Alternative markers of hyperglycemia and risk of diabetes

Abstract

Objective: Fructosamine, glycated albumin, and 1,5-anhydroglucitol (1,5-AG) are of interest for monitoring short-term glycemic control in patients with diabetes; however, their associations with diabetes risk are uncharacterized.

Research design and methods: We used Cox proportional hazards models to examine the associations of fructosamine, glycated albumin, and 1,5-AG with incident diabetes in 1,299 participants, from the Atherosclerosis Risk in Communities (ARIC) Study (2005-2006), who had no history of diagnosed diabetes at baseline. Incident diabetes was self-reported during annual telephone calls.

Results: There were 119 new cases of diabetes during a median follow-up of 3.3 years. When compared with the lowest quartile, the fourth quartiles of fructosamine and glycated albumin were significantly associated with diabetes risk (hazard ratio [HR] 3.99 [95% CI 1.93-8.28] and 5.22 [2.49-10.94], respectively). The fourth quartile of 1,5-AG was associated with a significantly lower diabetes risk (0.27 [0.14-0.55]). Associations were attenuated but still significant after adjustment for hemoglobin A(1c) (A1C) or fasting glucose.

Conclusions: Fructosamine, glycated albumin, and 1,5-AG were associated with the subsequent development of diabetes independently of baseline A1C and fasting glucose. Our results suggest these alternative biomarkers may be useful in identifying persons at risk for diabetes.

Figure 1

Fructosamine (A), glycated albumin (B), and 1,5-AG (C). Unadjusted HRs (solid line) for self-reported diagnosed diabetes according to baseline concentrations of glycemic markers from restricted cubic spline models. Dashed lines are the 95% CIs. The models were expressed relative to the 25th percentile with knots specified at the 25th, 50th, and 75th percentiles. The plots were truncated at the 1st and 99th percentiles. The HRs are shown on a natural log scale.