The Role of Nontraditional Glycemic Markers in Diabetes and Albuminuria

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DESCRIPTION (provided by applicant): Diabetes is a chronic disease associated with an increased risk of microvascular complications. In the United States, 13% of adults have diabetes and an additional 30% of adults are at high risk of developing diabetes. Nontraditional glycemic markers glycated albumin (GA), fructosamine, and 1,5-anhydroglucitol (1,5-AG)) may provide additional prognostic information to identify individuals at high risk of developing diabetes and microvascular complications. GA, fructosamine, and 1,5-AG reflect short-term hyperglycemia and have been shown to exhibit physiologic effects, including the initiation of signaling pathways, that are active in the development of diabetes microvascular complications. Moreover, important racial differences in GA, fructosamine, and 1,5-AG levels have been reported with African-Americans having higher GA and fructosamine and lower 1,5-AG levels than whites among individuals with and without diabetes. The aims of this research project are: 1) to evaluate the association of GA, fructosamine, and 1,5-AG with incident diabetes; 2) to evaluate the association of GA, fructosamine, and 1,5-AG with prevalent and incident albuminuria; and 3) to evaluate racial differences in the association of GA, fructosamine, and 1,5-AG with diabetes and albuminuria. To address these aims, this study proposes to measure GA, fructosamine, and 1,5- AG using stored specimens from the Coronary Artery Risk Development in Young Adults (CARDIA) Study and build upon the existing infrastructure of this prospective cohort study that has an extensive collection of socio- demographic, lifestyle, and clinical variables. The findings from this study may be used to improve risk stratification and inform the development of new therapeutic targets to prevent diabetes and microvascular complications. This research project will also be instrumental in helping the candidate gain expertise in the relation of glycemic markers and metabolomics with diabetes complications for establishing research independence. To foster the candidate's research training and career development, specific training activities are proposed in: 1) diabetes and renal pathophysiology; 2) advanced statistical methods in risk prediction; 3) metabolomics; and 4) research recruitment, data collection, and study management which will facilitate the candidate's transition to an independent investigator. In summary, this Mentored Research Scientist Development Award will foster the candidate's professional development as an independent scientist by providing an opportunity to gain expertise in glycemic markers and metabolomics and their effects on diabetes and albuminuria risk.