![]() ![]() Whereas the overall utility of HbA 1c is beyond question, discordances between HbA 1c and other measures of glycemic control are commonly encountered ( 5– 7) and are important because of the millions of yearly HbA 1c measurements. It is a predictor of diabetic complications, and interventions that reduce HbA 1c correspondingly reduce the risk of complications ( 1– 4). HbA 1c is regarded as the gold standard for measurement of glycemic control and is invaluable in the treatment of diabetic patients. GG correlated better with nephropathy than did either HbA 1c or FA alone in this population.ĬONCLUSIONS-The glycosylation gap may be a useful clinical research tool for evaluating physiologic sources of variation in diabetic complications beyond glycemic control. GG was −0.8 ± 0.2% in subjects with no nephropathy, −0.3 ± 0.2% with microalbuminuria/hypertension, and 0.7 ± 0.3% in subjects with proteinuria or renal dysfunction ( P < 0.05). In 40 patients with type 1 diabetes of ≥15 years’ duration, an increase in GG by 1% was associated with a 2.9-fold greater frequency of increasing nephropathy stage ( P = 0.0014). GG was highly correlated ( r = 0.81) between measurements repeated in 65 patients 23 ± 2 weeks apart, indicating that the discordances are reliable and not explained by differences in turnover of underlying proteins. RESULTS-GG had a broad distribution (range, −3.2% to 5.5%) 40% of samples had values indicating major differences in prediction of complications risk by the measured versus predicted HbA 1c. RESEARCH DESIGN AND METHODS-Measurements of HbA 1c and FA on the same sample in 153 people were used to calculate GG, defined as the difference between measured HbA 1c and HbA 1c predicted from FA based on the population regression of HbA 1c on FA. We termed this the glycosylation gap (GG) and sought to determine its relationship to diabetic nephropathy. ![]() We developed a measure of discordance between HbA 1c and fructosamine (FA) (glycosylated serum proteins) to conduct a systematic evaluation. OBJECTIVE-Discordances between HbA 1c and other measures of glycemic control are common in clinical practice and remain unexplained. Institutional Subscriptions and Site Licenses.Special Edition Series: Disrupting Therapeutic Inertia in Diabetes Management.Special Edition: SGLT2 Inhibitors and Diabetic Kidney Disease.Special Edition Series: SGLT2 Inhibitors in Type 2 Diabetes: Cardiovascular and Renal Outcomes.Special Edition Series: Diabetes and Influenza.Special Edition: Painful Diabetic Peripheral Neuropathy.Special Edition Series: COVID-19 and Diabetes.ADA Standards of Medical Care, Abridged. ![]()
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