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Detecting hyperglycemia using biomarkers versus continuous glucose monitoring

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posted on 2025-06-12, 18:24 authored by Natalie Rula Daya, Michael Fang, Jung-Im Shin, James S. Pankow, Pamela L. Lutsey, Arielle Valint, Justin B. Echouffo-Tcheugui, Scott Zeger, Elizabeth Selvin

Objective: To evaluate the concordance of glycated albumin, fructosamine, 1,5-anhydroglucitol (1,5-AG), and HbA1c with continuous glucose monitor (CGM) metrics of hyperglycemia and glycemic control in a diverse population of adults with type 2 diabetes.

Research Design and Methods: A pooled cross-sectional analysis of 552 adults, ages 30 to 97 years old, with diabetes. Participants wore a CGM for up to 2 weeks and we evaluated the agreement between blood biomarkers (glycated albumin, fructosamine, and 1,5-AG) with CGM-defined metrics of hyperglycemia and glycemic control.

Results: Of the 552 participants (mean age 74 years, 53% women, 36% who are Black), the median of mean CGM glucose was 132 mg/dL and participants spent on average 84% of their time in range (70-180 mg/dL). CGM mean glucose was strongly related to HbA1c (r=0.72), glycated albumin (r=0.64), and fructosamine (r=0.64) but weakly related to 1,5-AG (r=0.46). Results were similar for time above range (>180mg/dl). Glycated albumin and fructosamine performed similarly to HbA1c in the detection of target time in and above range (c-statistics ranged from 0.85-0.94).

Conclusion: Glycated albumin and fructosamine had similar associations with CGM-defined metrics of hyperglycemia compared to HbA1c. These three biomarkers performed similarly in the detection of time above range and in range. Our results provide evidence for the utility of glycated albumin and fructosamine as alternate measures of hyperglycemia.


Funding

The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under Contract nos. (75N92022D00001, 75N92022D00002, 75N92022D00003, 75N92022D00004, 75N92022D00005). The authors thank the staff and participants of the ARIC study for their important contributions. Ms. Daya was supported by the NIH/NHLBI grant T32 HL007024. Dr. Fang was supported by the NIH/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant K01 DK138273. Dr. Shin was supported by the NIH/NIDDK grant R01 DK115534. Dr. Echouffo-Tcheugui was supported by the NIH/NHLBI grant K23 HL153774. Dr. Selvin was supported by NIH/NHLBI grants K24 HL152440 and R01 HL158022. This research was also supported by NIH/NIDDK grants R01 DK128837 and R01 DK128900, and NIH/NIA grant RF1 AG074044 to Dr. Selvin. Abbott Diabetes Care provided continuous glucose monitoring systems for this investigator-initiated research. Dexcom provided continuous glucose monitoring systems at a discount.

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    Keywords

    Continuous Glucose Monitoring (CGM)Glucose Monitoring TechnologiesBiomarkers-hyperglycemiaGlycemic MarkerHemoglobin A1c (HbA1c)

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