The ratio of estimated average glucose to fasting plasma glucose level is superior to glycated albumin, hemoglobin A1c, fructosamine, and GA/A1c ratio for assessing β-cell function in childhood diabetes.

Ji Eun Lee,Noriyoshi Fujii,Ji Woo Lee,Tatsuyoshi Fujii,Jong Weon Choi

doi:10.1155/2014/370790

Ji Eun Lee, Noriyoshi Fujii + Show 3 more

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https://doi.org/10.1155/2014/370790

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Abstract

Objective. This study investigated the use of the estimated average glucose to fasting plasma glucose ratio (eAG/fPG ratio) to screen for β-cell function in pediatric diabetes. Methods. Glycated hemoglobin (HbA1c), glycated albumin (GA), fructosamine, insulin, and C-peptide levels were measured. The ratio of GA to HbA1c (GA/A1c ratio) was calculated, and the homeostasis model assessment of β-cell function (HOMA-β) was determined. Results. Median values of C-peptide, insulin, and HOMA-β levels were significantly higher in patients with an increased eAG/fPG ratio than in those with a decreased eAG/fPG ratio. C-peptide and HOMA-β levels were more closely correlated with the eAG/fPG ratio than with GA, HbA1c, the GA/A1c ratio, and fructosamine. In contrast, body mass index was significantly associated with GA, GA/A1c ratio, and fructosamine, but not with the eAG/fPG ratio and HbA1c levels. To test the diagnostic accuracies of the eAG/fPG ratio for identifying HOMA-β > 30.0% in patients with type 2 diabetes, the area under the ROC curve of the eAG/fPG ratio was significantly larger than that of the GA/A1c ratio [0.877 (95% CI, 0.780–0.942) versus 0.775 (95% CI, 0.664–0.865), P = 0.039]. Conclusions. A measurement of the eAG/fPG ratio may provide helpful information for assessing β-cell function in pediatric patients with diabetes.

Highlights

The major fraction of glycated hemoglobin, HbA1c, has been widely used to assess the long-term glycemic control and the risk for the development of complications in diabetes
Fructosamine is not affected by anemia or variant hemoglobins but the level is influenced by the concentrations of serum protein, bilirubin, uric acid, and low molecular weight substances coexisting in the blood [4, 5]
The present study investigated the usefulness of the new parameter, the eAG/fPG ratio, to screen for β-cell function in children and adolescents with diabetes mellitus (DM), comparing the glycated albumin (GA)/A1c ratio and the three glycated proteins

Summary

Introduction

The major fraction of glycated hemoglobin, HbA1c, has been widely used to assess the long-term glycemic control and the risk for the development of complications in diabetes. Measurement of HbA1c has recently been recommended for diagnosing diabetes. HbA1c is affected by a variety of conditions, such as hemolytic anemia, chronic renal failure, and the presence of variant hemoglobins [1, 2]. HbA1c levels are underestimated in patients with poor glycemic control because survival of erythrocytes is shortened under hyperglycemic conditions [3]. Fructosamine was previously introduced in an index of glycemic control for two weeks past, measuring the amount of total glycosylated protein in serum. Fructosamine is not affected by anemia or variant hemoglobins but the level is influenced by the concentrations of serum protein, bilirubin, uric acid, and low molecular weight substances coexisting in the blood [4, 5]

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Conclusion