Skip to main content

Research Repository

Advanced Search

Association of glycation gap with mortality and vascular complications in diabetes

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.

Acceptance Date Apr 29, 2013
Publication Date Oct 1, 2013
Journal Diabetes Care
Print ISSN 0149-5992
Publisher American Diabetes Association
Pages 3247 -3253
DOI https://doi.org/10.2337/dc12-1040
Keywords humans, diabetic retinopathy, diabetic nephropathies, diabetes mellitus, Type 1, Type 2, fructosamine, hemoglobin A, glycosylated
Publisher URL http://dx.doi.org/10.2337/dc12-1040

Downloadable Citations