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. 2013 Oct;36(10):3247-53.
doi: 10.2337/dc12-1040. Epub 2013 Jul 8.

Association of glycation gap with mortality and vascular complications in diabetes

Ananth U Nayak  1 , Alan M Nevill, Paul Bassett, Baldev M Singh
Affiliations

Association of glycation gap with mortality and vascular complications in diabetes

Ananth U Nayak et al. Diabetes Care. 2013 Oct.

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.

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Figures

Figure 1
Figure 1
The prevalence of negative and positive G-gap status by HbA1c quintile (χ2 = 505.8, P < 0.001). The HbA1c (mean [range]) for the quintiles of HbA1c: 1) 6.4% (3.8–7.0), 2) 7.5% (7.1–7.8), 3) 8.3% (7.9–8.6), 4) 9.2% (8.7–9.7), and 5) 11.3% (9.8–19.0).
Figure 2
Figure 2
Cox regression analysis for cumulative survival from time of first testing of the whole cohort categorized according to G-gap status (for positive G-gap, n = 651; neutral G-gap, n = 1,945; and negative G-gap, n = 586).
See this image and copyright information in PMC

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References

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