Nayak, AU and Nevill, AM and Bassett, P and Singh, BM (2013) Association of glycation gap with mortality and vascular complications in diabetes. Diabetes Care, 36 (10). 3247 -3253. ISSN 1935-5548

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Abstract

OBJECTIVE: The "glycation gap" (G-gap), an essentially unproven concept, is an empiric measure of disagreement between HbA1c and fructosamine, the two indirect estimates of glycemic control. Its association with demographic features and key clinical outcomes in individuals with diabetes is uncertain. RESEARCH DESIGN AND METHODS: The G-gap was calculated as the difference between measured HbA1c and a fructosamine-derived standardized predicted HbA1c in 3,182 individuals with diabetes. The G-gap's associations with demographics and clinical outcomes (retinopathy, nephropathy, macrovascular disease, and mortality) were determined. RESULTS: Demographics varied significantly with G-gap for age, sex, ethnic status, smoking status, type and duration of diabetes, insulin use, and obesity. A positive G-gap was associated with retinopathy (odds ratio 1.24 [95% CI 1.01-1.52], P=0.039), nephropathy (1.55 [1.23-1.95], P<0.001), and, in a subset, macrovascular disease (1.91 [1.18-3.09], P=0.008). In Cox regression analysis, the G-gap had a "U"-shaped quadratic relationship with mortality, with both negative G-gap (1.96 [1.50-2.55], P<0.001) and positive G-gap (2.02 [1.57-2.60], P<0.001) being associated with a significantly higher mortality. CONCLUSIONS: We confirm published associations of G-gap with retinopathy and nephropathy. We newly demonstrate a relationship with macrovascular and mortality outcomes and potential links to distinct subpopulations of diabetes.

Item Type: Article
Uncontrolled Keywords: humans, diabetic retinopathy, diabetic nephropathies, diabetes mellitus, Type 1, Type 2, fructosamine, hemoglobin A, glycosylated
Subjects: R Medicine > RC Internal medicine > RC648 Diseases of the endocrine glands. Clinical endocrinology.
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
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Depositing User: Symplectic
Date Deposited: 29 Feb 2016 09:12
Last Modified: 07 Jul 2017 15:01
URI: http://eprints.keele.ac.uk/id/eprint/1504

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