Limitations of glycated hemoglobin and emerging biomarkers for diabetes care after bariatric surgery.

Bariatric surgery significantly improves glycemic control and can lead to type 2 diabetes remission. However, the reliability of glycated hemoglobin (HbA1c) as a type 2 diabetes biomarker post-surgery can be confounded by conditions such as anemia and gastrointestinal complications. Hence, we explored the use of alternative biomarkers such as glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), and insulin-like growth factor binding protein-1 (IGFBP-1) to monitor glycemic control more effectively in post-bariatric surgery patients. Measuring GA and 1,5-AG levels can detect glycemic variability more sensitively than HbA1c, especially under non-fasting conditions. GA shows promise for short-term monitoring post-surgery while 1,5-AG could be useful for real-time glucose monitoring. IGFBP-1 can be used to monitor metabolic improvement and to predict HbA1c normalization. However, challenges in assay standardization and cost remain significant barriers to their clinical adoption. Although these biomarkers could offer a more personalized approach to glucose monitoring (thereby addressing the limitations of utilizing HbA1c in this endeavor in post-bariatric surgery patients), this would require overcoming technical, logistical, and cost-related challenges. While using GA, 1,5-AG, and IGFBP-1 shows promise for glycemic monitoring, further research and validation are crucial for their routine clinical implementation, especially in the context of diabetes management post-bariatric surgery.