Department of Agrotechnology and Food Sciences, Wageningen University, Wageningen, The Netherlands.
Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland.
Adv Nutr. 2020 Sep 1;11(5):1221-1236. doi: 10.1093/advances/nmaa058.
There is considerable interest in dietary and other approaches to maintaining blood glucose concentrations within the normal range and minimizing exposure to postprandial hyperglycemic excursions. The accepted marker to evaluate the sustained maintenance of normal blood glucose concentrations is glycated hemoglobin A1c (HbA1c). However, although this is used in clinical practice to monitor glycemic control in patients with diabetes, it has a number of drawbacks as a marker of efficacy of dietary interventions that might beneficially affect glycemic control in people without diabetes. Other markers that reflect shorter-term glycemic exposures have been studied and proposed, but consensus on the use and relevance of these markers is lacking. We have carried out a systematic search for studies that have tested the responsiveness of 6 possible alternatives to HbA1c as markers of sustained variation in glycemic exposures and thus their potential applicability for use in dietary intervention trials in subjects without diabetes: 1,5-anhydroglucitol (1,5-AG), dicarbonyl stress, fructosamine, glycated albumin (GA), advanced glycated end products (AGEs), and metabolomic profiles. The results suggest that GA may be the most promising for this purpose, but values may be confounded by effects of fat mass. 1,5-AG and fructosamine are probably not sensitive enough to the range of variation in glycemic exposures observed in healthy individuals. Use of measures based on dicarbonyls, AGEs, or metabolomic profiles would require further research into possible specific molecular species of interest. At present, none of the markers considered here is sufficiently validated and sensitive for routine use in substantiating the effects of sustained variation in dietary glycemic exposures in people without diabetes.
人们对通过饮食和其他方法将血糖浓度维持在正常范围内并尽量减少餐后高血糖波动的方法很感兴趣。评估持续正常血糖浓度的公认标志物是糖化血红蛋白 A1c（HbA1c）。然而，尽管它在临床上用于监测糖尿病患者的血糖控制，但它作为评估饮食干预效果的标志物存在一些缺点，因为这些干预可能对没有糖尿病的人有益地影响血糖控制。已经研究并提出了其他反映短期血糖暴露的标志物，但对于这些标志物的使用和相关性缺乏共识。我们已经系统地搜索了测试 6 种可能替代 HbA1c 的标志物作为血糖暴露持续变化的标志物的研究，从而评估它们在无糖尿病受试者饮食干预试验中的潜在适用性：1,5-脱水葡萄糖醇（1,5-AG）、二羰基应激、果糖胺、糖化白蛋白（GA）、晚期糖基化终产物（AGEs）和代谢组学特征。结果表明，GA 可能是最有前途的标志物，但由于脂肪量的影响，其值可能会受到干扰。1,5-AG 和果糖胺可能对健康个体中观察到的血糖暴露变化范围不够敏感。基于二羰基化合物、AGEs 或代谢组学特征的测量方法的使用需要进一步研究可能感兴趣的特定分子种类。目前，这里考虑的标志物都没有得到充分验证和敏感，无法常规用于证实无糖尿病患者饮食中血糖暴露持续变化的影响。
