Nontraditional markers of glycemia: Associations with microvascular conditions

OBJECTIVE - To compare the associations of nontraditional (fructosamine, glycated albumin, 1,5-anhydroglucitol [1,5-AG]) and standard (fasting glucose, HbA_1c) glycemic markers with common microvascular conditions associated with diabetes mellitus. RESEARCH DESIGN AN DMETHODS - We conducted a cross-sectional study of 1,600 participants (227 with a history of diabetes and 1,323 without) from the Atherosclerosis Risk in Communities (ARIC) Study, a community-based population. We conducted logistic regression analyses of the associations of diabetes-specific tertiles of fructosamine, glycated albumin, 1/(1,5-AG), fasting glucose, and HbA_1c with prevalence of chronic kidney disease, albuminuria, and retinopathy after adjustment for demographic, clinical, and lifestyle variables. RESULTS - We observed significant positive trends in the associations of each marker with albuminuria and retinopathy, even after accounting for demographic, clinical, and lifestyle factors (all P trends <0.05). The associations with chronic kidney disease were similar in direction but were only significant for higher glycated albumin (P trend = 0.005), fructosamine (P trend = 0.003), and HbA_1c (P trend = 0.005) values. After further adjustment for HbA_1c, glycated albumin and fructosamine remained significantly or borderline significantly associated with the microvascular outcomes. CONCLUSIONS - In cross-sectional analyses, two serum markers of glycemia - glycated albumin and fructosamine - are as, or more strongly, associated with microvascular conditions as HbA_1c. These markers may be useful in settings where whole blood is not available. Whether they might complement or outperform HbA_1c in terms of long-term predictive value requires further investigation.