-82 years without diabetes at baseline (diabetes was defined as fasting plasma glucose 70 mmol/L, self-reported clinician-diagnosed diabetes, or HbA(1c)65%) who attended Toranomon Hospital (Tokyo, Japan) for a routine health check between 1997 and 2003. Participants with a baseline diagnosis of prediabetesaccording to impaired fasting glucose (fasting plasma glucose 56-69 mmol/L) or HbA(1c) 57-64%, or both, were divided into four groups on the basis of baselinediagnosis of prediabetes. Rate of progression to diabetes was assessed annually.FINDINGS: Mean follow-up was 47 (SD 07) years. 412 (7%) of 6241 participantswere diagnosed with prediabetes on the basis of the HbA(1c) 57-64% criterion.Screening by HbA(1c) alone missed 1270 (61%) of the 2092 pred Continue reading >>
Improvements In Hba1c Remain After 5 Years A Follow Up Of An Educational Intervention Focusing On Patients Personal Understandings Of Type 2 Diabetes
Volume 81, Issue 1 , July 2008, Pages 50-55 Improvements in HbA1c remain after 5 years a follow up of an educational intervention focusing on patients personal understandings of type 2 diabetes Author links open overlay panel saHrnstena Get rights and content This paper reports a 5-year follow-up from a study aimed at evaluating whether an intervention which focused on patients personal understanding of their illness was more effective than conventional diabetes care with regard to metabolic control among patients with type 2 diabetes mellitus (DM2). The study was conducted within Swedish primary health care and included 102 patients (mean age 63 years). At clinic level they were randomised into control or intervention groups. The intervention directed at patients consisted of ten two-hour group sessions over 9 months, focusing on patients own needs and questions. The mean HbA1c at baseline was 5.71% (S.D. 0.76) in the intervention group and 5.78% (S.D. 0.71) in the control group. At the 5-year follow-up, the mean HbA1c in the intervention group still was 5.71% (S.D. 0.85) while among the controls it had increased to 7.08% (S.D. 1.71). The adjusted difference was 1.37 (p<0.0001). Treatment upgrade, BMI, total cholesterol, HDL, LDL and triglycerides at baseline did not influence the difference in HbA1c. These findings indicate that group sessions in patients with DM2 focusing on patients personal understanding of their illness are more effective than conventional diabetes care with regard to metabolic control. Continue reading >>
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Guide To Hba1c
Tweet HbA1c is a term commonly used in relation to diabetes. This guide explains what HbA1c is, how it differs from blood glucose levels and how it's used for diagnosing diabetes. What is HbA1c? The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'. By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months. For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications. HbA1c is also referred to as haemoglobin A1c or simply A1c. HbA1c refers to glycated haemoglobin (A1c), which identifies average plasma glucose concentration. How does HBA1c return an accurate average measurement of average blood glucose? When the body processes sugar, glucose in the bloodstream naturally attaches to haemoglobin. The amount of glucose that combines with this protein is directly proportional to the total amount of sugar that is in your system at that time. Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produced; also known as insulin resistance and/or Being unable to produce enough insulin Type 2 diabetes is characterised by the body being unable to metabolise glucose (a simple sugar). This leads to high levels of blood glucose which over time may damage the organs of the body. From this, it can be understood that for someone with diabetes something that is food for ordinary people can become a sort of metabolic poison. This is why peop Continue reading >>
5 Ways To Lower Your A1c
For some, home blood sugar testing can be an important and useful tool for managing your blood sugar on a day-to-day basis. Still, it only provides a snapshot of what’s happening in the moment, not long-term information, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City. For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past two to three months. Called the A1C test, or the hemoglobin A1C test, this provides a more accurate picture of how well your type 2 diabetes management plan is working. Taking the A1C Test If your diabetes is well controlled and your blood sugar levels have remained stable, the American Diabetes Association recommends that you have the A1C test two times each year. This simple blood draw can be done in your doctor's office. Some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition. Your doctor may want to run the test as often as every three months if your A1C is not within your target range. What the A1C Results Mean The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says. An A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 perce Continue reading >>
A Hemoglobin A1c Of Greater Than 5% Can Be A Predictor Of Incident Diabetes
The incidence of diabetes progressively and significantly increased among patients with an HbA1c greater than 5.0%…. Several studies have suggested that HbA1c levels may predict incident diabetes. With new recommendations for use of HbA1c in diagnosing diabetes, many patients with HbA1c results below the diagnostic threshold will be identified. Clinicians will need to categorize risk for a subsequent diabetic diagnosis in such patients. The objective of this study was to determine the ability of HbA1c to predict the incidence of a diabetic diagnosis. For this study they performed a historical cohort study using electronic medical record data from two Department of Veterans Affairs Medical Centers. Patients (12,589) were identified with a baseline HbA1c <6.5% between January 2000 and December 2001 and without a diagnosis of diabetes. Patients (12,375) had at least one subsequent follow-up visit. These patients were tracked for 8 years for a subsequent diagnosis of diabetes. The results showed that during an average follow-up of 4.4 years, 3,329 (26.9%) developed diabetes. HbA1c ≥5.0% carried a significant risk for developing diabetes during follow-up. When compared with the reference group (HbA1c <4.5%), HbA1c increments of 0.5% between 5.0 and 6.4% had adjusted odds ratios of 1.70 (5.0–5.4%), 4.87 (5.5–5.9%), and 16.06 (6.0–6.4%) (P < 0.0001). Estimates of hazard ratios similarly showed significant increases for HbA1c ≥5.0%. A risk model for incident diabetes within 5 years was developed and validated using HbA1c, age, BMI, and systolic blood pressure. The results showed that baseline HbA1c was significantly predictive of the subsequent development of a diagnosis of diabetes over an 8-year period. The risk of developing diabetes increased progressively at Hb Continue reading >>
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What Is The Hba1c?
In the blood stream are the red blood cells, which are made of a molecule, haemoglobin. Glucose sticks to the haemoglobin to make a 'glycosylated haemoglobin' molecule, called haemoglobin A1C or HbA1C. The more glucose in the blood, the more haemoglobin A1C or HbA1C will be present in the blood. Red cells live for 8 - 12 weeks before they are replaced. By measuring the HbA1C it can tell you how high your blood glucose has been on average over the last 8-12 weeks. A normal non-diabetic HbA1C is <36mmol/mol (5.5%). In diabetes about 48mmol/mol (6.5%) is good. The HbA1C test is currently one of the best ways to check diabetes is under control; it is the blood test that gets sent to the laboratory, and it is done on the spot in some hospital clinics. Remember, the HbA1C is not the same as the glucose level. Coincidentally the glucose/HbA1C numbers for good control are rather similar though in the UK and Europe: glucose levels averaging 6.5 mmols/l before meals is equivalent to 60mmol/mol (7%). HbA1C (glucose levels are higher after meals) (see below). Two examples Below are two examples of people who have their HbA1c measured. One is poorly controlled, one well controlled. When should the HbA1C be measured? Measure HbA1c every 3 months if trying to improve every 6 months if very stable If your diabetes is controlled (basically an HbA1C lower than 53mmol/mol ( 7% ), every 3-6 months. But if the last reading is above 53mmol/mol (7%) and you are in reasonable health, you will need to achieve a lower level if possible, and the next reading should be sooner. This assumes you will make changes to improve your control. There is no point in having your HbA1c measured if you are not trying to achieve good control of your diabetes, although the level does predict the likelihood of co Continue reading >>
Reduced Testing Frequency For Glycated Hemoglobin, Hba1c, Is Associated With Deteriorating Diabetes Control
OBJECTIVE We previously showed that in patients with diabetes mellitus, glycated hemoglobin (HbA1c) monitoring outside international guidance on testing frequency is widespread. Here we examined the relationship between testing frequency and diabetes control to test the hypothesis that retest interval is linked to change in HbA1c level. RESEARCH DESIGN AND METHODS We examined repeat HbA1c tests (400,497 tests in 79,409 patients, 2008–2011) processed by three U.K. clinical laboratories. We examined the relationship between retest interval and 1) percentage change in HbA1c and 2) proportion of cases showing a significant HbA1c rise. The effect of demographics factors on these findings was also explored. RESULTS Our data showed that the optimal testing frequency required to maximize the downward trajectory in HbA1c was four times per year, particularly in those with an initial HbA1c of ≥7% (≥53 mmol/mol), supporting international guidance. Testing 3-monthly was associated with a 3.8% reduction in HbA1c compared with a 1.5% increase observed with annual testing; testing more frequently provided no additional benefit. Compared with annual monitoring, 3-monthly testing was associated with a halving of the proportion showing a significant rise in HbA1c (7–10 vs. 15–20%). CONCLUSIONS These findings provide, in a large, multicenter data set, objective evidence that testing outside guidance on HbA1c monitoring frequency is associated with a significant detrimental effect on diabetes control. To achieve the optimum downward trajectory in HbA1c, monitoring frequency should be quarterly, particularly in cases with suboptimal HbA1c. While this impact appears small, optimizing monitoring frequency across the diabetes population may have major implications for diabetes contro Continue reading >>
Hemoglobin A1c Test (hba1c, A1c, Hb1c)
Hemoglobin A1c definition and facts Hemoglobin A1c is a protein on the surface of red blood cells that sugar molecules stick to, usually for the life of the red blood cell (about three months). The higher the level of glucose in the blood, the higher the level of hemoglobin A1c is detectable on red blood cells. Hemoglobin A1c levels correlate with average levels of glucose in the blood over an approximately three-month time period. Normal ranges for hemoglobin A1c in people without diabetes is about 4% to 5.9%. People with diabetes with poor glucose control have hemoglobin A1c levels above 7%. Hemoglobin A1c levels are routinely used to determine blood sugar control over time in people with diabetes. Decreasing hemoglobin A1c levels by 1% may decrease the risk of microvascular complications (for example, diabetic eye, nerve, or kidney disease) by 10%. Hemoglobin A1c levels should be checked, according to the American Diabetic Association, every six months in individuals with stable blood sugar control, and every three months if the person is trying to establish stable blood sugar control. Hemoglobin A1c has many other names such as glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin, and HbA1c. To explain what hemoglobin A1c is, think in simple terms. Sugar sticks to things, and when it has been stuck to something for a long time it's harder to the get sugar (glucose) off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die. When sugar (glucose) sticks to these red blood cells by binding to hemoglobin A1c, it gives us an idea of how much glucose has been around in the blood for the preceding three months. Hemoglobin A1c is a minor component of hemoglobin to which gl Continue reading >>
5 Things Every Diabetic Should Know About Hba1c
If you or someone you love has diabetes, you may have heard the term “Hemoglobin A1c,” or HbA1c, in reference to tests that monitor blood sugar levels. Monitoring HbA1c is an important part of diabetes care, and it can have a huge impact on your ability to maintain a healthy mouth and body. These essential facts on HbA1c will show what the numbers are all about. 1. Measures the Sugars Attached to Your Blood Cells Your HbA1c value gives the percentage of red blood cells that have glucose (sugar) attached to them. Because red blood cells live for about 3 months, the HbA1c test measures the average blood sugar levels across a two or three-month period (according to WebMD). If your HbA1c level is higher, more sugar is bound to your blood cells. 2. HbA1c Tests Give a Broad Perspective HbA1c values are used to measure your blood sugar control over time, which differs from blood glucose readings that diabetic patients take multiple times per day. The main difference is that an HbA1c test will let your doctor learn about your blood sugar levels over a long period, while glucose readings only provide information about the past few hours. High HbA1c numbers may be a warning sign of diabetes or of complications from uncontrolled diabetes – diminished healing, blindness, and even kidney failure. 3. Diabetes Can Affect Oral Health If you have diabetes, be sure to take the time to discuss your condition with your dentist and dental hygienist. Many people with diabetes are at increased risk of gum disease, dry mouth, fungal infections, tooth decay, and mouth ulcers. Diabetes may also diminish and slow your ability to heal after dental surgeries such as tooth extractions. Maintaining a target HbA1c value (as advised by your doctor) can lower your risk for oral health complication Continue reading >>