Glycation in human fingernail clippings using ATR-FTIR spectrometry, a new marker for the diagnosis and monitoring of diabetes mellitus

Objectives Although HbA1c is a good diagnostic tool for diabetes, the precarity of the health system and the costs limit the use of this biomarker in developing countries. Fingernail clippings contain ± 85% of keratins, which are prone to glycation. Nail keratin glycation may reflect the average glycemia over the last months. We explored if attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) can be used as a non-invasive tool for assessing glycation in diabetes. Design and methods Using ATR-FTIR spectroscopy, glycation and deglycation experiments with fructosamine 3-kinase allowed to identify the spectrum that corresponds with keratin glycation in fingernail clippings. Clippings of 105 healthy subjects and 127 diabetics were subjected to the standardized ATR-FTIR spectroscopy method. Results In vitro glycation resulted in an increased absorption at 1047 cm− 1. Following enzymatic deglycation, this peak diminished significantly, proving that the AUC between 970 and 1140 cm− 1 corresponded with glycated proteins. Within-run CV of the assay was 3%. Storage of nail clippings at 37 °C for 2 weeks did not significantly change results. In diabetics, glycated nail protein concentrations (median: 1.51 μmol/g protein, IQR: 1.37–1.85 μmol/g protein) were significantly higher than in the controls (median: 1.19 μmol/g protein, IQR: 1.09–1.26 μmol/g protein) (p < 0.0001). ROC analysis yielded an AUC of 0.92 at a cut-off point of 1.28 μmol/g nail (specificity: 82%; sensitivity: 90%). No correlation was observed between the glycated nail protein concentrations and HbA1c. Conclusions Protein glycation analysis in fingernails with ATR-FTIR spectroscopy could be an alternative affordable technique for diagnosing and monitoring diabetes. As the test does not consume reagents, and the preanalytical phase is extremely robust, the test could be particularly useful in developing countries.