Nontraditional Markers of Glycemia

Abstract

OBJECTIVE To compare the associations of nontraditional (fructosamine, glycated albumin, 1,5-anhydroglucitol [1,5-AG]) and standard (fasting glucose, HbA1c) glycemic markers with common microvascular conditions associated with diabetes mellitus. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study of 1,600 participants (227 with a history of diabetes and 1,323 without) from the Atherosclerosis Risk in Communities (ARIC) Study, a community-based population. We conducted logistic regression analyses of the associations of diabetes-specific tertiles of fructosamine, glycated albumin, 1/(1,5-AG), fasting glucose, and HbA1c with prevalence of chronic kidney disease, albuminuria, and retinopathy after adjustment for demographic, clinical, and lifestyle variables. RESULTS We observed significant positive trends in the associations of each marker with albuminuria and retinopathy, even after accounting for demographic, clinical, and lifestyle factors (all P trends <0.05). The associations with chronic kidney disease were similar in direction but were only significant for higher glycated albumin (P trend = 0.005), fructosamine (P trend = 0.003), and HbA1c (P trend = 0.005) values. After further adjustment for HbA1c, glycated albumin and fructosamine remained significantly or borderline significantly associated with the microvascular outcomes. CONCLUSIONS In cross-sectional analyses, two serum markers of glycemia—glycated albumin and fructosamine—are as, or more strongly, associated with microvascular conditions as HbA1c. These markers may be useful in settings where whole blood is not available. Whether they might complement or outperform HbA1c in terms of long-term predictive value requires further investigation.