Published online Jan 15, 2019. doi: 10.4239/wjd.v10.i1.1
Peer-review started: August 29, 2018
First decision: October 16, 2018
Revised: November 14, 2018
Accepted: December 5, 2018
Article in press: December 5, 2018
Published online: January 15, 2019
Processing time: 140 Days and 20.2 Hours
Attaining and maintaining good glycemic control is a cornerstone of diabetes care. The monitoring of glycemic control is currently based on the self-monitoring of blood glucose (SMBG) and laboratory testing for hemoglobin A1c (HbA1c), which is a surrogate biochemical marker of the average glycemia level over the previous 2-3 mo period. Although hyperglycemia is a key biochemical feature of diabetes, both the level of and exposure to high glucose, as well as glycemic variability, contribute to the pathogenesis of diabetic complications and follow different patterns in type 1 and type 2 diabetes. HbA1c provides a valuable, standardized and evidence-based parameter that is relevant for clinical decision making, but several biological and analytical confounders limit its accuracy in reflecting true glycemia. It has become apparent in recent years that other glycated proteins such as fructosamine, glycated albumin, and the nutritional monosaccharide 1,5-anhydroglucitol, as well as integrated measures from direct glucose testing by an SMBG/continuous glucose monitoring system, may provide valuable complementary data, particularly in circumstances when HbA1c results may be unreliable or are insufficient to assess the risk of adverse outcomes. Long-term associations of these alternative biomarkers of glycemia with the risk of complications need to be investigated in order to provide clinically relevant cut-off values and to validate their utility in diverse populations of diabetes patients.
Core tip: Monitoring of glycemic control is currently based on the self-monitoring of blood glucose and laboratory testing for hemoglobin A1c (HbA1c), which is a surrogate marker of the average glycemia level over the past 2-3 mo. The severity of hyperglycemia and glycemic variability contribute to the pathogenesis of complications, but the HbA1c measurement reflects only a piece of these important variables. In this review, we provide a critical update on the use of HbA1c and alternative biomarkers of glycemic control, with particular emphasis on the need for a personalized approach in utilizing and interpreting different tests in a clinically meaningful manner.