HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) All Versions of this Article: db07-0028v1 56/7/1913    most recent Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lachin, J. M. Articles by Rutledge, B. N. Search for Related Content PubMed PubMed Citation Articles by Lachin, J. M. Articles by Rutledge, B. N. Social Bookmarking                What's this?

The Hemoglobin Glycation Index is Not an Independent Predictor of the Risk of Microvascular Complications in the Diabetes Control and Complications Trial

¹The Biostatistics Center, The George Washington University, Rockville, MD
²Case Western Reserve University, Cleveland, OH
³Massachusetts General Hospital and Harvard Medical School, Boston MA

Correspondence: jml{at}biostat.bsc.gwu.edu

The Diabetes Control and Complications Trial demonstrated that intensive therapy aimed at improved glucose control markedly reduced the risk of diabetes complications compared to conventional therapy. The principal determinant of risk was the history of glycemia. Recently, McCarter et al. have presented analyses of the publicly available DCCT data using their Hemoglobin Glycation Index (HGI) that is computed as the difference between the observed HbA1c and that predicted from the level of blood glucose (Diabetes Care 27: 1259-1264, 2004). In their analyses, the HGI level was a significant predictor of progression of retinopathy and nephropathy in the DCCT, which the authors claimed to support the hypothesis that the biological propensity for glycation, so-called biological variation in glycation, is another mechanism that determines risk of complications. However, we have criticized these analyses and conclusions because, from statistical principles, the glycation index must be positively correlated with the HbA1c level and thus may simply be a surrogate for HbA1c.

Herein we present the statistical properties of the glycation index to document its high correlation with HbA1c. We then replicate the analyses of McCarter et al. using both the HGI and the HbA1c together. Analyses show conclusively that the glycation index is not an independent risk factor for microvascular complications and that the effect of the glycation index on risk is wholly explained by the associated level of HbA1c.

The hemoglobin glycation index should not be used to estimate risk of complications or to guide therapy.

CiteULike

Del.icio.us

Digg

Reddit

Technorati

This article has been cited by other articles:

				S. Chalew, J. Hempe, and R. McCarter Comment on: Lachin et al. (2007) The Hemoglobin Glycation Index Is Not an Independent Predictor of the Risk of Microvascular Complications in the Diabetes Control and Complications Trial: Diabetes 56:1913-1921, 2007 Diabetes, February 1, 2008; 57(2): e4 - e4. [Full Text] [PDF]

				D. M. Nathan, S. Genuth, B. Rutledge, and J. Lachin Response to Comment on: Lachin et al. (2007) The Hemoglobin Glycation Index Is Not an Independent Predictor of the Risk of Microvascular Complications in the Diabetes Control and Complications Trial: Diabetes 56:1913-1921, 2007 Diabetes, February 1, 2008; 57(2): e5 - e5. [Full Text] [PDF]

				R. M. Cohen A1C: Does One Size Fit All? Diabetes Care, October 1, 2007; 30(10): 2756 - 2758. [Full Text] [PDF]