Nayak, AU, Singh, BM and Dunmore, SJ (2019) Potential Clinical Error Arising From Use of HbA1c in Diabetes: Effects of the Glycation Gap. Endocrine Reviews, 40 (4). 988 - 999. ISSN 0163-769X

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The glycation gap (GGap) and the similar hemoglobin glycation index (HGI) define consistent differences between glycated hemoglobin and actual glycemia derived from fructosamine or mean blood glucose, respectively. Such a disparity may be found in a substantial proportion of people with diabetes, being >1 U of glycated HbA1c% or 7.2 mmol/mol in almost 40% of estimations. In this review we define these indices and explain how they can be calculated and that they are not spurious, being consistent in individuals over time. We evaluate the evidence that GGap and HGI are associated with variation in risk of complications and mortality and demonstrate the potential for clinical error in the unquestioning use of HbA1c. We explore the underlying etiology of the variation of HbA1c from mean glucose in blood plasma, including the potential role of enzymatic deglycation of hemoglobin by fructosamine-3-kinase. We conclude that measurement of GGap and HGI are important to diabetes clinicians and their patients in individualization of therapy and the avoidance of harm arising from consequent inappropriate assessment of glycemia and use of therapies.

Item Type: Article
Additional Information: The final version of this article is available online at
Uncontrolled Keywords: diabetes; pancreatic and gastointestinal hormones
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC660 Diabetes
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 26 Sep 2019 11:10
Last Modified: 27 Sep 2019 10:04

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