Abbott Diabetes Care, Alameda, California, USA.
International Diabetes Center, Park Nicollet, HealthPartners, Minneapolis, Minnesota, USA.
Diabetes Obes Metab. 2022 Sep;24(9):1779-1787. doi: 10.1111/dom.14763. Epub 2022 Jun 2.
Glycated haemoglobin (HbA1c) can fail to reflect average glucose levels, potentially compromising management decisions. We analysed variability in the relationship between mean glucose and HbA1c in individuals with diabetes.
Three months of continuous glucose monitoring and HbA1c data were obtained from 216 individuals with type 1 diabetes. Universal red blood cell glucose transporter-1 Michaelis constant K and individualized apparent glycation ratio (AGR) were calculated and compared across age, racial and gender groups.
The mean age (range) was 30 years (8-72) with 94 younger than 19 years, 78 between 19 and 50 years, and 44 were >50 years. The group contained 120 women and 96 men with 106 white and 110 black individuals. The determined K value was 464 mg/dl and AGR was (mean ± SD) 72.1 ± 7 ml/g. AGR, which correlated with red blood cell lifespan marker, was highest in those aged >50 years at 75.4 ± 6.9 ml/g, decreasing to 73.2 ± 7.8 ml/g in 19-50 years, with a further drop to 71.0 ± 5.8 ml/g in the youngest group (p <0 .05). AGR differed between white and black groups (69.9 ± 5.8 and 74.2 ± 7.1 ml/g, respectively; p < .001). In contrast, AGR values were similar in men and women (71.5 ± 7.5 and 72.5 ± 6.6 ml/g, respectively; p = .27). Interestingly, interindividual AGR variation within each group was at least four-fold higher than average for between-group variation.
In this type 1 diabetes cohort, ethnicity and age, but not gender, alter the HbA1c-glucose relationship with even larger interindividual variations found within each group than between groups. Clinical application of personalized HbA1c-glucose relationships has the potential to optimize glycaemic care in the population with diabetes.
糖化血红蛋白（HbA1c）可能无法反映平均血糖水平，从而影响管理决策。我们分析了糖尿病患者中平均血糖与 HbA1c 之间关系的变异性。
从 216 例 1 型糖尿病患者中获得连续 3 个月的血糖监测和 HbA1c 数据。计算并比较了通用红细胞葡萄糖转运蛋白-1（GLUT1）米氏常数 K 和个体化表观糖化比（AGR）在年龄、种族和性别组中的差异。
平均年龄（范围）为 30 岁（8-72 岁），其中 94 例年龄小于 19 岁，78 例年龄在 19-50 岁之间，44 例年龄大于 50 岁。该组包含 120 名女性和 96 名男性，其中 106 名是白人，110 名是黑人。确定的 K 值为 464mg/dl，AGR 为（平均值±标准差）72.1±7ml/g。在年龄大于 50 岁的患者中，AGR 与红细胞寿命标志物相关，最高为 75.4±6.9ml/g，在 19-50 岁的患者中降低至 73.2±7.8ml/g，在最年轻的患者中进一步降至 71.0±5.8ml/g（p<0.05）。白人和黑人组之间的 AGR 存在差异（分别为 69.9±5.8 和 74.2±7.1ml/g，p<0.001）。相比之下，男性和女性的 AGR 值相似（分别为 71.5±7.5 和 72.5±6.6ml/g，p=0.27）。有趣的是，在每个组内，个体间 AGR 变异至少是组间平均变异的四倍。
在 1 型糖尿病患者中，种族和年龄而非性别改变了 HbA1c 与血糖的关系，且每个组内的个体间变异大于组间变异。个性化 HbA1c-血糖关系的临床应用有可能优化糖尿病患者的血糖控制。
