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An Analysis of Glycosylated Blood Proteins and Blood Glucose Profiles Over One Year in Patients with Type 1 Diabetes
Author(s) -
Winocour P.H.,
Bhatnagar D.,
Kalsi P.,
Hillier V.F.,
Anderson D.C.
Publication year - 1989
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1989.tb01262.x
Subject(s) - fructosamine , medicine , diabetes mellitus , albumin , glycosylated haemoglobin , endocrinology , serum albumin , blood proteins , type 2 diabetes
The clinical value of prospective measurement of several direct and indirect measures of blood glucose control in the management of Type 1 diabetes has been investigated. Ninety‐eight Type 1 diabetic patients were followed over a period of 1 year after a 6‐week period of intensification of management, with monthly measurements of blood glucose profiles and 3‐monthly HbA 1 , glycosylated serum albumin, and fructosamine measurements. All measures improved markedly after the initial 6‐week period ( p < 0.001), and all except glycosylated serum albumin and fructosamine then remained relatively stable. Of fourteen serial comparisons, glycosylated blood proteins were significantly correlated more often with levels of mean blood glucose and M value (on 4–7 occasions, r s 0.30‐0.58) than with fasting blood glucose levels (on only 2–3 occasions, r s 0.34‐0.44). Serum fructosamine levels correlated significantly with mean blood glucose on four occasions ( r s 0.30‐0.50), whilst glycosylated serum albumin and HbA 1 correlated with mean blood glucose on six occasions ( r s 0.36‐0.54). Glycosylated serum albumin correlated with HbA 1 and fructosamine levels throughout the year ( r s 0.47‐0.68 and 0.48‐0.76, respectively), but HbA 1 and fructosamine were less clearly correlated with each other ( r s 0.38‐0.44), with no significant association immediately after the period of intensive management or 3 months later. When the various measures were used to categorize blood glucose control, HbA 1 was more often discordant with fructosamine than with glycosylated albumin. Over the year glycosylated albumin and fructosamine values were discordant on 6–15% of comparisons. Significant intra‐individual variations in levels of glycosylated albumin, fructosamine, mean blood glucose, and the M value were observed during the stable year of the study. Cluster analyses revealed that fructosamine values were least closely associated with other variables. In 19 patients with normal HbA 1 levels and near normal mean blood glucose and M values throughout the year following intensified management, a substantial proportion had persistently high levels of fructosamine and glycosylated albumin. We conclude that the use of several measures of blood glucose control in the management of Type 1 diabetes provides complementary information. Fructosamine is a less appropriate measure of blood glucose control in Type 1 diabetes than glycosylated serum albumin.