Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2025; 16(4): 100917
Published online Apr 15, 2025. doi: 10.4239/wjd.v16.i4.100917
Hemoglobin glycation index among adults with type 1 diabetes: Association with double diabetes features
Xiao-Lin Ji, Min Yin, Chao Deng, Li Fan, Yu-Ting Xie, Fan-Su Huang, Yan Chen, Xia Li
Xiao-Lin Ji, Min Yin, Chao Deng, Li Fan, Yu-Ting Xie, Fan-Su Huang, Yan Chen, Xia Li, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Xiao-Lin Ji, Department of Endocrinology, The First Affiliated Hospital, Southwest Hospital, Army Medical University, Chongqing 400038, China
Min Yin, Fan-Su Huang, Department of Nutrition, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Co-first authors: Xiao-Lin Ji and Min Yin.
Author contributions: Ji XL and Yin M conceived the study, conducted statistical analyses, interpreted the results, and drafted the manuscript; Deng C, Fan L, Xie YT, Huang FS and Chen Y contributed to the data collection; Li X supervised the study; All authors provided critical feedback, helped shape the research, analysis, and manuscript, and gave final approval of the version to be published.
Supported by the National Key R D Program of China, No. 2022YFC2010102; Natural Science Foundation of Hunan Province, No. 2021JC0003; National Natural Science Foundation of China, No. 82070812; and the Sinocare Diabetes Foundation, No. LYF2022039.
Institutional review board statement: This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University and conducted in accordance with the Declaration of Helsinki.
Informed consent statement: Written informed consent was obtained from all participants prior to data collection.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Data available from the corresponding author at lixia@csu.edu.cn. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xia Li, PhD, Professor, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, Furong District, Changsha 410011, Hunan Province, China. lixia@csu.edu.cn
Received: September 1, 2024
Revised: December 24, 2024
Accepted: January 16, 2025
Published online: April 15, 2025
Processing time: 182 Days and 6.8 Hours
Abstract
BACKGROUND

The hemoglobin glycation index (HGI) represents the discrepancy between the glucose management indicator (GMI) based on mean blood glucose levels and laboratory values of glycated hemoglobin (HbA1c). The HGI is a promising indicator for identifying individuals with excessive glycosylation, facilitating personalized evaluation and prediction of diabetic complications. However, the factors influencing the HGI in patients with type 1 diabetes (T1D) remain unclear. Autoimmune destruction of pancreatic β cells is central in T1D pathogenesis, yet insulin resistance can also be a feature of patients with T1D and their coexistence is called “double diabetes” (DD). However, knowledge regarding the relationship between DD features and the HGI in T1D is limited.

AIM

To assess the association between the HGI and DD features in adults with T1D.

METHODS

A total of 83 patients with T1D were recruited for this cross-sectional study. Laboratory HbA1c and GMI from continuous glucose monitoring data were collected to calculate the HGI. DD features included a family history of type 2 diabetes, overweight/obesity/central adiposity, hypertension, atherogenic dyslipidemia, an abnormal percentage of body fat (PBF) and/or visceral fat area (VFA) and decreased estimated insulin sensitivity. Skin autofluorescence of advanced glycation end products (SAF-AGEs), diabetic complications, and DD features were assessed, and their association with the HGI was analyzed.

RESULTS

A discrepancy was observed between HbA1c and GMI among patients with T1D and DD. A higher HGI was associated with an increased number of SAF-AGEs and a higher prevalence of diabetic microangiopathy (P = 0.030), particularly retinopathy (P = 0.031). Patients with three or more DD features exhibited an eight-fold increased risk of having a high HGI, compared with those without DD features (adjusted odds ratio = 8.12; 95% confidence interval: 1.52-43.47). Specifically, an elevated PBF and/or VFA and decreased estimated insulin sensitivity were associated with high HGI. Regression analysis identified estimated insulin sensitivity and VFA as factors independently associated with HGI.

CONCLUSION

In patients with T1D, DD features are associated with a higher HGI, which represents a trend toward excessive glycosylation and is associated with a higher prevalence of chronic diabetic complications.

Keywords: Type 1 diabetes; Double diabetes; Insulin resistance; Hemoglobin glycation index; Advanced glycation end products; Diabetic complications

Core Tip: Insights into the discrepancy between the glucose management indicator (GMI) based on mean blood glucose levels and the laboratory estimated glycated hemoglobin (HbA1c) levels in patients with type 1 diabetes (T1D) are limited. This study aimed to quantify this discrepancy by calculating the hemoglobin glycation index (HGI) based on laboratory HbA1c and continuous glucose monitoring-derived GMI levels. The results indicated that double diabetes features in patients with T1D are associated with a higher HGI, which represents a trend toward excessive glycosylation and is associated with a higher prevalence of chronic diabetic complications.