title: Glycation gap is associated with macroproteinuria but not with other complications in patients with type 2 diabetes.
abstract: OBJECTIVE
  We investigated whether glycation gap (G-Gap), an index of intracellular glycation of proteins, was associated with diabetes complications.
  
  
  METHODS
  We measured concomitantly HbA1c and fructosamine in 925 patients with type 2 diabetes to calculate the G-Gap, defined as the difference between measured HbA1c, and fructosamine-based predicted HbA1c. Patients were explored for retinopathy, nephropathy, peripheral neuropathy, cardiac autonomic neuropathy (n = 512), and silent myocardial ischemia (n = 506).
  
  
  RESULTS
  Macroproteinuria was the only complication that was associated with G-Gap (prevalence in the first, second, and third tertile of G-Gap: 2.9, 6.2, and 11.0%, respectively; P < 0.001). The G-Gap was higher in patients with macroproteinuria than in those without (1.06 ± 1.62 vs. 0.03 ± 1.30%; P < 0.0001). Because HbA1c was associated with both G-Gap (HbA1c 7.0 ± 1.4, 7.9 ± 1.4, and 10.1 ± 1.8% in the first, second, and third G-Gap tertile, respectively; P < 0.0001) and macroproteinuria (HbA1c 8.8 ± 2.2% if macroproteinuria, 8.3 ± 2.0% if none; P < 0.05), and because it could have been a confounder, we matched 54 patients with macroproteinuria and 200 patients without for HbA1c. Because macroproteinuria was associated with lower serum albumin and fructosamine levels, which might account for higher G-Gap, we calculated in this subpopulation albumin-indexed fructosamine and G-Gap; macroproteinuria was independently associated with male sex (odds ratio [OR] 3.2 [95% CI 1.5-6.7]; P < 0.01), hypertension (2.9 [1.1-7.5]; P < 0.05), and the third tertile of albumin-indexed G-Gap (2.3 [1.1-4.4]; P < 0.05) in multivariate analysis.
  
  
  CONCLUSIONS
  In type 2 diabetic patients, G-Gap was associated with macroproteinuria, independently of HbA1c, albumin levels, and confounding factors, suggesting a specific role of intracellular glycation susceptibility on kidney glomerular changes.
authors: AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology, Diabetology, and Nutrition, CRNH-IdF, Bondy, France.
authors: Emmanuel
authors: E
authors: Cosson
authors: Isabela
authors: I
authors: Banu
authors: Camille
authors: C
authors: Cussac-Pillegand
authors: Qinda
authors: Q
authors: Chen
authors: Sabrina
authors: S
authors: Chiheb
authors: Yahya
authors: Y
authors: Jaber
authors: Minh Tuan
authors: MT
authors: Nguyen
authors: Nathalie
authors: N
authors: Charnaux
authors: Paul
authors: P
authors: Valensi
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000378:metabolism; D005260:Female; D019270:Fructosamine / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000378:metabolism*
chemical_list: D019270:Fructosamine; D006442:Glycated Hemoglobin
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