Traditional and nontraditional glycemic markers and risk of peripheral artery disease: The Atherosclerosis Risk in Communities (ARIC) study

Ding, Ning; Kwak, Lucia; Ballew, Shoshana H.; Jaar, Bernard G.; Hoogeveen, Ron C.; Ballantyne, Christie M.; Sharrett, A. Richey; Folsom, Aaron R.; Heiss, Gerardo; Salameh, Maya; Coresh, Josef; Hirsch, Alan T.; Selvin, Elizabeth; Matsushita, Kunihiro

doi:10.1016/j.atherosclerosis.2018.04.042

Cited by 21 publications

(14 citation statements)

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“…In addition, with a shorter half-life than hemoglobin, glycated proteins reflect average glycemic burden of the previous 2-3 weeks and so may be better suited than HbA 1c to monitor shorter-term changes in glycemia (2,11). Higher glycated albumin and fructosamine levels have both been linked to increased risk of cardiovascular outcomes and mortality as well as to other important clinical outcomes (13)(14)(15)(16), and previous studies have suggested that glycated albumin and fructosamine may be comparable or superior to HbA 1c as a measure of glycemic control in patients treated with dialysis (3,(17)(18)(19)(20)(21). However, there are few data evaluating the performance of these alternative biomarkers compared with a gold-standard measure of glycemia in patients with eGFR ,60 mL/min/ 1.73 m 2 not treated with dialysis (2,19).…”

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confidence: 99%

Continuous Glucose Monitoring and Use of Alternative Markers To Assess Glycemia in Chronic Kidney Disease

et al. 2020

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In chronic kidney disease, glycated albumin and fructosamine have been postulated to be better biomarkers of glycemic control than HbA 1c . We evaluated the accuracy, variability, and covariate bias of three biomarkers (HbA 1c , glycated albumin, and fructosamine) compared with continuous glucose monitoring (CGM)-derived measurement of glycemia across estimated glomerular filtration rate (eGFR) in type 2 diabetes. RESEARCH DESIGN AND METHODSA prospective cohort study was conducted of 104 participants with type 2 diabetes, 80 with eGFR <60 mL/min/1.73 m 2 (not treated with dialysis) and 24 frequency-matched control subjects with eGFR ‡60 mL/min/1.73 m 2 . Participants wore a blinded CGM for two 6-day periods separated by 2 weeks, with blood and urine collected at the end of each CGM period. HbA 1c , glycated albumin, and fructosamine were measured by high-performance liquid chromatographic, enzymatic, and colorimetric nitroblue tetrazolium methods, respectively. RESULTSWithin-person biomarker values were strongly correlated between the two CGM periods (r 5 0.92-0.95), although no marker fully captured the within-person variability of mean CGM glucose. All markers were similarly correlated with mean CGM glucose (r 5 0.71-77). Compared with mean CGM glucose, glycated albumin and fructosamine were significantly biased by age, BMI, serum iron concentration, transferrin saturation, and albuminuria; HbA 1c was underestimated in those with albuminuria. CONCLUSIONSGlycated albumin and fructosamine were not less variable than HbA 1c at a given mean CGM glucose level, with several additional sources of bias. These results support measuring HbA 1c to monitor trends in glycemia among patients with eGFR <60 mL/min/1.73 m 2 . Direct measurements of glucose are necessary to capture short-term variability.Glycated hemoglobin (HbA 1c ) is commonly used in people with diabetes to monitor long-term (;3 months) glycemic control. However, HbA 1c may not appropriately measure glycemic burden in those who also have chronic kidney disease (CKD), with both bias (defined as a difference in mean values) and more variability around the

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confidence: 99%

Continuous Glucose Monitoring and Use of Alternative Markers To Assess Glycemia in Chronic Kidney Disease

et al. 2020

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“… 28 In the Atherosclerosis Risk in Communities (ARIC) study, the baseline HbA1c was a strong predictor for the occurrence of PAD. 29 Hjellestad et al 30 reported that preoperative HbA1c could predict mortality in patients with type 2 DM after surgical treatment for PAD. The mean HbA1c over 5 years could predict all-cause mortality in aged French patients with type 2 DM.…”

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confidence: 99%

Mean and variability of annual haemoglobin A1c are associated with high-risk peripheral artery disease

Lee

2020

Diabetes and Vascular Disease Research

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Background: Glucose variability is predictive of cardiovascular events and all-cause mortality. However, the association between peripheral artery disease and glucose variability has not been thoroughly investigated. Therefore, the standard deviation of annual haemoglobin A1c was assessed in patients with type 2 diabetes for evaluating the different risks of peripheral artery disease. Methods: A total of 4144 patients underwent an evaluation for the ankle-brachial index and the percentage of mean arterial pressure at the ankle. The first haemoglobin A1c record was retrospectively collected from each year until the ankle-brachial index measurement. Results: The standard deviation of annual haemoglobin A1c was higher in patients with ankle-brachial index ⩽0.90 than in those with ankle-brachial index >0.90 (1.1 ± 0.9% vs 1.0 ± 0.8%, p = 0.009) and was higher in patients with percentage of mean arterial pressure ⩾45% than in those with percentage of mean arterial pressure <45% (1.1 ± 0.8% vs 1.0 ± 0.8%, p = 0.007). A high standard deviation and mean of annual haemoglobin A1c are associated with high-risk peripheral artery disease, which is defined as a combination of ankle-brachial index ⩽0.90, percentage of mean arterial pressure ⩾45% or both (odds ratio = 1.306; 95% confidence interval = 1.057–1.615; p = 0.014). Conclusion: Fluctuation in the haemoglobin A1c value indicates higher risk for peripheral artery disease in patients with type 2 diabetes and poor glucose control.

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“…Among traditional markers for glycemic control, hemoglobin A1c (HbA1c) level was shown to be more strongly associated with PAD development than the fasting glucose level in patients with established DM in the Atherosclerosis Risk in Communities study. 14 However, fasting glucose provided a better contribution to predict cardiovascular events than HbA1c in Taiwanese patients with type 2 DM. 15 It was recently reported that normal coronary artery was associated with a higher HbA1c level compared with documented coronary atherosclerosis on coronary computed tomography angiography in patients with type 2 DM.…”

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confidence: 99%

Variability in Annual Fasting Glucose and the Risk of Peripheral Artery Disease in Patients with Diabetes Mellitus

Chang

Lee

2021

DMSO

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Purpose High glucose concentrations and swings are associated with endothelial dysfunction. We examined the effects of variability in fasting plasma glucose on peripheral artery disease (PAD) in patients with diabetes mellitus (DM). Patients and Methods In this screening study for the risk factors of PAD, we retrospectively collected data on the ankle-brachial index (ABI) and the percentage of mean arterial pressure (%MAP) at the ankle between August 01, 2016 and July 31, 2017. We defined low ABI ≤0.90, high %MAP ≥45%, or both as high-risk PAD and others as low-risk PAD. We compared the standard deviation (SD) of the first fasting plasma glucose data available each year after January 01, 2007. Results In 2577 patients, a higher SD of annual fasting glucose was observed in those with an ABI ≤0.90 than in patients with an ABI >0.90 (2.6 ± 2.1 vs 2.2 ± 2.3, P = 0.009), and in patients with %MAP ≥45% than in those with %MAP <45% (2.4 ± 2.1 vs 2.2 ± 2.3, P = 0.034). A high-risk PAD was significantly associated with the SD (P = 0.032) but not with the mean (P = 0.338) of annual fasting glucose. The former was an independent risk factor for high-risk PAD (odds ratio = 1.424; 95% CI = 1.118‒1.814; P = 0.004). Conclusion Variability but not mean of annual fasting plasma glucose was significantly associated with a high risk of PAD in patients with DM.

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Traditional and nontraditional glycemic markers and risk of peripheral artery disease: The Atherosclerosis Risk in Communities (ARIC) study

Abstract: Nontraditional glycemic markers were associated with incident PAD independent of fasting glucose but not necessarily HbA1c. Our results also support the importance of glucose metabolism in the progression to CLI.

Cited by 21 publications

References 44 publications

Continuous Glucose Monitoring and Use of Alternative Markers To Assess Glycemia in Chronic Kidney Disease

Continuous Glucose Monitoring and Use of Alternative Markers To Assess Glycemia in Chronic Kidney Disease

Mean and variability of annual haemoglobin A1c are associated with high-risk peripheral artery disease

Variability in Annual Fasting Glucose and the Risk of Peripheral Artery Disease in Patients with Diabetes Mellitus

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