Fructosamine and glycated hemoglobin as biomarkers of glycemic control in people with type 2 diabetes mellitus and cancer (GlicoOnco study)

Toyoshima, Marcos Tadashi Kakitani; Cukier, Priscilla; Damascena, Aline Santos; Batista, Rafael Loch; Correa, Fernanda de Azevedo; Kawahara, Eduardo Zanatta; Minanni, Carlos André; Hoff, Ana O.; Nery, Marcia

doi:10.1016/j.clinsp.2023.100240

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Sumário

Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100240 copy

Fructosamine and glycated hemoglobin as biomarkers of glycemic control in people with type 2 diabetes mellitus and cancer (GlicoOnco study)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

Fructosamine and HbA1c are associated in individuals with diabetes and cancer, even on chemotherapy.
HbA1c and fructosamine are associated with self-monitoring of blood glucose in cancer.
The association between fructosamine and HbA1c occurs even in anemia and hypoproteinemia.

Abstract

Introduction

Glycemic control is important to avoid diabetes complications in individuals with cancer. There is no evidence for HbA1c and fructosamine as reliable biomarkers in these conditions. There are particularities in caring for patients with diabetes and cancer that can alter these biomarkers.

Objective

The aim of this study was to evaluate HbA1c and fructosamine as glycemic biomarkers in people with type 2 diabetes and cancer, undergoing clinical or surgical oncological treatment.

Methods

The authors conducted a single-center, retrospective analysis with people who have cancer and diabetes. Comparison of glycemic biomarkers (HbA1c, fructosamine, and Self-Monitoring of Blood Glucose [SMBG]) was performed including evaluation in individuals undergoing chemotherapy, using glucocorticoids, with anemia, hypoproteinemia or with reduced estimated Glomerular Filtration Rate (eGFR).

Results

There was a strong positive correlation between fructosamine and HbA1c (n = 318, r= 0.66, p < 0.001) in people with diabetes and cancer even in those under chemotherapy (n = 101, r= 0.61, p < 0.001) or using glucocorticoids (n = 96, r= 0.67, p<0.001). There was a strong correlation between HbA1c and fructosamine in subjects with anemia (n = 111, r= 0.66, p < 0.001), hypoproteinemia (n = 54, r= 0.67, p < 0.001), or with eGFR ≥ 60 mL/min/1.73 m² (n = 189, r= 0.70, p < 0.001), and moderate correlation with hypoalbuminemia (n = 21, r= 0.54, p = 0.001) and with reduced eGFR (n = 67, r= 0.57, p < 0.001). The correlations between fructosamine and HbA1c with SMBG were moderate (n = 164, r= 0.49, p < 0.001; n = 111, r= 0.55, p < 0.001, respectively), strong in subjects undergoing chemotherapy, with hypoalbuminemia or hypoproteinemia, and at least moderate, if eGFR < 60 mL/min/1.73 m² or with anemia.

Conclusions

Fructosamine and HbA1c can be used as glycemic biomarkers in people with diabetes and cancer, even in those with anemia, hypoproteinemia, or undergoing chemotherapy.

Keywords
Chemotherapy; Glucocorticoids; Cancer; Glycemic control; Fructosamine; HbA1c

	Analysis 1	Analysis 2	Analysis 3
	(Fructosamine vs. HbA1c)	(Fructosamine vs. 1-month SMBG)	(HbA1c vs. 3-month SMBG)
Variable	n = 318	n = 164	n = 111
Female sex	176 (55.3%)	72 (43.9%)	50 (45.0%)
Age (years)	65 (58‒72)	64 (57‒71)	65 (58‒73)
Fasting glucose (mg/dL)	137.0 (103.0‒190.0)	132.0 (104.0‒189.0)	125.0 (103.0‒170.0)
HbA1c (%)	8.0 (7.0‒9.4)	NA	7.6 (6.7‒8.7)
Fructosamine (µmoL/L)	315.5 (273.0‒366.8)	309.0 (268.0‒369.3)	NA
Number of BG/month	NA	63 (28)	66 (29)
Number of preprandial BG/month		48 (25)	53 (27)
Number of postprandial BG/month		15 (14)	14 (14)
1-month SMBG (mg/dL)	NA	170.1 (48.6)	NA
3-month SMBG (mg/dL)	NA	NA	168.8 (43.2)
Creatinine (mg/dL)	0.9 (0.7‒1.2)	0.9 (0.7‒1.2)	0.9 (0.7‒1.4)
eGFR (mL/min/1.73 m²)	81.9 (59.4‒96.3)	79.9 (58.7‒98.6)	76.2 (46.5‒94.5)
Hemoglobin (g/dL)	11.9 (11.1‒12.9)	12.2 (11.2‒13.0)	12.1 (11.1‒13.3)
Serum albumin (mg/dL)	4.2 (3.8‒4.4)	4.2 (3.9‒4.4)	4.2 (3.9‒4.4)
Serum protein (mg/dL)	6.9 (6.4‒7.3)	7.0 (6.4‒7.3)	6.9 (6.5‒7.3)
Anemia (hemoglobin <12 g/dL)	111 (45.3%)	68 (51.5%)	41 (43.6%)
Hypoalbuminemia (albumin ≤3.5 g/dL)	21 (6.6%)	10 (9.3%)	7 (9.7%)
Hypoproteinemia (total protein ≤6.5 g/dL)	54 (30.3%)	33 (30.6%)	25 (34.7%)
Cancer treatment
Chemotherapy	96 (30.2%)	62 (37.8%)	38 (34.2%)
Glucocorticoids	101 (31.8%)	64 (39.0%)	41 (36.9%)

	Analysis 1					Analysis 2					Analysis 3
	(Fructosamine vs. HbA1c)					(Fructosamine vs. 1-month SMBG)					(HbA1c vs. 3-month SMBG)
Variable	n	r	a	b	p	n	r	a	b	p	n	r	a	b	p
Corticosteroid use	96	0.67	0.015	3.22	<0.001	62	0.77	1.26	95.13	<0.001	38	0.76	0.022	3.51	<0.001
On chemotherapy	101	0.61	0.015	3.55	<0.001	64	0.74	1.16	108.40	<0.001	41	0.67	0.022	3.81	<0.001
Anemia	111	0.66	0.015	3.01	<0.001	68	0.59	0.78	183.04	<0.001	41	0.75	0.020	3.94	<0.001
Hypoalbuminemia	21	0.54	0.012	4.17	0.01	10	0.77	1.08	114.24	0.01	7	0.85	0.028	2.39	0.01
Hypoproteinemia	54	0.66	0.017	3.01	<0.001	33	0.73	0.97	117.89	<0.001	25	0.80	0.027	2.76	<0.001
Normal kidney function or grade 1 and 2 CKD	189	0.70	0.015	3.35	<0.001	99	0.64	0.93	164.90	<0.001	58	0.71	0.023	3.61	<0.001
Grade 3 and 4 CKD	67	0.57	0.012	3.92	<0.001	38	0.41	0.83	198.25	0.01	34	0.44	0.014	5.36	0.01

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[1] * Corresponding author. E-mail address;marcos.tadashi@hc.fm.usp.br (M.T.K. Toyoshima).