Monday, February 14, 2011

Can Death and Disability be Prevented by GlycoMark ?

You Bet!! According to the American Diabetes Association, monitoring of glycemic (blood sugar) status is the cornerstone of diabetes care. Many doctors and most patients use a Fasting Blood Sugar to determine not only if diabetes is present but how they were doing with their treatment. For the last eight years I have used a better test, the Hemoglobin A1C the average glucose, encompassing both hyperglycemia and hypoglycemia of all blood glucose levels over three months – invaluable information, to be sure. But it doesn’t show after meal spikes, which can affect 40% of patients who otherwise appear to have their diabetes under control.

GlycoMark® is a blood test, FDA approved in 2003, and now available. It is a new generation test that specifically targets glucose response above the renal threshold (about 175) over one to two weeks to give a window on postprandial (after-meal) glucose peaks. That is critical information! This knowledge can improve patient care by targeting the spikes with specific treatments that also have become available. This will prevent dangerous cardiovascular complications in patients who had previously these undetected postprandial serum glucose spikes. It allows patients to seek medical intervention in a more timely manner and when to start or change therapy, empowering them to achieve and maintain control of their disease. . The currently available markers, A1C and fructosamine (like A1C but a two week window) only reflect average glucose, potentially missing the most important hyperglycemic (high blood sugar) excursion that is balanced out by normal or slightly low sugars. The GlycoMark is an alternative marker that acurately reflects postprandial elevations. It is these sudden spikes of glucose that hit hard the sensitive endothelium (lining) of our blood vessels damaging them to form plaque. It is the plaque that not only narrows the vessel but encourages clot formation.

The test uses a natural “in serum” molecule, 1,5-anhydroglucitol (Glycomark) which like glucose, we ingest, is obviously in our blood. During normal blood sugars, the Glycomark is maintained at constant steady state level due to a large body pool and unlike glucose is not metabolized. Normally, in the kidneys, the Glycomark is filtered and completely reabsorbed and therefore neither raised or lowered in our blood under normal conditions. However, with elevated serum glucose concentrations (about 175 – the average renal threshold for glucose), glucose is not completely reabsorbed by the kidney, and serum Glycomark unlike glucose falls due to competiton of renal tubular reabsorption by glucose. Therefore the change in Glycomark depends on both the duration and amount of glucosuria (sugar in the urine). The Glycomark has been shown to reflect daily glycemic excursions in patients with A1Cs at or near goal. Even though the A1C has been validated as marker of risk of both micro- and macrovascular complications, the Glycomark is even better.

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