Feskens, E. et al. | September 2020 


There is considerable interest in dietary and other approaches to maintaining blood glucose concentrations within the normal range and minimizing exposure to postprandial hyperglycemic excursions. The accepted marker to evaluate the sustained maintenance of normal blood glucose concentrations is glycated hemoglobin A1c (HbA1c). However, although this is used in clinical practice to monitor glycemic control in patients with diabetes, it has a number of drawbacks as a marker of efficacy of dietary interventions that might beneficially affect glycemic control in people without diabetes. Other markers that reflect shorter-term glycemic exposures have been studied and proposed, but consensus on the use and relevance of these markers is lacking. We have carried out a systematic search for studies that have tested the responsiveness of 6 possible alternatives to HbA1c as markers of sustained variation in glycemic exposures and thus their potential applicability for use in dietary intervention trials in subjects without diabetes: 1,5-anhydroglucitol (1,5-AG), dicarbonyl stress, fructosamine, glycated albumin (GA), advanced glycated end products (AGEs), and metabolomic profiles. The results suggest that GA may be the most promising for this purpose, but values may be confounded by effects of fat mass. 1,5-AG and fructosamine are probably not sensitive enough to the range of variation in glycemic exposures observed in healthy individuals. Use of measures based on dicarbonyls, AGEs, or metabolomic profiles would require further research into possible specific molecular species of interest. At present, none of the markers considered here is sufficiently validated and sensitive for routine use in substantiating the effects of sustained variation in dietary glycemic exposures in people without diabetes.

Keywords: dietary intervention; HbA1c; 1,5-anhydroglucitol; dicarbonyl stress; fructosamine; glycated albumin; advanced glycated end products; metabolomics; nondiabetic population; systematic review

AUTHORS: Edith Feskens, Lorraine Brennan, Pierre Dussort, Matthieu Flourakis, Lena ME Lindner, David Mela, Naila Rabbani, Wolfgang Rathmann, Frédérique Respondek, Coen Stehouwer, Stephan Theis, Paul Thornalley and Sophie Vinoy
Advances in Nutrition, Volume 11, Issue 5, September 2020, Pages 1221-1236
©The Authors on behalf the American Society for Nutrition 2020


© 2020 Feskens, E. et al.

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