Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: A comprehensive review

Abstract

Diabetes Mellitus (DM) is a group of metabolic diseases characterized by chronic high blood glucose concentrations (hyperglycemia). When it is left untreated or improperly managed, it can lead to acute complications including diabetic ketoacidosis and non-ketotic hyperosmolar coma. In addition, possible long-term complications include impotence, nerve damage, stroke, chronic kidney failure, cardiovascular disease, foot ulcers, and retinopathy. Historically, universal methods to measure glycemic control for the diagnosis of diabetes included fasting plasma glucose level (FPG), 2-h plasma glucose (2HP), and random plasma glucose. However, these measurements did not provide information about glycemic control over a long period of time. To address this problem, there has been a switch in the past decade to diagnosing diabetes and its severity through measurement of blood glycated proteins such as Hemoglobin A1c (HbA1c) and glycated albumin (GA). Diagnosis and evaluation of diabetes using glycated proteins has many advantages including high accuracy of glycemic control over a period of time. Currently, common laboratory methods used to measure glycated proteins are high-performance liquid chromatography (HPLC), immunoassay, and electrophoresis. HbA1c is one of the most important diagnostic factors for diabetes. However, some reports indicate that HbA1c is not a suitable marker to determine glycemic control in all diabetic patients. GA, which is not influenced by changes in the lifespan of erythrocytes, is thought to be a good alternative indicator of glycemic control in diabetic patients. Here, we review the literature that has investigated the suitability of HbA1c, GA and GA:HbA1c as indicators of long-term glycemic control and demonstrate the importance of selecting the appropriate glycated protein based on the patient's health status in order to provide useful and modern point-of-care monitoring and treatment.

Increased Levels of sRAGE in Diabetic CKD-G5D Patients: A Potential Protective Mechanism against AGE-Related Upregulation of Fibroblast Growth Factor 23 and Inflammation

“…Of course, the upregulation of sRAGE at levels above controls in both groups and its further increase in DM seem to suggest the existence of a glycated milieu in all CKD-G5D patients, regardless of the presence of DM. According to these data, the observation that GA levels were over the range of normality only in DM CKD-G5D group strongly reinforces the utility of GA as a useful glycation marker for DM monitoring in CKD-G5D patients in which HbA1c does not work well due to just kidney-related anemia [51, 52]. …”

Effect of Prestroke Glycemic Variability Estimated Glycated Albumin on Stroke Severity and Infarct Volume in Diabetic Patients Presenting With Acute Ischemic Stroke

“…Crude and multivariable analyses were performed according to dichotomized HbA1c (<6.5% vs. ≥ 6.5%). In addition, we included the ratio of GA to HbA1c (GA/HbA1c ratio) in multinomial logistic regression analysis because the GA/HbA1c ratio could reflect more accurate glycemic control (14). The impact of elevated HbA1c and GA/HbA1c ratio on outcomes was assessed by multinomial logistic regression analysis.…”

Emergency medicine point of view on epidemiology of diabetes and diabetes-related complications

“…The most characteristic feature of patients with type 2 diabetes is overweight and obesity, as well as: age above 50 years of age, history of diabetes in the family; low physical activity; recurrent infection (especially of the skin and urinary tract) in the history; features of glucose intolerance observed in the past; abdominal obesity; other features of the metabolic syndrome: hypertension, lipid disorders; existing vascular complications (heart attack, stroke, retinopathy, nephropathy); moderately elevated, high or very high HbA 1c value at the time of diagnosis [13][14][15].…”