Biomarker for Diabetes

Biomarkers are conventionally defined as ‘biological molecules that represent health and disease states.’ They typically are measured in readily available body fluids (blood or urine), lie outside the causal pathway, are able to detect sub-clinical disease, and are used to monitor clinical and sub-clinical disease burden and response to treatments. Biomarkers can be “direct” endpoints of the disease itself, or “indirect” or surrogate endpoints. New technologies (such as metabolomics, proteomics, genomics) bring a wealth of opportunity to develop new biomarkers. Other new technologies enable the development of non-molecular, functional or bio-physical tissue-based biomarkers.

Biomarkers may reflect the presence and severity of hyperglycemia (i.e. diabetes itself), or the presence and severity of the vascular complications of diabetes. Illustrative examples are considered in this brief review. In blood, hemoglobin A1c (HbA1c) may be considered as a biomarker for the presence and severity of hyperglycemia, implying diabetes or pre-diabetes, or, over time, as a “biomarker for a risk factor”, i.e. hyperglycemia as a risk factor for diabetic retinopathy, nephropathy, and other vascular complications of diabetes. In tissues, glycation and oxidative stress resulting from hyperglycemia and dyslipidemia lead to widespread modification of biomolecules by advanced glycation end products (AGEs).

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