Diabetes: The Role of Fructosamine
Diabetes Week is an annual week to raise awareness of diabetes. This year, the aim is to increase the public’s understanding of diabetes 1. Diabetes mellitus (DM) is a global epidemic, increasing at an alarming rate and burdening healthcare systems 2. DM is a life-long condition characterised by the body’s inability to produce / respond to insulin resulting in the abnormal metabolism of carbohydrates and elevated blood glucose levels.
Whilst it is important to increase the public’s understanding of DM, it is imperative that clinicians and physicians are aware of the different in vitro diagnostic tests to diagnose and monitor DM. Not only is this vital, but is also important that clinicians and physicians also understand the different methodologies available when choosing the diagnostic test.
It has been highlighted in numerous clinical studies that diabetic complications may be reduced through the long-term monitoring and tight control of blood glucose levels. Both fasting plasma glucose (FPG) and glycated haemoglobin A1c (HbA1c) tests are universally accepted as reliable measurements of diabetic control. However, studies have emerged highlighting the role of fructosamine in diabetes monitoring. Whilst HbA1c provides an index of glycaemia over 2 to 3 months, fructosamine provides this index over the course of 2 to 3 weeks, enabling closer monitoring of diabetic control 1.
Drawbacks of Traditional Diabetes Tests
The FPG test measures the level of blood sugars which is used to diagnose and monitor diabetes based on insulin function. The main drawback of this test is that a hormone called glucagon, produced in the pancreas, is triggered during prolonged fasting, signalling the liver to release glucose into the bloodstream. In diabetic conditions, either the body is unable to generate enough insulin or cannot appropriately respond to insulin. Consequently, FPG levels remain high 4.
In the 1980’s, HbA1c was incorporated into clinical practice as HbA1c levels correlated well with glycaemic control over a 2 to 3-month period. The main drawback of this test is that any condition that reduces the survival rate of erythrocytes such as haemolytic anaemia will falsely lower the HbA1c test results, regardless of the assay method utilised 5.
In a diabetic patient where blood glucose levels are abnormally elevated, the concentration levels of fructosamine also increase as fructosamine is formed by a non-enzymatic Maillard reaction between glucose and amino acid residues of proteins. During this glycation process, an intermediate labile Schiff base is produced which is converted to a more stable ketoamine (fructosamine) via an Amadori rearrangement 2.
Fructosamine has been identified as an early indicator of diabetic control compared to other markers such as HbA1c. Red blood cells live for approximately 120 days, HbA1c represents the average blood glucose levels for the previous 2 to 3 months. Conversely fructosamine has a shorter lifespan, about 14 to 21 days, reflecting average blood glucose levels from the previous 2 to 3 weeks. Due to the shorter time span of fructosamine, it is also used to evaluate the effectiveness of medication changes and to monitor the treatment of gestational diabetes. The test is also particularly useful in situations where HbA1c cannot be reliably measured e.g. haemolytic anaemia, thalassemia or with genetic haemoglobin variants 5.
Fructosamine Assay Methodology
The most commonly utilised method for fructosamine testing is the colorimetric method. Whilst widely available, automated and inexpensive, the main drawback is the lack of standardisation across the different fructosamine assays 4.
Randox, on the other hand, utilise an enzymatic method, offering improved specificity and reliability compared to conventional NBT-based methods. The Randox enzymatic method does not suffer from non-specific interferences unlike existing methods which can also be time consuming and difficult to automate.
The Randox fructosamine assay is also standardised to the highest level as the Randox fructosamine calibrator and control is assigned relative to human serum glycated with 14C-glucose, which directly reflects the nature of the patient sample.
With an excellent stability of 28 days on-board the analyser, the Randox fructosamine assay is developed in a liquid ready-to-use format for convenience and ease-of-use.
Randox offer fully automated applications detailing instrument-specific settings for the convenient use of the Randox fructosamine assay on a wide range of clinical chemistry analysers.
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Reagents Resource Hub
 Diabetes UK. Diabetes Week. [Online] 2019. [Cited: May 31, 2019.] https://www.diabetes.org.uk/get_involved/diabetes-week.
 Gounden, Verena and Jialal, Ishwarlal. Fructosamine. [Online] January 23, 2019. [Cited: April 11, 2019.] https://www.ncbi.nlm.nih.gov/books/NBK470185/.
 World Health Organization (WHO). Diabetes. [Online] October 30, 2018. [Cited: May 2, 2019.] https://www.who.int/news-room/fact-sheets/detail/diabetes.
 Manzella, Debra. The Fasting Plasma Glucose Test. very well health. [Online] November 16, 2018. [Cited: April 11, 2019.] https://www.verywellhealth.com/understanding-the-fasting-plasma-glucose-test-1087680.
 BMJ. Using haemoglobin A1c to diagnose type 2 diabetes or to identify people at high risk of diabetes. [Online] 2014. [Cited: April 11, 2019.] https://www.bmj.com/content/348/bmj.g2867/rr/695927.
An event on preventative healthcare and cardiac screening is being delivered in Liverpool this week by a wealth of world-leading industry and academic speakers.
Hosted by the sponsor of the Randox Health Grand National, in association with Liverpool John Moores University, Liverpool Hope University and the Tim Cogley Cardiac Screening Foundation, the event, entitled the Preventative Cardiac and Metabolic Health Seminar, runs on Wednesday 3rd April and is open to the public.
It follows a morning of engaging fitness programmes, including boxing, taekwondo and indoor cycling, for local pupils and teachers from across Merseyside and Cheshire. During these exercises, which will also include the opportunity to experience life as a jockey by having a go on a horse simulator, the children will also have some physiological measurements taken, including their heart rate.
“Prevention is always better than cure”, says Managing Director Dr Peter FitzGerald. “Our aim is to empower people to take control of their health, to live longer and more healthy lives.
“We are delighted to be teaming up with Liverpool John Moores, Liverpool Hope and the Tim Cogley Cardiac Screening Foundation ahead of the Randox Health Grand National. The world’s greatest race offers us the perfect platform to spread our message of preventative health, and we look forward to sharing our knowledge with the audiences at this exciting event.”
This is the third year that the educational event from Randox Health has been held in the city, and for the second time will be championed by Frank Cogley of the Tim Cardiac Screening Foundation, whose son suffered a fatal heart attack due to a genetic condition. Frank is now working to raise the profile of cardiac health checks for young people.
“It’s been recently reported that at least 12 under-35s die from undiagnosed heart conditions every week in the UK. The current lack of routine screening of 18 to 40-year-olds leaves a gaping chasm in our healthcare provision.
“With our highly motivated partners, through events like this, we hope to redress this through lifestyle changes and preventative medical programmes.
“The Tim Cogley Cardiac Screening Foundation is committed to delivery positive, action-focused and life-changing programmes. I can’t imagine a legacy more in tune with the generous, kind and supportive person that was Tim.”
Tickets for the Randox Health seminar, which focuses on health screening and how the right approach can deliver significant benefits, are priced at £3 and are available at https://www.eventbrite.co.uk/e/preventative-cardiac-and-metabolic-health-seminar-tickets-59041545853?aff=ebdshpsearchautocomplete
£2.27 of each ticket payment will go towards the ‘Tim Cogley Cardiac Screening Foundation’ charity. Each attendee at the event will also be entered into a raffle on the day, with the winning prize being general admission tickets for the Randox Health Grand National on Saturday 6th April.
For further information please contact the Randox PR team by emailing firstname.lastname@example.org or phoning 028 9442 2413
According to Diabetes UK about 90% of people in the UK with diabetes have type 2, leaving only 10% with type 1. So what are the causes of type 2 diabetes? To be able to live we all need insulin. Insulin allows glucose in our blood to enter our cells to give us energy.
However, if you have type 2 diabetes the body breaks down carbohydrates into glucose but because the insulin does not work correctly, it releases more insulin. This can cause the pancreas of some people who have type 2 to diabetes tire out and cause their body to make less and less insulin. As a result this causes even higher blood glucose levels.
So what happens when your body can’t get enough glucose into its cells? You’ll start to show symptoms. The most common is tiredness due to the lack of energy from not getting glucose in your cells. A lot of people don’t experience symptoms but some others experience needing to pee a lot, feeling extremely thirsty, cuts healing slowly, and contacting infections such as thrush. Diabetes UK say that some people live with type 2 diabetes for up to 10 years before being diagnosed.
THE COMPLICATIONS OF DIABETES
Having diabetes can cause complications in other parts of your body. Over a long period of time, high glucose levels in your blood can cause serious damage to your:
New figures coming from Diabetes UK, have shown the number of children and young people up to age 25 in the UK that have been diagnosed with type 2 diabetes is 6,836. These figures are shocking because type 2 diabetes had previously been virtually unknown in young people. But why is this and how do you know if you’re at risk of getting type 2 diabetes?
ARE YOU AT HIGHER RISK?
- Your risk increases with age. You’re more at risk if you’re white and over 40 or over 25 if you’re African-Caribbean, Black African, or Asian.
- You’re two to six times more likely to get Type 2 diabetes if you have a parent, brother, sister or child with diabetes.
- Type 2 diabetes is two to four times more likely in people of South Asian descent and African-Caribbean or Black African descent.
- You’re more at risk if you’ve ever had high blood pressure.
- You’re more at risk of type 2 diabetes if you’re overweight, especially if you’re large around the middle.
The main cause of people developing type 2 diabetes is because of bad lifestyle choices. An unhealthy lifestyle with poor diet is causing more people to become overweight or obese. This is giving them a much higher risk of developing Type 2 diabetes.
A STUDY BY THE WORLD HEALTH ORGANIZATION FOUND THAT:
- 58% of women were obese or overweight.
- 68% of men were obese or overweight.
- 1 in 5 children were obese or overweight.
- 1 in 3 children were obese or overweight.
- 617,000 admissions to the NHS where obesity was recorded as a factor in 2017, up 18% on 2015/16.
- 26% of adults are obese.
These are worrying statistics but you can lower your chances of developing type 2 diabetes by changing your lifestyle. You can reduce your risk by maintaining a healthy weight, eating a well-balanced diet and being more active. You can be prediabetic and turn things around to avoid becoming diabetic. Randox has helped clients do so by identifying prediabetics with our preventive health checks.
Randox Health packages will give you a comprehensive look into your health, not only now but how it could look in the future. We’ve helped previous clients overcome being prediabetic and change their future health. We can help you if you have any worries about being prediabetic or if you have any other health concerns.
Contact a member of our team today to make a booking or for more information. Call 0800 2545 130.
Talking about diabetes can be tough, but it doesn’t have to be.
This month, we’re joining the conversation on diabetes to help raise awareness of the condition, and importantly, how it can be diagnosed, managed, and even prevented.
Today, our focus is on a lesser-known variant of the chronic illness and one which you may not have heard of – prediabetes.
A third of all adults in the UK have prediabetes and with the UK’s estimated 3.8million diabetics estimated to climb to 5million by 2025 – largely as a result of obesity and the ageing population – it’s more important than ever to check if you’re suffering from this pre-cursor to diabetes.
WHAT IS PREDIABETES?
Illness doesn’t just happen overnight. Over time, your body begins to display symptoms but, often, irregularly has been present for some time. Prediabetes is an early indicator of type 2 diabetes which is characterised by the presence of blood glucose levels that are higher than normal but not yet high enough to be classed as diabetes.
For this reason, prediabetes is often described as the “grey area” between normal blood sugar and diabetic levels. In the UK, around 7 million people are estimated to have prediabetes and thus have a high risk for developing type 2 diabetes.
WHAT ARE THE SYMPTOMS OF PREDIABETES?
93% of the 60 million people with prediabetes globally are unaware they have it. This is because the condition often develops gradually without any warning signs or symptoms. In many cases, the sufferer only learns of their diabetic state once the symptoms of type 2 diabetes start to appear.
TESTING FOR PREDIABETES
Traditional biomarker tests used to diagnose type 2 diabetes include Fasting Plasma Glucose, Oral Glucose Tolerance Test, and HbA1c. However, these cannot be utilised as tests for prediabetes, as beta cell damage has already occurred, and insulin insensitivity is already underway.
Adiponectin, a hormone responsible for regulating glucose metabolism has proven to be a strong predictor of type 2 diabetes at a crucial stage – before it has fully manifested.
Adiponectin’s ability to diagnose prediabetes is due to its relationship with a hazardous type of fat within the body which wraps around internal organs. This visceral fat is particularly dangerous because it can occur even within individuals deemed to have a healthy waist circumference, making them appear deceptively healthy simply because they are slim.
By measuring Adiponectin levels, clinicians can identify someone with high levels of visceral fat and therefore at risk of type 2 diabetes long before they would be identified by tests which measure blood sugar levels.
THE BENEFIT OF A PREDIABETES DIAGNOSIS
Whilst being diagnosed with prediabetes may come as a real shock, it offers a unique opportunity for lifestyle modification and prevention that is often not possible with other illnesses.
And this is because prediabetes is reversible. In fact, up to 80% of all cases of type 2 diabetes are preventable – if detected early. We want to help more and more people understand their health as early as possible so they can take reversible action now when there’s the best chance of a positive outcome.
With this information at your disposal, you can then take the necessary action to stop diabetes in its tracks.
For more information about Adiponectin; please visit https://www.randox.com/adiponectin/
To book the world’s most advanced health check which assess up to 350 different indicators of disease at their very earliest stage, including diabetes, visit www.randoxhealth.com
For further information, please contact Randox PR by emailing email@example.com or phoning 028 9442 2413.
Randox Laboratories is this month driving awareness of diabetes and the need for early and accurate diagnosis to enable patients to take preventive action before the condition worsens.
Diabetes UK have stated that diabetes is the fastest growing health threat of our times and an urgent public health issue. Statistics show that since 1996, the number of people living with diabetes has more than doubled. It has been estimated that there are 1.1 million people living with diabetes in the UK that have yet to be diagnosed, including 84,836 people in Northern Ireland.
According to Diabetes UK around 700 people a day are diagnosed with diabetes, which equates to one person every two minutes. If nothing changes, it is estimated that diabetes will affect one in ten people by 2040. This will raise diabetes prevalence from 415 million to 642 million by 2040. With current treatment taking up almost 9% of the annual NHS budget – roughly £8.8bn a year – the implications for future healthcare budgets are clear if this dangerous trend persists.
The good news however, is that recent research has found that type 2 diabetes is preventable through lifestyle changes. The NHS recently released the UK’s National Diabetes Prevention Programme which is aimed at tackling the increasing growing threat of diabetes.
However, following a warning raised by an Oxford University study, which looked into efforts of this Prevention Programme, it was found that it is unlikely to have much impact because the blood tests used were inaccurate at detecting pre-diabetes – the stage at which diabetes is reversible.
The blood tests used in the National Diabetes Prevention Programme were only effective at detecting diabetes at a stage when damage had already been done.
At Randox, we have developed a number of tests that can help detect the earliest possible signs of diabetes, often before symptoms have even manifested – including a pioneering test for the hormone Adiponectin.
Assessing Adiponectin levels allows doctors to calculate a patient’s levels of visceral fat – a dangerous, internal fat stored around organs. This deep fat, which is not visible to the naked eye, is linked to health problems including Type-2 diabetes.
Low levels of adiponectin equate to high levels of visceral fat which can be combated by improving your diet, exercise habits and even stress levels. Given that 70% of Type-2 diabetes can be prevented by lifestyle changes, there is strong correlation that by detecting low levels of Adiponectin and taking corrective and preventive action, it could result in a decrease in the numbers of people who develop the life-altering condition.
In addition to a test for the Adiponectin biomarker, Randox Biosciences have created a Metabolic Syndrome Array that measures 12 markers associated with metabolic syndrome and cardiovascular disease. Metabolic Syndrome is a is a group of cardiovascular risk factors that affects over 20% of adults and results in a person being three times more likely to have a stroke or heart attack, and five times more likely to develop diabetes.
Ultimately, we would like to see all medical professionals who are at the forefront of patient care armed with the most accurate diagnostic tools available. Updating traditional practice may not be easy but we believe it is imperative to do so, if we are to effectively challenge this global epidemic.
Randox remains focused on providing early diagnoses and preventing illnesses by providing innovative diagnostics tests that will continue to revolutionise the healthcare landscape.
For further information, please contact Randox PR by emailing firstname.lastname@example.org or phoning 028 9442 2413.
Approximately 400,000 people in the UK are living with type 1 diabetes, with over 29,000 being children and young people . Type 1 diabetes affects 96% of all children with diabetes in England and Wales, with incidences increasing by approximately 4% each year.
Globally, the UK has the fifth highest rate of type 1 diabetes diagnosis in children (aged up to 14) with 85% of these children having no family history of the condition. Whilst the condition isn’t fatal and can be managed, it cannot be cured. Type 1 diabetes increases the risk of developing other health problems such as heart disease, stroke, foot and circulation problems, sight problems including blindness, nerve damage and kidney problems. However, many of these related conditions are preventable and it is recommended to stabilise blood sugar levels, attend diabetes appointments regularly and complete a diabetes course to educate patients and family members and prevent the risk of further help complications.
Diabetes in children
Children under five are at the highest risk of developing diabetic ketoacidosis due to a late diagnosis and it is also thought to be due to of lack of public knowledge of the signs and symptoms attributed to type 1 diabetes. Such symptoms include:
- Frequent urination as the kidneys are trying to expel excess sugar in the blood, resulting in dehydration which leads to extreme thirst.
- Increased hunger or unexpected weight loss because the body is unable to attain enough energy from food
- Slow healing cuts as high blood sugar levels can affect blood flow which can cause nerve damage.
- Fatigue as the body is unable to convert sugar into energy
- Irritable behaviour combined with other symptoms can be a means of concern
Diabetes and the NHS
Diabetes costs the NHS approximately £9.8 billion per year, an estimate of 10% of total expenditures. Hospital admissions of children and young people with diabetes presents a considerable burden on themselves, their families and the NHS. It is estimated that approximately 80% of these cases are potentially avoidable.
A report produced by the National Paediatric Diabetes Audit found that although the numbers of admissions didn’t significantly differ year to year, it highlighted differences in terms of socio-economic risk factors:
- Living in a deprived area increases the risk of hospital admissions which can be attributed to lack of education in the community about diabetic symptoms and the management of diabetes.
- Children below 5 years of age have a 35% increased risk of hospitalisation compared to those aged 5-9
- Females have a 33% increased risk of developing type 1 diabetes compared to males.
- Children with poor diabetes control have a twelve-fold increased risk of hospital admission
- Insulin pump users have a 27% increased risk of hospital admission compared to those who use insulin injections.
Figure A. Number of preventable paediatric diabetes admissions 
There are campaigns in place to aid in the early diagnosis of type 1 diabetes which mainly focus on raising awareness of the signs and symptoms of diabetes. On this World Diabetes Day, it is important to know that it is not just simply the responsibility of the diabetic patient to prevent admission but the main responsibility lies with the diabetic teams that inform the families with children who are diagnosed with type 1 diabetes.
Paediatric diabetes teams should ensure that the families and the children receive structured education for self-management when diagnosed and throughout the illness. In doing so, the diabetic teams should implement blood ketone testing from diagnosis and utilise the nationally agreed hypoglycaemia management guidelines. It is also important that diabetic teams are fully aware of the patient characteristics associated with a greater risk of admission and that they use this knowledge to develop anti-admission strategies specifically tailored to the needs of each individual group.
Primary care practitioners should seek access to a specialist diabetic team who they can refer to when deciding if a patient requires admission to hospital. Furthermore, they should access blood glucose and ketone testing to identify patients at risk of diabetic ketoacidosis that require hospital admission.
How Randox can Help
Randox offer a range of assays to diagnosis and monitor diabetes and to monitor associated complications. Some of these tests are unique to Randox, including:
The Randox fructosamine assay employs the enzymatic method which offers improved specificity and reliability compared to conventional NBT-based methods. The Randox enzymatic method does not suffer from non-specific interferences unlike other commercially available fructosamine assays.
The Randox D-3-Hydroxybutyrate (Ranbut) assay detects the most abundant and sensitive ketone in the body, D-3-Hydroxybutyrate. The Randox Ranbut assay is used for the diagnosis of ketosis, more specifically diabetic ketoacidosis. Other commercially available tests, such as the nitroprusside method, are less sensitive as they only detect acetone and acetoacetate, not D-3-Hydroxybutyrate.
The Randox adiponectin assay is a biomarker in diabetes testing as adiponectin is a protein hormone responsible for regulating the metabolism of lipids and glucose and influences the body’s response to insulin. Adiponectin levels inversely correlates with abdominal visceral fat levels.
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 National Paediatric Diabetes Audit and Royal College of Paediatrics and Child Health, National Paediatric Diabetes Audit Report 2012-15: Part 2, 2017
 NHS, “Avoiding Complications” – Type 1 Diabetes, Available at: https://www.nhs.uk/conditions/type-1-diabetes/avoiding-complications/ [Accessed on 24th October 2018].
 “Potentially Preventable Pediatric Hospital Inpatient Stays for Asthma and Diabetes, 2003-2012”, www.hcup-us.ahrq.gov, 2015. [Online] Available: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb192-Pediatric-Preventable-Hospitalizations-Asthma-Diabetes.jsp [Accessed 08-Nov-18]
The aim of Biomedical Science Day is to raise the public’s awareness of the importance of biomedical science and the vital role it plays in the world. Randox are dedicated to improving healthcare worldwide through placing a major focus on research and development. The Randox scientists work in pioneering research into a range of common illnesses such as cancer, cardiovascular disease and Alzheimer’s disease.
A recent blog from Doris-Ann Williams, the Chief Executive at BIVDA, explains how “increased funding is not enough to sustain the NHS” and how “we need to make better use of in vitro diagnostics to ensure a successful future”.
The National Health Service (NHS) is a publicly funded, primarily taxation, national healthcare system in the United Kingdom. It was first set-up on July 5th, 1948 by Aneurin Bevan as he believed that everyone, regardless of wealth, should have access to good healthcare. Whilst the NHS is an extremely important aspect of healthcare in the UK, in vitro diagnostics are the heart and soul of the healthcare system as healthcare professionals not only rely on blood tests to diagnose and treat patients, but also to rule out the different contributing causes to a disease state. In vitro diagnostics also plays a key role in monitoring chronic disease states. In vitro diagnostics can also aid in reducing hospital stays, reduce misdiagnosis and support patients in looking after their own health and to deliver personalised treatment plans.
The Randox scientists have developed several niche assays to improve patient diagnosis, monitor treatment and eliminate misdiagnosis.
Adiponectin is a protein hormone secreted by adipocytes with anti-inflammatory and insulin-sensitising properties. It plays an important role in a number of metabolic processes including glucose regulation and fatty acid oxidation. Adiponectin levels are inversely correlated with abdominal visceral fat which have proven to be a strong predictor of several pathologies, including: metabolic syndrome, type 2 diabetes mellitus (T2DM), cancers and cardiovascular disease (CVD). For more information on the importance of testing Adiponectin levels, check out our Adiponectin Whitepaper.
Cystatin C is an early risk marker for renal impairment. The most commonly run test for renal impairment is Creatinine. Creatinine measurements have proven to be inadequate as certain factors must be taken into consideration, including age, gender, ethnicity etc. The National Institute for Health and Care Excellence (NICE) have updated their guidelines, which now recommends Cystatin C as a more superior test for renal impairment due to its higher specificity for significant disease outcomes than those based on Creatinine. For more information on the importance of testing Cystatin C levels, check out our Cystatin C Whitepaper.
Small-dense LDL Cholesterol (sdLDL-C)
LDL Cholesterol (LDL-C) consists of two parts: the large and buoyant LDL Cholesterol and the small and dense LDL Cholesterol. Whilst all LDL-C transports triglycerides and cholesterol to bodily tissues, their atherogensis varies according to their size. As sdLDL-C is small and dense, they can more readily permeate the arterial wall and are more susceptible to oxidation. Research indicates that individuals with a predominance of sdLDL-C have a 3-fold increased risk of myocardial infarction. It has been noted that sdLDL-C carries less Cholesterol than large LDL, therefore a patient with predominately sdLDL-C particle may require nearly 70% more sdLDL-C particles to carry the same amount of cholesterol as the patient with predominately LDL-C particles. For more information on the importance of testing sdLDL-C levels, check out our sdLDL-C Whitepaper.
These three niche in vitro diagnostics tests developed by Randox scientists can aid in reducing NHS costs due to their higher performance compared to the traditional tests. Randox are constantly striving to improve healthcare worldwide.
For more information on the extensive range of Randox third-party in vitro diagnostic reagents, visit: https://www.randox.com/diagnostic-reagents/ or contact email@example.com.
A peer-reviewed study, published in The Lancet Medical Journal suggests there are five types of diabetes. Could diabetes be more complex than we once thought? Could diabetes be segmented into five separate diseases?
What is diabetes?
Diabetes is an incurable disease which prohibits the body’s ability to produce and respond to insulin. Currently, diabetes is classified into two main forms, type 1 and type 2.
Type 1 diabetes is an autoimmune disease which manifests in childhood. In type 1 diabetes, the body’s white blood cells attack the insulin-producing cells in the pancreas. As a result, individuals with Type 1 diabetes rely on the injection of insulin for the remainder of their lives.
Type 1 diabetes affects 10 percent of individuals with diabetes. 96 percent of children diagnosed with diabetes have type 1. Type 1 diabetes in children is commonly diagnosed between the ages of 10 and 14. The prevalence of type 1 diabetes in children and young people (under the age of 19) is 1 in every 430-530 and the incidence of type 1 in children under 14 years of age is 24.5/100,000 (Diabetes UK, 2014).
Type 2 diabetes is the result of insulin resistance, meaning that the pancreas does not produce enough insulin or the body’s cells do not respond to the insulin produced. As type 2 diabetes is a mixed condition, with varying degrees of severity, there are a few methods to manage the disease, including dietary control, medication and insulin injections.
Type 2 diabetes is the most common form of diabetes, affecting 90 percent of individuals with diabetes, and has now become a global burden. The global prevalence of diabetes has almost doubled from 4.7 percent in 1980 to 8.5 percent in 2014, with a total of 422 million adults living with diabetes in 2014. It is expected to rise to 592 million by 2035. In 2012, diabetes accounted for 1.5 million deaths globally with hypertension causing a further 2.2 million deaths. 43 percent of these deaths occurred before 70 years of age. Previously type 2 diabetes was commonly seen in young adults but is now commonly seen in children as well. In 2017, 14% more children and teenagers in the UK were treated for diabetes compared to the year before (World Health Organization, 2016).
In both forms of diabetes, hyperglycemia can occur which can lead to number of associated complications including renal disease, cardiovascular disease, nerve damage and retinopathy.
The novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables – peer-review study
This new research studied 13,270 individuals from different demographic cohorts with newly diagnosed diabetes, taking into consideration body weight, blood sugar control and the presence of antibodies, in Sweden and Finland.
This peer-reviewed study identified 5 disease clusters of diabetes, which have significantly different patient characteristics and risk of diabetic complications. The researchers also noted that the genetic associations in the clusters differed from those seen in traditional type 2 diabetes.
Cluster One – Severe autoimmune diabetes (SAID)
SAID is similar to type 1 diabetes. SAID manifests in childhood, in patients with a low BMI, have poor blood sugar and metabolic control due to insulin deficiency and GADA. 6% of individuals studied in the ANDIS study were identified with having SAID.
Cluster Two – Severe insulin-deficient diabetes (SIDD)
SIDD is similar to SAID, however, GADA is negative. This means that the characteristics of SIDD are the same as SAID, young, of a healthy weight and struggled to make insulin, however, SIDD is not the result of an autoimmune disorder as no autoantibodies are present. Patients have a higher risk of diabetic retinopathy. 18% of subjects in the ANDIS study were identified with having SIDD.
Cluster Three – Severe insulin-resistant diabetes (SIRD)
SIRD is similar to that of type 2 diabetes and is characterised by insulin-resistance and a high BMI. Patients with SIRD are the most insulin resistant and have a significantly higher risk of kidney disease, and microalbuminuria, and non-alcoholic fatty liver disease. 15% of subjects in the ANDIS study were identified as having SIRD.
Cluster Four – Mild obesity-related diabetes (MOD)
MOD is a mild form of diabetes which generally affects a younger age group. This is not characterised by insulin resistance but by obesity as their metabolic rates are close to normal. 22% of subjects in the ANDIS study were identified as having MOD.
Cluster Five – Mild age-related diabetes (MARD)
MARD is the most common form of diabetes manifesting later in life compared to the previous four clusters. Patients with MARD have mild problems with glucose regulation, similar to MOD. 39% of subjects in the ANDIS study were identified with having MARD.
This new sub-classification of diabetes could potentially enable doctors to effectively diagnose diabetes earlier, through the characterisation of each cluster, including: BMI measurements, age, presence of autoantibodies, measuring HbA1c levels, ketoacidosis, and measuring fasting blood glucose levels. This will enable a reduction in the incidence of diabetes complications and the early identification of associated complications, and so patient care can be tailored, thus improving healthcare (NHS, 2018) (The Week, 2018) (Ahlqvist, et al., 2018) (Collier, 2018) (Gallagher, 2018).
The Randox diabetes reagents cover the full spectrum of laboratory testing requirements from risk assessment, using our Adiponectin assay, to disease diagnosis and monitoring, using our HbA1c, glucose and fructosamine assays, to the monitoring of associated complications, using our albumin, beta-2 microglobulin, creatinine, cystatin c, d-3-hydroxybutyrate, microalbumin and NEFA assays.
Whilst this study is valuable, alone it is not sufficient for changes in the diabetes treatment guidelines to be implemented, as the study only represents a small proportion of those with diabetes. For this study to lead the way, the clusters and associated complications will need to be verified in ethnicities and geographical locations to determine whether this new sub-stratification is scientifically relevant.
Ahlqvist, E. et al., 2018. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. [Online]
Available at: http://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30051-2/fulltext?elsca1=tlpr
[Accessed 16 April 2018].
Collier, J., 2018. Diabetes: Study proposes five types, not two. [Online]
Available at: https://www.medicalnewstoday.com/articles/321097.php
[Accessed 16 April 2018].
Diabetes UK, 2014. Diabetes: Facts and Stats. [Online]
Available at: https://www.diabetes.org.uk/resources-s3/2017-11/diabetes-key-stats-guidelines-april2014.pdf
[Accessed 16 April 2018].
Gallagher, J., 2018. Diabetes is actually five seperate diseases, research suggests. [Online]
Available at: http://www.bbc.co.uk/news/health-43246261
[Accessed 16 April 2018].
NHS, 2018. Are there actually 5 types of diabetes?. [Online]
Available at: https://www.nhs.uk/news/diabetes/are-there-actually-5-types-diabetes/
[Accessed 16 April 2018].
The Week, 2018. What are the five types of diabetes?. [Online]
Available at: http://www.theweek.co.uk/health/92048/what-are-the-five-types-of-diabetes
[Accessed 16 April 2018].
World Health Organization, 2016. Global Report on Diabetes, Geneva: World Health Organization.
Metabolic health is a term used to describe a collection of required chemical reactions that take place in all living organisms. A metabolic disorder develops when an abnormal chemical reaction occurs which alters the normal metabolic process.
A common misconception surrounding metabolic health is that it refers solely to your weight, and if you are overweight you are considered to be unhealthy. But in actual fact this may not be entirely true. Good metabolism means that your body is in good overall health, which doesn’t account for just your weight! Common metabolic disorders include genetic metabolic disorders, diabetes and metabolic syndrome. Understanding and testing to see how well your metabolism is functioning is key to ensuring long lasting health.
There are a number of genetic metabolic disorders caused by mutations of single genes. Examples of common disorders include Gaucher’s disease, hemochromatosis and cystic fibrosis. Gaucher’s disease is a genetic disorder that affects the body’s ability to break down fat that can accumulate in the liver/spleen and bone marrow. Hemochromatosis is a condition that is caused by the over-absorption and build-up of iron while cystic fibrosis is a metabolic disorder that appears as a result of a build-up of mucus in lungs/liver and intestines. Each of these metabolic disorders affect certain organs from functioning properly and therefore your overall healthiness.
Type 2 diabetes is one of the most common types of metabolic disorders in the world that is expected to affect 592 million people by 2035. It is characterised by high blood sugar, insulin resistance or a lack of insulin being produced by the pancreas. Insulin resistance occurs when the body isn’t able to use insulin the right way which increases blood glucose levels. Insulin is needed for cells to take in glucose (sugar) from the bloodstream and convert it into energy. Over time this lack of insulin can damage the organs in your body.
Metabolic syndrome (also known as syndrome X, Reaven’s syndrome, and CHAOS) is not a disease but a collection of risk factors that affect your health; these include high blood pressure, high blood sugar/cholesterol and abdominal fat. Left untreated, these risk factors, together, can lead to long term serious problems including an increased risk of heart disease, stroke and developing type 2 diabetes.
Can you improve your metabolic health?
Yes! The good news is that if you discover that your metabolic health is not up to scratch you can improve it through a combination of diet, exercise and lifestyle adjustments such as:
- 30 minutes of moderate to intense exercise 5-7 times a week
- Low-dose aspirin to reduce your risk of stroke or heart attack
- Quit smoking
- Medication for blood pressure/cholesterol/ blood sugar
- Limit alcohol intake
- Eat a healthy balanced diet
Randox has developed the RX series of clinical chemistry analysers for superior semi-automated and fully automated testing. The RX series extensive dedicated test menu goes beyond routine testing and has many unique and high-performance tests available. Our range of tests covers several parameters to assess your overall metabolic health.
Metabolic Health Profile
|Alkaline Phosphatase||C02 Total||Sodium|
|AST (GOT)||Glucose||Total Protein|
The RX series clinical chemistry analysers provide laboratories with a robust and smart solution ensuring you maintain a consistent workflow and can provide accurate results first time, every time. Offering excellent customer support services, our trained engineers are on hand to work with you in preserving the continuity of your operations while maximising the potential of your RX series instrument. Our world-famous test menu of high quality reagents ensures excellence in patient care, guaranteeing unrivalled precision and accuracy reducing costly test re-runs or misdiagnosis and offering complete confidence in results.
For more information visit: https://www.randox.com/clinical-chemistry-analysers/
How much do you know about metabolic syndrome?
It is often mistaken for diabetes, but the truth is, metabolic syndrome is a cluster of conditions – including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol. When these occur together, your risk of heart disease, stroke and diabetes is increased.
Determining whether or not a patient has metabolic syndrome is a complex process, with basic measurements including height and weight, as well as tests for insulin, leptin (a hunger-suppressing hormone) and adiponectin (a hormone inversely related to dangerous internal fat) factoring in to a comprehensive scientific investigation.
The first step in this investigation is often a test for Basal Metabolic Rate (BMR), which is the rate at which the body consumes calories for basic bodily processes – eg. maintaining internal temperature, repairing cells, pumping blood and powering muscles.
With the results of your Basal Metabolic Rate at hand, the scientific team at Randox Health can then present you with your Metabolic Age, or True Body Age as it is often known, by comparing your best Basal Metabolic Rate to other age groups.
The result is relative to gender, age, height and weight and other lifestyle factors. Increased BMR can be the result of frequent physical exercise, stress, illness, diabetes or hyperthyroidism (an overactive thyroid gland), whereas decreased BMR can be associated with old age, loss of lean body mass or hypothyroidism (an underactive thyroid gland). Certain drugs, for example antidepressants, and menopause, can also affect BMR.
If the age indicated is lower than your actual age, then congratulations! With your healthy living habits, you have managed to shave years off your age. If the result is higher than your actual age, then you may need to increase your exercise levels or review your diet to improve your results.
And therein lies the good news. With changes to diet and exercise, you can prevent or even reverse metabolic syndrome.
And that’s why it’s so important to find out the status of your health at the earliest possible stage – so that you can make the necessary changes to your lifestyle before you develop a more serious condition.
At Randox Health events across the country, including this year’s Randox Health Grand National, our team of scientists are offering free ‘True Body Age’ results on their Body Composition Analysis machine, which assesses 25 different areas of your body. It takes measurements including ratio of muscle to fat, bone density, hidden visceral fat and cellular hydration levels.
In its measurement of Basal Metabolic Rate the BCA machine will give challengers their True Body Age, which can be a great way to kickstart your health improvement journey.
It is however, only the first step in obtaining a comprehensive understanding of your current health, and determining the conditions of which you are personally at risk of developing in the future.
Randox Health goes beyond standard testing – offering the world’s most comprehensive and personalised health check. Following your initial Body Composition Analysis and True Body Age reading, our scientific experts will then analyse up to 350 different results from a blood sample you provide. Armed with the knowledge of your results, you can truly take control of your health and make a change to improve your future wellbeing.
Phone the Randox Health team today to make a booking: 0800 2545 130
Or join us at the Randox Health Grand National for a FREE Body Composition Analysis which will tell you your True Body Age.