Update on biomarkers of glycemic control

Table 3 Characteristics of glycaemic biomarkers

Markers of hyperglycemia	Assessment period	Advantages	Limitations
HbA1c	2-3 mo	Fasting not necessary; low interindividual variabiliy screening tool for diabetes; association with diabetes complications; standardization	Surrogate biomarker analytical interferences; biological confounders; costs
Fructosamine	2-3 wk	Fasting not necessary; inexpensive and easily automated; good correlation with HbA1c; association with diabetes complication; marker of choice in severe chronic kidney disease	Surrogate biomarker; higher interindividual variability; unreliable in conditions with altered protein and albumin metabolism (nephrotic disease, severe liver disease), thyroid disfunction; not standardized
Glycated albumin
1,5-anhydroglucitol	1-2 wk	Fasting not necessary; glycemic excursion detection; good correlation with HbA1c; association with diabetes complications	Surrogate biomarker; unreliable in the setting of chronic kidney disease (stage 4 and 5), dialysis, pregnancy or other conditions with changes in renal threshold (sglt inhibitors); not suitable for diabetes diagnosis
Fasting glucose	8-10 h	Current glycemic status; immediate availability for daily diabetes management SMBG/CGMS	Affected by acute illness and stress; SMBG and CGMS-accuracy
Postprandial glucose	2-4 h
Indices of glycaemic variabily	24-72 h	Short-term glucose dynamics; improves glycaemic control beyond HbA1c and patient’s satisfaction/outcomes	CGMS mandatory; costs education; standardization

HbA1c: Hemoglobin A1c; SMBG: Self-monitoring of blood glucose; CGMS: Continuous glucose monitoring system.