The hidden complexities in measurement of fructosyl-lysine and advanced glycation endproducts for risk prediction of vascular complications of diabetes

Diabetes is associated with increased glycation of proteins by glucose and methylglyoxal (MG). Early-stage glycation by glucose forms fructosamine adducts, mainly Ne-fructosyllysine (FL), which can be exploited for assessment of glycemic control in the measurement of A1C (FL and Na-fructosyl-valine). Later- or advanced-stage glycation processes involving degradation of FL and glycation of proteins by MG and related physiological dicarbonyl metabolites form advanced glycation end products (AGEs) (1). AGEs contribute to the pathogenesis of vascular complications of diabetes, and their measurement may provide improved complications-risk prediction