New indices for predicting glycaemic variability.

Akifumi Ogawa,Masayoshi Shichiri,Eriko Kishihara,Akinori Hayashi,Sonomi Yoshino,Akihiro Takeuchi,Massimo Pietropaolo

doi:10.1371/journal.pone.0046517

Akifumi Ogawa, Masayoshi Shichiri + Show 5 more

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https://doi.org/10.1371/journal.pone.0046517

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Journal: PloS one	Publication Date: Sep 27, 2012
Citations: 82	License type: CC BY 4.0

Affiliation: Kitasato University

Abstract

Blood glucose variability is known to be associated with increased risk of long-term complications. Reliable indices for predicting hyperglycaemic and hypoglycaemic fluctuations are therefore needed. Glycaemic standard deviation (SD) obtained by continuous glucose monitoring correlates closely with nine previously described glycaemic variability formulas. Here, new indices predictive of glycaemic variability were developed, which can be calculated from laboratory measures based on a single blood draw. The indices included the glycated albumin (GA) to HbA1c ratio (GA/A1c ratio) and the fasting C-peptide immunoreactivity (FCPR) to fasting plasma glucose (FPG) ratio (FCPR index). Predictive values of these indices were assessed in 100 adults with diabetes. GA/A1c ratio and FCPR index showed close associations with glycaemic SD in addition to the nine existing glucose variability formulas. Subjects with a GA/A1c ratio ≥2.8 and FCPR index <3.0 showed the greatest SD and longest durations of hypoglycaemia, while those with a GA/A1c ratio <2.8 and FCPR index ≥3.0 had smaller SDs and little sign of hypoglycaemia. In adults with diabetes, a high GA/A1c ratio and low FCPR index value reflect higher glycaemic excursions, irrespective of diabetes type. Simultaneous measurements of GA, HbA1c, FPG and FCPR may help to identify a group of patients who warrant closer monitoring in relation to glycaemic variability and hypoglycaemia.

Highlights

The predominant focus of diabetic therapy has long been on lowering HbA1c (A1c) levels, with a strong emphasis on fasting plasma glucose (FPG), but the role of postprandial hyperglycaemia and glucose variability in relation to the risk of cardiovascular disease has recently been the subject of intense debate [1,2]
Stepwise multiple linear regression analysis of these items revealed that only Glycated albumin (GA)/A1c ratio (Fig. 1A) and fasting C-peptide immunoreactivity (FCPR) index (Fig. 1B) were significantly correlated with glycaemic standard deviation (SD)
The results indicate the validity of GA/A1c ratio $2.8 and FCPR index,3.0 as predictors of high glycaemic variability

Summary

Introduction

The predominant focus of diabetic therapy has long been on lowering HbA1c (A1c) levels, with a strong emphasis on fasting plasma glucose (FPG), but the role of postprandial hyperglycaemia and glucose variability in relation to the risk of cardiovascular disease has recently been the subject of intense debate [1,2]. Glycaemic variability influences endothelial function in both nondiabetic and type 2 diabetic subjects [3], accounting for increased cardiovascular risk [4]. Glycated albumin (GA) levels are expected to reflect average blood glucose level over the previous 1–2 weeks, given that the half-life of albumin is approximately 17 days [8]. GA/A1c ratio is associated with fasting C-peptide immunoreactivity (FCPR) to FPG ratio (FCPR index) in type 2 diabetic patients [14,15]. Based on these results, we hypothesized that basal b-cell function and GA/A1c ratio could serve as clinical indices to predict blood glucose variability. We introduce the use of FCPR index combined with GA/A1c ratio as potential predictors of glycaemic variability

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