The Ratio of Estimated Average Glucose to Fasting Plasma Glucose Level Is Superior to Glycated Albumin, Hemoglobin A1c, Fructosamine, and GA/A1c Ratio for Assessingβ-Cell Function in Childhood Diabetes

Abstract

Objective. This study investigated the use of the estimated average glucose to fasting plasma glucose ratio (eAG/fPG ratio) to screen for β-cell function in pediatric diabetes. Methods. Glycated hemoglobin (HbA1c), glycated albumin (GA), fructosamine, insulin, and C-peptide levels were measured. The ratio of GA to HbA1c (GA/A1c ratio) was calculated, and the homeostasis model assessment of β-cell function (HOMA-β) was determined. Results. Median values of C-peptide, insulin, and HOMA-β levels were significantly higher in patients with an increased eAG/fPG ratio than in those with a decreased eAG/fPG ratio. C-peptide and HOMA-β levels were more closely correlated with the eAG/fPG ratio than with GA, HbA1c, the GA/A1c ratio, and fructosamine. In contrast, body mass index was significantly associated with GA, GA/A1c ratio, and fructosamine, but not with the eAG/fPG ratio and HbA1c levels. To test the diagnostic accuracies of the eAG/fPG ratio for identifying HOMA-β > 30.0% in patients with type 2 diabetes, the area under the ROC curve of the eAG/fPG ratio was significantly larger than that of the GA/A1c ratio [0.877 (95% CI, 0.780–0.942) versus 0.775 (95% CI, 0.664–0.865), P = 0.039]. Conclusions. A measurement of the eAG/fPG ratio may provide helpful information for assessing β-cell function in pediatric patients with diabetes.

Serum uromodulin is associated with impaired glucose metabolism

“…[ 35 ] In addition, the eAG/FPG ratio has been previously used to assess β-cell function. [ 25 ] In our study, the eAG-FPG difference as well as the eAG/FPG ratio were both correlated with uromodulin and this was also true for the correlation with HOMA-β and ISI. This might suggest that uromodulin could play a role for glycemic control as well as for β-cell function.…”

“…The estimated average glucose (eAG) value has been calculated from HbA1c according to (HbA1c × 28.7) − 46.7 [ 22 ] Serum insulin was measured by an enzyme immunoassay on an AIA 1200 (Tosoh, Foster City, CA). Insulin sensitivity index (ISI) was calculated according to cederholm as follows: ISI = 75,000 + (G0 − G120) × 1.15 × 180 × 0.19 × weight/120 × Gmean × log (Imean) [ 23 ] and the homeostatic model assessment (HOMA) index of insulin resistance (IR) was calculated according to the formula HOMA-IR = (insulin × glucose)/22.5 as described by Matthews et al [ 24 ] For assessing the function of β cells, HOMA-β (formula: HOMA-β (%) = 20 × insulin/[glucose −3.5]) [ 24 ] and the eAG/FPG ratio [ 25 ] were calculated. All subjects had fasting glucose concentrations above 3.5 mmol/L, thus permitting calculation of HOMA-β and insulin concentration above the detectable limit of this method of 0.8 μU/mL.…”

Serum uromodulin is associated with impaired glucose metabolism

“…[35] In addition, the eAG/FPG ratio has been previously used to assess b-cell function. [25] In our study, the eAG-FPG difference as well as the eAG/FPG ratio were both correlated with uromodulin and this was also true for the correlation with HOMA-b and ISI. This might suggest that uromodulin could play a role for glycemic control as well as for b-cell function.…”

“…The estimated average glucose (eAG) value has been calculated from HbA1c according to (HbA1c  28.7) À 46.7 [22] Serum insulin was measured by an enzyme immunoassay on an AIA 1200 (Tosoh, Foster City, CA). Insulin sensitivity index (ISI) was calculated according to cederholm as follows: ISI = 75,000 + (G0 À G120)  1.15  180  0.19  weight/120  Gmean  log (Imean) [23] and the homeostatic model assessment (HOMA) index of insulin resistance (IR) was calculated according to the formula HOMA-IR = (insulin  glucose)/22.5 as described by Matthews et al [24] For assessing the function of b cells, HOMA-b (formula: HOMA-b (%) = 20  insulin/[glucose À3.5]) [24] and the eAG/ FPG ratio [25] were calculated. All subjects had fasting glucose concentrations above 3.5 mmol/L, thus permitting calculation of HOMA-b and insulin concentration above the detectable limit of this method of 0.8 mU/mL.…”

The ratio of estimated average glucose to fasting plasma glucose level as an indicator of insulin resistance in young adult diabetes

“…These discrepancies may reflect the differences in patient populations, the severity of disease, the status of glucose tolerance, or the number of subjects. [17] …”