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Comparisons of home blood glucose testing and glycated protein measurements
P D Lee1, L D Sherman, M R O'Day
1Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Insights
Four glycated protein assays were compared to home blood glucose monitoring (HBGM) in children with diabetes. Assays using boronate affinity chromatography (glycated hemoglobin and glycated serum proteins) best indicated short-term glycemic control changes.
Area of Science:
- Clinical Chemistry
- Pediatric Endocrinology
- Diabetes Mellitus Management
Background:
- Accurate monitoring of glycemic control is crucial for managing insulin-dependent diabetes mellitus (IDDM).
- Various glycated protein assays exist, but their utility in reflecting short-term glycemic changes in pediatric populations requires further investigation.
Purpose of the Study:
- To evaluate the relationship between four glycated protein assays and home blood glucose monitoring (HBGM) in children with poorly-controlled IDDM.
- To determine which assay best reflects short-term glycemic control fluctuations during improved diabetes management.
Main Methods:
- Twenty-six children with IDDM underwent 6 visits over 12 weeks with HBGM data collection and blood sampling.
- Four assays were used: glycated hemoglobin (GHb) and glycated serum proteins (GP) by boronate affinity chromatography, hemoglobin A1C by HPLC, and fructosamine (FA).
Main Results:
- All four glycated protein levels significantly decreased over the 12-week study period.
- Significant correlations were found between glycated proteins and HBGM over 2-week intervals.
- Glycated hemoglobin (GHb) and glycated serum proteins (GP) demonstrated the most variation with mean blood glucose (MBG), indicating better reflection of short-term changes, while fructosamine (FA) showed the least.
Conclusions:
- Fructosamine (FA) has limited clinical value for assessing short-term glycemic control compared to other assays.
- Assays utilizing boronate affinity chromatography (GHb and GP) are the most clinically useful indicators of short-term glycemic control changes in pediatric IDDM.
- A new HPLC method for glycated hemoglobin determination also showed clinical utility.
Abstract:
We examined the relationships between 4 glycated protein assays and home blood glucose monitoring (HBGM) in 26 children with poorly-controlled insulin-dependent diabetes mellitus (IDDM) during a period of improved management. At 2 week intervals for 6 visits (12 weeks in total), HBGM records were collected and a blood sample was obtained for measurement of glycated proteins and glucose. Assays included glycated hemoglobin (GHb) and glycated serum proteins (GP) by boronate affinity chromatography, hemoglobin A1C by PolyCAT A high performance liquid chromatography (HAC) and fructosamine (FA). All 4 glycated protein levels declined significantly over the 12 week period. Significant correlations between the glycated proteins and HBGM were observed over 2 week intervals. None of the 4 assays were affected by the glucose level in the sample. Changes in mean HBGM readings over 2 week intervals were correlated with both FA and GP with wide prediction intervals. Over cumulative 2 week intervals, which may more accurately reflect longitudinal trends, all 4 glycated proteins were correlated with mean HBGM readings. At each cumulative interval, GHb and GP showed the largest variation with MBG, while FA showed the least variation with MBG. Our data indicate that of the 4 assays tested, FA has limited clinical values as compared to other glycated protein assays, whereas assays based on boronate affinity chromatography (GHb and GP) provide the most useful clinical indicators of short-term changes in glycemic control. The clinical utility of a new HPLC method for determination of glycated hemoglobins is also demonstrated.