Level of glycation gap in a healthy subject
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Department of Laboratory Diagnostic, Medical University, Lublin, Poland
Oral Medicine Independent Unit, Medical University, Lublin, Poland
Legionowo Military Polyclinic, Legionowo, Poland
Ann Agric Environ Med 2012;19(4):842–845
The discordance between glycated hemoglobin (HbA1C) and fructosamine (FA) estimations in the assessment of glycemia is often encountered. A number of mechanisms might explain such discordance, but whether or not they are consistent is uncertain. Nevertheless, the fact that there is a discrepancy in HbA1C and mean blood glucose cannot be ignored in the monitoring of glycemic control. To address the discrepancy between HbA1C and mean blood glucose, Robert Cohen proposed the measurement of glycation gap (GG). Recently, the ‘Glycation Gap’ (GG) has been defined as the difference between the measured HbA1C. GG has improved the quality of the monitoring of glycemic control, especially for those patients whose HbA1C levels do not truly reflect the mean blood glucose levels.

The aims of the statistical analyses were to estimate GG values in a healthy subject. The research was conducted among the inhabitants of the Zwierzyniec commune and nearby villages.

Material and Methods:
The study population consisted of 93 subjects: 63 women and 30 men, between the ages of 18-79. Measurements of HbA1C and FA in the 93 people were used to calculate GG, defined as the difference between measured HbA1C and HbA1C predicted from FA, based on the population regression of HbA1C on FA.

In considering the values GG in the study group, particular significance should be attributed to a progressive increase of GG with advancing age. Elderly people who are at risk of developing diabetes, or who have already developed the disease, may not exhibit the classic symptoms expected. Age-related changes can mean that some symptoms will be masked, or more dificult to spot. It is worth pointing out that HbA1C together with GG must be taken into account in the correct interpretation of the glycation processes.

Marcin Dziedzic   
Department of Laboratory Diagnostic, Medical University, Lublin, Poland
1. Dziedzic M, Hałabiś M, Kuna J, Lenart-Lipińska M, Solski J. The level of glycated hemoglobin in healthy subjects. Ann UMCS Sect DDD 2010; 2(16): 107-113.
2. Jabłońska-Trypuć A, Czerpak R. The role of non-enzymatic glycosylation of protein in ageing processes and pathogenesis of geriatric diseases. Post Biol Kom. 2007; 34: 683-693 (in Polish).
3. Calisti L, Tognetti S. Measure of glycosylated hemoglobin. Acta Biomed. 2005; 76: 59-62.
4. Nagai R, Fujiwara Y, Mera K, Otagiri M. Investigation of pathways of advanced glycation end products accumulation in macrophages. Mol Nutr Food Res. 2007; 51(4): 462-467.
5. Macdonald DR, Hanson AM, Holland MR, Singh BM. Clinical impact of variability in HbA1c as assessed by simultaneously measuring fructosamine and use of error grid analysis. Ann Clin Biochem. 2008; 45: 421-425.
6. Hempe JM, Gomez R, McCarter RJ Jr, Chalew SA. High and low hemoglobin glycation phenotypes in type 1 diabetes: a challenge for interpretation of glycemic control. J Diabetes Complications. 2002; 16: 313-320.
7. Sacks DB, Nathan DM. Lachin Gaps in the Glycation Gap Hypothesis. Clin Chem. 2011; 57(2): 150-152.
8. Nayak AU, Holland MR, Macdonald DR, Nevill A, Baldev M. Singh Evidence for Consistency of the Glycation Gap in Diabetes. Diabetes Care 2011; 34: 1712-1716.
9. Cohen RM, Holmes YR, Cheniner TC, Joiner CH. Disordance between HbA 1C and fructosamine evidence for a glycosylation gap and its relation to diabetic nephropathy. Diabetes Care 2003; 26(1): 163-167.
10. Cohen RM, LeCaire TJ, Lindsell CJ, Smith EP, D’Alessio DJ. Relationship of prospective GHb to glycated Serum Proteins in incident diabetic retinopathy – Implications of the glycation gap for mechanism of risk prediction. Diabetes Care 2008; 31(1): 151-153.
11. Rodriguez-Segade S, et al. Progression of Nephropathy in Type 2 diabetes: The Glycation Gap is a significant predictor after adjustment for Glycohemoglobin. Clin Chem. 2011; 57(2): 264-271.
12. Priego Capote F, Sanchez J. Strategies for proteomic analysis of non-enzymatically glycated proteins. Mass Spectrom Rev. 2009; 28(1): 135-146.
13. Freeman BI, et al. Glycated albumin and risk of death and hospitalizations in Diabetic Dialysis Patients. Clin J Am Soci Nephrol. 2011; 6: 1-9.
14. Mooradian A, McLaughlin S, Casey Boyer C, Winter J. Diabetes Care for Older Adults. Diabetes Spectrum 1999; 12(2): 70-77.
15. Subramaniam I, Gold D. Diabetes Mellitus in Elderly – An Overview. J Indian Acad Geriatr. 2005; 2: 77-81.
16. Meneilly GS, Tessier D. Diabetes in the elderly. Diabet Med. 1995; 12: 949-960.
17. Bent-Hansen L, Feldt-Rasmussen B, Kverneland A, Deckert T. Plasma disappearance of glycated and non-glycated albumin in type 1 (insulin-dependent) diabetes mellitus: evidence for charge dependent alterations of the plasma to lymph pathway. Diabetologia 1993; 36(4): 361-363.
18. Cavallo-Perin P, Chiambretti A, Calefato V, Tomalino M, Cecchini G, Gruden G, Pagano G. Urinary excretion of glycated albumin in insulin-dependent diabetic patients with micro- and macroalbuminuria. Clin Nephrol. 1992; 38(1): 9-13.
19. Valeri C, Pozzilli P, Leslie D. Glucose control in diabetes. Diabetes Metab Res Rev. 2004; 20(2): 1-8.
20. Muller DC, Elahi D, Tobin JD, Anders R. The effect of age on insulin resistance and secretion: a review. Semin Nephrol. 1996; 90(4): 289-293.
21. Lydie NP, Korenda L, Meigs JB, Driver C, Chamany S, Fox CS, et al. Effect of Aging on A 1C Levels in Individuals Without Diabetes – Evidence from the Framingham O spring Study and the National Health and Nutrition Examination Survey 2001-2004. Diabetes Care 2008; 31: 1991-1996.
22. Meneilly GS, Tessier D. Diabetes in elderly adults. J Gerontol A Biol Sci Med Sci. 2001; 56(1): 5-13.