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. 2023 Jun 28:78:100240.
doi: 10.1016/j.clinsp.2023.100240. eCollection 2023.

Fructosamine and glycated hemoglobin as biomarkers of glycemic control in people with type 2 diabetes mellitus and cancer (GlicoOnco study)

Marcos Tadashi Kakitani Toyoshima  1 , Priscilla Cukier  2 , Aline Santos Damascena  3 , Rafael Loch Batista  4 , Fernanda de Azevedo Correa  4 , Eduardo Zanatta Kawahara  5 , Carlos André Minanni  6 , Ana O Hoff  4 , Marcia Nery  5
Affiliations

Fructosamine and glycated hemoglobin as biomarkers of glycemic control in people with type 2 diabetes mellitus and cancer (GlicoOnco study)

Marcos Tadashi Kakitani Toyoshima et al. Clinics (Sao Paulo). .

Abstract

Introduction: Glycemic control is important to avoid diabetes complications in individuals with cancer. There is no evidence for HbA1c and fructosamine as reliable biomarkers in these conditions. There are particularities in caring for patients with diabetes and cancer that can alter these biomarkers.

Objective: The aim of this study was to evaluate HbA1c and fructosamine as glycemic biomarkers in people with type 2 diabetes and cancer, undergoing clinical or surgical oncological treatment.

Methods: The authors conducted a single-center, retrospective analysis with people who have cancer and diabetes. Comparison of glycemic biomarkers (HbA1c, fructosamine, and Self-Monitoring of Blood Glucose [SMBG]) was performed including evaluation in individuals undergoing chemotherapy, using glucocorticoids, with anemia, hypoproteinemia or with reduced estimated Glomerular Filtration Rate (eGFR).

Results: There was a strong positive correlation between fructosamine and HbA1c (n = 318, r = 0.66, p < 0.001) in people with diabetes and cancer even in those under chemotherapy (n = 101, r = 0.61, p < 0.001) or using glucocorticoids (n = 96, r = 0.67, p<0.001). There was a strong correlation between HbA1c and fructosamine in subjects with anemia (n = 111, r = 0.66, p < 0.001), hypoproteinemia (n = 54, r = 0.67, p < 0.001), or with eGFR ≥ 60 mL/min/1.73 m2 (n = 189, r = 0.70, p < 0.001), and moderate correlation with hypoalbuminemia (n = 21, r = 0.54, p = 0.001) and with reduced eGFR (n = 67, r = 0.57, p < 0.001). The correlations between fructosamine and HbA1c with SMBG were moderate (n = 164, r = 0.49, p < 0.001; n = 111, r = 0.55, p < 0.001, respectively), strong in subjects undergoing chemotherapy, with hypoalbuminemia or hypoproteinemia, and at least moderate, if eGFR < 60 mL/min/1.73 m2 or with anemia.

Conclusions: Fructosamine and HbA1c can be used as glycemic biomarkers in people with diabetes and cancer, even in those with anemia, hypoproteinemia, or undergoing chemotherapy.

Keywords: Cancer; Chemotherapy; Fructosamine; Glucocorticoids; Glycemic control; HbA1c.

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Conflict of interest statement

Conflicts of interest There authors declare no conflicts of interest. All authors have read and approved the submission of the manuscript; the manuscript has not been published and is not being considered for publication elsewhere, in whole or in part, in any language.

Figures

Fig 1
Fig. 1
Dispersion between HbA1c and fructosamine (A), fructosamine and 1-month Self-Monitoring Blood Glucose (SMBG) (B), and HbA1c and 3-month SMBG (C) in subjects with diabetes and cancer, and the respective correlation between the variables. Gray dashed lines represent the confidence band for the regression line. The regression lines for the whole sample are [HbA1c = 0.014 × fructosamine + 3.49], [Fructosamine = 0.89 × 1-month SMBG + 176.35] and [HbA1c = 0.018 × 3-month SMBG + 4.60]. 95% CI, 95% Confidence Interval for r. r, Pearson's correlation coefficient.
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