Circulating biomarkers of glycemia in diabetes management and implications for personalized medicine

Abstract

Personalized medicine represents a new model in how the medical community approaches disease management. Rather than managing those with a particular diagnosis according to an established guideline, the personalized medicine model seeks to identify unique characteristics within each patient that can serve as a basis for disease characterization and specialized treatment. This article reviews several circulating biomarkers of glycemia that are used in the medical management of diabetes, to include hemoglobin A1c, fructosamine, and 1,5-anhydroglucitol. Within the discussion, specific attention is paid to areas in which biomarker results do not correlate with anticipated results based on actual mean glycemia. Variability between actual and anticipated results of the various biomarker tests represents opportunities to identify previously undefined subcategories of diabetes and groups of patients that fit into these subcategories. Finally, research areas are proposed for these subcategories that would further promote the field of personalized medicine in diabetes.

Figure 1.

Linear regression of HbA1c at the end of month 3 and calculated average glucose during the preceding 3 months. Calculated average glucose (mg/dl) = 28.7 × HbA1c − 46.7; average glucose (mmol) = 1.59 × HbA1c − 2.59; R² = 0.84, p < .0001. Reprinted with permission from Diabetes Care.

Figure 2.

Proposed algorithm for 1,5-AG. Reprinted with permission from Expert Review of Molecular Diagnostics.