Acta Diabetologica

, Volume 52, Issue 3, pp 453–459 | Cite as

Influence of the glycation gap on the diagnosis of type 2 diabetes

  • Santiago Rodriguez-Segade
  • Javier Rodriguez
  • José M. García-López
  • Felipe F. Casanueva
  • Ian C. Coleman
  • Carmen Alonso de la Peña
  • Félix Camiña
Original Article



The results of using HbA1C-based criteria for diagnosis of type 2 diabetes and prediabetes have been reported to differ from those obtained using fasting plasma glucose (FPG) or an oral glucose tolerance test (OGTT). We aimed to determine whether these discrepancies might be due to the influence of the glycation gap.


For 430 patients without previously diagnosed diabetes for whom an OGTT had been requested in normal clinical practice, FPG, fructosamine and HbA1C were measured at the time of the test and again 1 month later. Glycaemia/diabetes status was classified as normoglycaemia, prediabetes or diabetes using both HbA1C-based and FPG/OGTT-based criteria, and their glycation gaps GG were calculated.


The specificity of an HbA1C level of 6.5 % (48 mmol/mol) for diagnosis of FPG/OGTT-defined type 2 diabetes was 99 %, but its sensitivity was less than 37 %. HbA1C-diabetic patients had higher average blood glucose levels than FPG/OGTT-diabetic patients. With either set of criteria, high-GG patients were disproportionately numerous among those classified as diabetic and were disproportionately infrequent among those classified as normoglycaemic, but the effect was greater for the HbA1C criteria.


The differences between HbA1C-based and FPG/OGTT-based diagnoses are largely due to the influence of the glycation gap, which may also influence the early stages of FPG/OGTT-defined diabetes.


Glycated haemoglobin Fructosamine HbA1C Clinical care Diagnosis Diabetes 



American Diabetes Association


Frutosamine corrected for albumin concentration


Confidence interval


Fasting plasma glucose


Instantaneous glycation gap for each visit


Glycation gap


Characteristic glycation gap of each patient


Glycated haemoglobin


Oral glucose tolerance test


Post-challenge plasma glucose


Receiver operating characteristic


World Health Organization

Supplementary material

592_2014_666_MOESM1_ESM.pdf (469 kb)
Supplementary material 1 (PDF 469 kb)


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Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Santiago Rodriguez-Segade
    • 1
    • 2
  • Javier Rodriguez
    • 1
    • 2
  • José M. García-López
    • 3
  • Felipe F. Casanueva
    • 3
    • 4
  • Ian C. Coleman
    • 2
  • Carmen Alonso de la Peña
    • 2
  • Félix Camiña
    • 1
  1. 1.Department of Biochemistry and Molecular BiologyUniversity of Santiago de CompostelaSantiago de CompostelaSpain
  2. 2.Clinical Biochemistry Laboratory, University Hospital Clinical ComplexUniversity of Santiago de CompostelaSantiago de CompostelaSpain
  3. 3.University Hospital Division of EndocrinologyUniversity of Santiago de CompostelaSantiago de CompostelaSpain
  4. 4.The Physiopathology of Obesity and Nutrition Biomedical Research Network ConsortiumSantiago de CompostelaSpain

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