Okpete Uchenna Esther, Byeon Haewon
Department of Digital Anti-aging Healthcare (BK21), Inje University, Gimhae 50834, South Korea.
Worker's Care & Digital Health Lab, Department of Future Technology, Korea University of Technology and Education, Cheonan 31253, South Korea.
World J Diabetes. 2025 Jul 15;16(7):107928. doi: 10.4239/wjd.v16.i7.107928.
Bariatric surgery significantly improves glycemic control and can lead to type 2 diabetes remission. However, the reliability of glycated hemoglobin (HbA1c) as a type 2 diabetes biomarker post-surgery can be confounded by conditions such as anemia and gastrointestinal complications. Hence, we explored the use of alternative biomarkers such as glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), and insulin-like growth factor binding protein-1 (IGFBP-1) to monitor glycemic control more effectively in post-bariatric surgery patients. Measuring GA and 1,5-AG levels can detect glycemic variability more sensitively than HbA1c, especially under non-fasting conditions. GA shows promise for short-term monitoring post-surgery while 1,5-AG could be useful for real-time glucose monitoring. IGFBP-1 can be used to monitor metabolic improvement and to predict HbA1c normalization. However, challenges in assay standardization and cost remain significant barriers to their clinical adoption. Although these biomarkers could offer a more personalized approach to glucose monitoring (thereby addressing the limitations of utilizing HbA1c in this endeavor in post-bariatric surgery patients), this would require overcoming technical, logistical, and cost-related challenges. While using GA, 1,5-AG, and IGFBP-1 shows promise for glycemic monitoring, further research and validation are crucial for their routine clinical implementation, especially in the context of diabetes management post-bariatric surgery.
减重手术能显著改善血糖控制，并可导致2型糖尿病缓解。然而，糖化血红蛋白（HbA1c）作为术后2型糖尿病生物标志物的可靠性可能会受到贫血和胃肠道并发症等情况的干扰。因此，我们探索使用糖化白蛋白（GA）、1,5-脱水葡萄糖醇（1,5-AG）和胰岛素样生长因子结合蛋白-1（IGFBP-1）等替代生物标志物，以更有效地监测减重手术后患者的血糖控制情况。测量GA和1,5-AG水平比HbA1c能更敏感地检测血糖变异性，尤其是在非空腹条件下。GA在术后短期监测方面显示出前景，而1,5-AG可用于实时血糖监测。IGFBP-1可用于监测代谢改善情况并预测HbA1c正常化。然而，检测标准化和成本方面的挑战仍然是其临床应用的重大障碍。尽管这些生物标志物可为血糖监测提供更个性化的方法（从而解决在减重手术后患者中利用HbA1c的局限性），但这需要克服技术、后勤和成本相关的挑战。虽然使用GA、1,5-AG和IGFBP-1在血糖监测方面显示出前景，但进一步的研究和验证对于它们的常规临床应用至关重要，尤其是在减重手术后糖尿病管理的背景下。
