COMPARISON OF GLYCOMARK TEST TO HBA1C AND

● it is the impaired ability to metabolize carbohydrates

FRUCTOSAMINE: A MONITORING TESTS FOR DIABETES
usually caused by the deficiency of insulin or
metabolic hormonal changes
Diabetes Mellitus
● Is a group of metabolic disorders characterized by hyperglycemia
resulting from defects in insulin secretion, insulin receptors or COMPARISON BETWEEN TYPE 1 DM AND TYPE 2 DM
both. Type 1 DM Type 2 DM

TYPES OF DIABETES MELLITUS Pathogenesis Β-cell destruction Insulin resistance

Type 1 ● Insulin Dependent Diabetes Mellitus (IDDM) Incidence Rate 5-10% 90-95%
● Juvenile Onset Diabetes Mellitus
● Brittle Diabetes Onset Any age but common Any age but common
● Ketosis Prone Diabetes in children in older population
- commonly caused by insulin autoantibodies
(IAA) in children and glutamic acid Risk Factors Genetic/Autoimmune Genetic/ lifestyle,
PCOS
decarboxylase 65 (GAD65) in adults
- destruction of 60-90% of β-cells to be C-peptide levels Decreased/undetected Detectable
symptomatic
- genetic association of HLA-DR3 and DR4 found Pre-diabetes POSITIVE to NEGATIVE
in chromosome 6 autoantibodies

Type 2 ● Non Insulin Dependent Diabetes Mellitus Symptomatology Abrupt Gradual

● Adult Onset Diabetes Mellitus
Ketosis Common Rare
● Stable Diabetes
● Ketosis Resistant Diabetes Mellitus Medications Insulin Oral agents
● Receptor-Deficient Diabetes Mellitus
- caused by defective insulin receptor, insulin
GLYCOSYLATED HEMOGLOBIN
resistance, or insulin deficiency
● It is the largest subfraction of normal hemoglobin A in both diabetic
- can be inherited or due to improper lifestyle
and non-diabetic individuals
● Glycation - process wherein the glucose permanently binds with the
GDM ● diabetes among pregnant women
protein
(Gestational ● In some cases, it can return and progress to type 2
● Diagnostic Significance:
Diabetes DM
○ a reliable method in the monitoring of long term glucose
Mellitus)
control
 ○ it represents a “weighted” average of glucose levels, with
youngest erythrocytes contributing to greater extent than
older ones
● Measurement:
○ Dietary status on the day of the test has no effect on the test
○ It is recommended that HbA1c be measured twice a year for
a patient who are meeting treatment goals, and quarterly for
non-compliant patients
○ Specimen: Anticoagulated whole blood (EDTA whole blood)
○ Methods: Electrophoresis, Immunoassay, HPLC, Affinity
Chromatography
● Interpretation of Results:
○ 5.7-6.4% indicates pre-diabetes/increased risk for DM
○ ≥ 6.5% on at least two occasions - indicative of DM
○ For every 1% change in the HbA1c value, 30-35 mg/dL (35
mg/dL) is added to the plasma glucose
○ Normal glycosylation value: ≤ 5.7% (5.2-5.6%)
● Problems with measuring HbA1c:
○ older RBCs, patients with iron deficiency anemia (IDA) - high
level
○ Shortened RBC lifespan, hemolytic anemia, sickle cell
anemia, high level of Vit. C - low level
THE GLYCOMARK TEST
● Is a non fasting glucose test
● Indicates blood glucose control over a one-to-two week period in
people with DM
● It measures 1,5-Anhydroglucitol (1,5-AG)
WHAT IS 1,5 ANHYDROGLUCITOL?
● It is a particular type of glucose like sugar in the blood
● It is filtered in the kidney like the glucose
● It is present in concentration far lower than glucose
● It is stored at a steady state in tissue and bloodstream (making a
High GlycoMark Score)
● When blood glucose reached the renal threshold to glucose, 1,5-AG
does not stay in the blood (making a Low GlycoMark Score)
● Its concentration is intimately tied to the renal threshold (180 mg/dL)

FRUCTOSAMINE
● It is a reflection of short term glucose control
● May be useful for monitoring diabetic individuals with chronic
hemolytic anemias and hemoglobin variants (HbS and HbC).
● It should not be measured in cases of low plasma albumin (<30 g/L).
● Method: Affinity Chromatography, HPLC, and Photometric
● Reference value: 205-285 umol/L
● Interferences: High uric acid, triglyceride and bilirubin levels; and the
presence of hemolysis
 ADVANTAGES OF USING GLYCOMARK TEST THREATS OF DM
1. It is a test that provides information that HbA1c and other test can’t ● Hyperglycemia - it is a condition wherein the blood sugar is at higher
provide level than the body can handle
2. It is the only specific indicator of recent hyperglycemic spikes ● Long term, persistently high glucose level decreases energy, alter
3. It is a valuable addition to the traditional glucose monitoring regimen your mood , and compromise brain function
● Hyperglycemia and glycemic variability have been linked to
IT DETECTS OR IDENTIFY: diabetes-related health complications including:
1. High glucose episodes ○ Vascular damage (reduced flow-mediated dilation and
2. Daily maximum blood glucose coronary lumen diameter; increased carotid artery stiffness
3. Glycemic variability and carotid intima-media thickness)
- It is caused by spikes in glucose level followed by drop in its ○ Oxidative stress (plasma 3-nitrotyrosine and 24-h urinary
concentration excretion rates of free 8-iso PGF2)
- Identify patients with A1c at 8% or less who have had more ○ Increased inflammatory markers (C-Reactive protein,
frequent and extreme hyperglycemic excursions in the pasty Interleukin 6)
one to two weeks ○ Poor cardiovascular outcomes (repeat MI, acute heart
4. Recognize recent glycemic deterioration before changes are visible failure)
with A1c ○ Stroke
○ Dementia
○ Increased risk of death from cardiovascular causes

GLYCOMARK TEST IS NOT AFFECTED BY:

1. It is not affected by hemoglobinopathies, such as anemia, sickle cell
disease or malaria.
2. The GlycoMArk test
3. Has been tested and found to be unaffected by hemoglobin (125
mg/dL), triglycerides (1153 mg/dL), bilirubin (40 mg/dL), glucose
(1000 mg/dL), maltose (500 mg/dL), ascorbic acid (25 mg/dL), uric
acid (20 mg/dL), urea (20 mg/dL), and creatinine (10 mg/dL)

HBA1c IS AFFECTED BY:

1. Hemoglobinopathies, HIV, cirrhosis and liver conditions, heart
disease, kidney disease, and hypothyroidism
2. Blood loss, transfusions, and hemodialysis
3. Certain drugs and medications, including alcohol, nicotine, opioids,
aspirin therapy, and vitamin supplements\
 4.
5. LIMITATIONS OF GLYCOMARK TEST

However, there are some conditions that may interfere with the results
of the GlycoMark test, which include the following:
I. Kidney Disease - The GlycoMark results are not accurate in
advance kidney disease (Stage 4 or 5; GFR below 30) or dialysis
patients.
II. Liver Disease - Advanced cirrhosis of the liver may cause low
GlycoMark results.
III. Pregnancy - GlycoMark results may run lower due to lower and
varying renal thresholds during pregnancy.
IV. Reduced Food Absorption - Reduced food absorption, as after
gastrectomy, in celiac disease or use of the drug acarbose, may
cause low GlycoMark values. Other α-glucosidase inhibitors have not
been found to cause low results.
V. Glucose in the ?Urine - Persistently positive urine glucose levels in
certain kidney conditions or use of diabetes agents called SGLT2
inhibitors (sodium-glucose transporter-2) such as INVOKANA®
cause low GlycoMark values.
VI. Steroid Use - Can cause hyperglycemia, which may result in
expected low GlycoMark levels.
VII. Intravenous Hyperalimentation and Chinese Medicines - Use of
certain Chinese medicines (Polygala, Tenuifolia, and Senega Syrup)
may cause high GlycoMark values.

GlycoMark Reference Value:

Result Interpretation

10-31 ug/mL Normal

<10 ug/mL Abnormal/hyperglycemia

 exuss
Glomerulus the ste
ad
e
iny fA1ters of the kidre uhich renves
vnne
form o
Flud from blond then erete it in he
Glomerular Filtration Rate rervlus
the qlomrvi
mch bled pasges though
A Hext that estimarte howa thet pacse hgh ony
Per mine speLialy qgainG notl mopuole

a
Cystatin C, Widely accepted as the best
overall measure or

Comparison to Creatinine and kidney function.

molecules
other Clearance Markers A measure of the clearance of normal
are freely
that are not bound to protein and
neither reabsorbed
filtered by glomeruli
the
Prepared by: nor secreted by the tubules.
Cystatin C Billy Africa, RMT, MPH sinte prorelns are mauromoleoles, they are net p l y
0ne ot he marker for oagssing one he ttn in urine (pesen ce
kldney damoge)
nean«
tohich is
the filirahin toed( eliminatemajor
fhe
funcion of tho dney
Apprmimottly 150L (125-130 ml/min) f glomarvlar
present in the árulchon) metubollo waste praducto fltrafe is pndued daily io aur kidey
Kidney
body's main fittraing system end ene f is hdjor funcrion is to rewye a
products rom wr bdy and then exerete * in tom of uine
FUNCTION6:
Fithation f blood moaiptenance of iniu eqikbrium
Regulahon t plasma 44 wattr volume and ad bast balançet
What is it used for? Vendocrine ftnchon (renin d EPO) l need GFR test?
Why do a
g h pogbibliky t wont pngrass to renal failurt or chronic kidney
disease
A GFR test is you may need a GFR test if you are at higher
used to help diagnose kidney
disease at an early stage mst treateble stmge risk of getting kidney disease. Risk factors
GFR may also be used to monitor people with include: Diebehc rehnopety /blindnss
chronic kidney disease (CKD) or other congrene
conditions that cause kidney damage. Diabetes(hyporglycemia) makes bjood nore vistous
Other anditions High blood pressure leods to damaqe in nephrons
Hypertension Family history of kidney failure hureditary
Diabetes most tammon compliuatien are
Kidney disease Nott: Early shage kidney disease has no
ymptoms
(Asymptomartic)

Clearance
Later stage kidney disease does cause symptoms. Volume of plasma from which the substance is completely
So you may need a GFR test if you have any of the
cleared (removed) by the kidney per unit of time.
following symptoms: Removal of the substance from plasma into urine over a fixed
Polyorna Auria time.
Oliguna I t is
- Urinating more or less often than usual expressed in mL/minute, representing the volume of plasma
that would be totally cleared of solute in one minute.
Itching
plasma concentration and
clearance of a substance is inversely
- Fatigue
porportional. clearonce ot absfance jn plasma Cnc
- Swelling in your arms, legs, or feet (elkcroyts afect the movemenit
Measurement of clearance may require accurate measurement
- Muscle cramps ofwater EDEMA of
serum and urinary concentration of the marker used

- Nausea and vomiting Anosarco: goner ali2ed edem a

- Loss of appetite to the whole buy
 Markers for Clearance Test Methods:
Most involved the ability of the kidney to clear
Substance used must be: an exogenous and endogenous marker.
Stable concentration (does not vary within the
day) Exogenous Marker
Physiologically inert (svbstun is ndt metabojize in Ideal, but costly and cumbersome.
Freely filtered at the glomerulus the bod)
Note: cells in Neither secreted,
-
Enable smaller deterioration in renal function to
the tubus
reabsorbed, synthesized, nor
metabolized by the kidney
be observed. (mere sensihive)
The amount of that substance
(ll goes to the uninte, nthing 3oes b -Examples: Radioisotopic- Cr-EDTA, TC-DTPA,
art nuoeated filtered at the in he
glomerulus is equal to the amount excreted in the blod) iothalamate
urine.
Non-Radioisotopic iohexol, inulin
Additi nal
Markers must not be prvtein bovnd Tnulin:reterene mdhod Ar 6FA test
cann ot be iHered f bound t
protein)

prodoced by all naeated cells in

Cystatin C tbes)
Endogenous Markers Aka
Simplest and readily available (produced in the bocy) Cystatin 3, formerly Gamma Trace, Post-Gammaglobulin
or Neuroendocrine Basic Polypeptide
-

Obviate the necessity for

injection and requires I s a low
molecular weight (12.8 kD) protein synthesized by all
only a single blood sample, it simplifies the nucleated celis whose physiologic role is that of
cysteine
procedure. proteinase inhibitor.
- Examples: With regards to renal function, its most important attributes
areits small size and high isoelectric
point (pl 9.2), which
Creatinine(waste prwuct of muscle that camc fron CREAtINE enable it to be more freely filtered than other
protein at the
Cystatin C(produ cod ball voleated cells) glomeruli.
The production rate of
Urea (deamin ahj on of ammonia) cystatin C has always been considered
qlso prodoced fnm prolein dtbxthicatian
to be constant
of LVER ( from age 4 mos. To 70 y/o.)
Serum concentration of
met abn lism Cystatin C appears to be
unaffected by muscle mass, diet, or gender. relatively
No extrarenal route elimination.

Creatinine affected by musle mass

-

, diet, gender
Vrta- variavly reabsorbed y the tvhwky
Tnulin-needls to be administerd byIV infisjan
(egeneas
uiolahon in the murker
Since it is completely reabsorbed, change in
serum concentration of cystatin C are used as
Several proteins with molecular weight of less indirect estimate of GFR. idirect estimate
kecage sanplc
than 30 kD are primarily cleared from Its presence in the urine denotes damage of in e test
circulation by renal filtration and can be the tubules. is BLODD!!
considered to be relatively freely filtered at Its plasma concentration is
inversely related to
the glomeruli. GFR.

Examples: a2-macroglobulin, RBP, a1- Renal clearance cannot be measured

microglobulin, B trace protein, Cystatin C, (Gphin Cis omplettly rlprbel un ks there i problen
tryptophan glycoconjugate. in the rena)
tubules
1
1
 Creari nineproduced in liver co liver disease affects
its on
Urea diet («ffeted conc. in protein diet)
ender Cretinine of male is tan female
Advantage of Cystatin C as GFR marker Creatinine vs. Cystatin C
sensitive and
Cystatin measurement may offer
a more
Asymptomoth c in changes in GFR
Virtually unaffected by non renal factorsy stoge kidney specific m e a s u r e m e n t of monitoring
than in serum creatinine.
Sensitive to called creatinine blind range damoge So it is
so
teded if .
cvstatin C increase faster than creatinine
Can be used to detect and monitor kidney
disease in patient with hepatic disease
damage is n abnormality.
certain
Swere Creatinine is affected by age, gender, exercise,
and nutitional status.
-

Creatinine for GFR in liver disease not recommended drugs, muscle mass,

C measurement appears resistant

to spectrall
Correlates to appearance of microalbuminuria Cystatin
-

Clinical studies suggest that very early renal failure interference. (st spechrophotometer in Masonng9)
may be the first clinical indication of progressive renal
damage associated with diabetes reftets the conc of
Tnicoakouminuria
Percistent elevation ofalbumin in vrine
Cystoin C
behwen 3o- 30 mg/day (bt the unine
dipshick can detect albumin conc at
300/day)
Cystatin C and other diseases HIV
Diabetes Studies have reported increased in Cystatin C
A reliable marker of GFR in patients with mild-to- levels in HIV
moderate kidney dysfuntion_(stage 2-3 of CKD) in
Because of an increase of cystatin C levels
both type 1 and 2 diabetes.
with active HIV infection, an overestimation of
Elevated serum cystatin C levels identified as a
kidney impairment may occur, particularly in
significant prognosticator for the development of treatment-naive patients with renal disease.
cardiovascular disease in people with diabetes. they dont rexponse to trearm ent
Cystatin C is not only a better indicator of GFR in
diabetes, it has the best correlation with changes f HIV nfechion
in GFR over two years, making it a useful measure
for follow up of patients with diabetes.

Cystatin is almst the same wth cardiac morkers,

EX: AST, LDH , CKMb, Tnpnin

Thyroid Function tpothyoid (shin C typertihyrd= Obesity Fat cels has nocleus mcons thy prduce (ystain C
Like creatinine concentrations, Cystatin C levelsalso ystatin C
are
lower in the hypothyroid and higher in the hyperthyroid Serum cystatin C concentration are increased in
state as compared with the euthyroid state. human obesity in relation to over production by
normel hrd normal Gyshtin C the adipose tissue. So, cystatin C levels are higher
in obese subjects as compare to lean.
Cardiovascular Disease
Cystatin C has been reported to be a potent predictor of Adipose tissue is a source of cystatin C in a way
that is not related to eGFR but to the status of
cardiovascular mortality beyond classical risk factors in
patient with CAD and normal or mildly reduced kidney adipose tissue itself, including enlarged
function. adipocytes, hypoxia, pro-inflammatory cytokines
Serum cystatin C may have a stronger association with production, increased number of macrophages,
mortality and cardiovascular disease than serum and probably other cellular and molecular
creatinine in patients without CKD, as reported in a large alterations known to occur in obesity.
study of older adults.
 Levels of cystatin C are Contraindication of Cystatin C Estimation
altered in following
conditions: Thyroid function
- Cancer
ient A ystatin - Levels of cystatin C are sensitive to change in thyroid
function and should not be performed without
-Thyroid dysfunction depends if tyothyroid or
tyorthy rotd
Glucocorticoid therapy AGysturin g r urtiwstenid whle knowledge of patients thyroid status

-HIV infection tostahin in oydasporine

Corticosteroids
-

Increased levels in MI, stroke, heart failure,

of
peripheral arterial syndrome -Cystatin C concentrations are affected in patients
-

Increased in metabolic syndrome impaired renal function receiving corticosteroids

- Cystatin Cis affected by corticosteroid (increase) and
-

Increased in alzheimer disease

cyclosporine (decrease).
-

Levels decreased in atherosclerosis and

aneurysmal (saccular bulging) lesions of aorta

Laboratory Measurement
Assay Principle Cstmrin C t AntcystatinC Asglutination
- Cystatin C in the sample binds to the specific anticystatin c
and causes
antibody which is coated on latex particles - Reference value:
agglutination
- The degree of turbidity caused by agglutination is Males: 0.52-0.98 mg/dl
amount of
measured optically and is proportional to the
Female: 0.52-0.90 mg/dl
C in the sample by a method called turbidimetry.
Cystatin
Specimen: serum or plasma (fastingg is not required)
-
Increased levels: acute or chronic renal failure, diabetic
nephropathy

Is there anything else I need to know abouta GFR

test?

you can
kidneys is usually permanent,
Athough damage to your
take steps to prevent
further damage. Steps may
include: Thank you for listening,
Blood pressure medicines (hypertension
Medicines to control blood sugar
if you have diabetes
exercise and maintaining a
getting
Study Hard!
more
Lifestyle dhanges such as

healty weight

.Limitingalcohol o subsons ir Billy

.Quitting smoking Kidney tranplant:

disose is treted erly, you mdy be able o prevent olt immnosvppresive drys etause t is ftreqn to the buly
kidnty
b t immuno 6uppresive drgs can wwken immine
kidney l t system
Kidnsy falurt uphon
only engfHen your te span to 10 yeacs
Dioysis
Kidney Tronsplont