Beyond HbA1c and glucose: the role of nontraditional glycemic markers in diabetes diagnosis, prognosis, and management

Curr Diab Rep. 2014;14(11):548. doi: 10.1007/s11892-014-0548-3.


Fasting glucose and hemoglobin A1c (HbA1c) are the standard measures for diagnosis and monitoring of diabetes. There has been recent interest in nontraditional markers of hyperglycemia, including fructosamine, glycated albumin, and 1,5-anhydroglucitol (1,5-AG), as alternatives or adjuncts to standard measures. There is a growing literature linking these nontraditional markers with microvascular and macrovascular complications. Fructosamine and glycated albumin have also been shown to improve identification of persons with diabetes. However, long-term prospective studies with clinical outcomes are lacking. Some modern laboratory assays for fructosamine, glycated albumin, and 1,5-AG have excellent performance. Expanded use of these tests has the potential to improve diabetes care as these measures may overcome limitations of HbA1c in certain patients, complement traditional measures by providing additional information on shorter-term glycemic control, and improve risk stratification for diabetes and its complications. Nonetheless, studies are needed to demonstrate if their routine use will benefit patients and improve outcomes.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Biomarkers / blood
  • Blood Glucose / metabolism
  • Cross-Sectional Studies
  • Deoxyglucose / blood*
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / physiopathology
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / physiopathology
  • Fasting
  • Fructosamine / blood*
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hyperglycemia / blood*
  • Hyperglycemia / physiopathology
  • Hyperglycemia / prevention & control
  • Prognosis
  • Prospective Studies
  • Serum Albumin / metabolism*


  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • Serum Albumin
  • glycated serum albumin
  • hemoglobin A1c protein, human
  • Fructosamine
  • 1,5-anhydroglucitol
  • Deoxyglucose