Glycated albumin and HbA1c as predictors of mortality and vascular complications in type 2 diabetes patients with normal and moderately impaired renal function: 5-year results from a 380 patient cohort

Abstract

Background: Glycated albumin (GA) represents a better marker of glycemic control than HbA1c in patients with renal failure. Studies on the clinical impact of GA in patients with normal or moderately impaired renal function (CKD stages 1-3) are sparse. The present study investigates the relationship between GA and HbA1c in this patient group and the ability of both biomarkers to predict vascular complications. Methods: A total of 380 type 2 diabetic patients were followed-up during a median time of 4.7 years in a prospective, monocentric cohort study. Following parameters were measured at 6-12 month intervals : GA, HbA1c, NT-pro-BNP and further routine laboratory parameters; clinical status regarding treatment modality and onset of cardiovascular, cerebrovascular, peripheral vascular, renal, and ophthalmological events as well as death by any cause. Results: GA showed a strong positive correlation with HbA1c (r=0.71, 95% CI 0.61 to 0.75), with little dependence on patient gender, age, renal function and anemia. No association was found between the two biomarkers and risk of cardiovascular and cerebrovascular events. The risk of peripheral vascular events significantly increased with increasing HbA1c (Pval=0.002, HR=1.45) and showed a borderline association with increasing GA (Pval=0.06, HR=1.09). A strong association was found between GA and onset of renal events (Pval=0.01, HR=1.15). Conclusions: GA and HbA1c measurements are correlated in diabetic patients with CKD stages 1-3. The association with macroangiopathic complications is stronger for HbA1c than for GA values. GA levels predict particularly well renal events.

Effect of renal function on serum concentration of 1,5‐anhydroglucitol in type 2 diabetic patients in chronic kidney disease stages I–III: A comparative study with HbA1c and glycated albumin

“…Examinations were performed in 377 patients with T2D (211 men, 166 women) who participated in a prospective observational study at St. Josefskrankenhaus Heidelberg GmbH and Diabetesinstitut Heidelberg from 2005 to 2011. The design of the study, as well as the inclusion and exclusion criteria, have been published in detail elsewhere . The following parameters were evaluated at the first visit: HbA1c, serum concentrations of 1,5‐AG, GA and creatinine, full blood count, urine status, urinary albumin/creatinine ratio and α 1 ‐microglubulin (A1M) excretion.…”

“…The design of the study, as well as the inclusion and exclusion criteria, have been published in detail elsewhere. 14 The following parameters were evaluated at the first visit: HbA1c, serum concentrations of 1,5-AG, GA and creatinine, full blood count, urine status, urinary albumin/creatinine ratio and α 1 -microglubulin (A1M) excretion. Estimated glomerular filtration rate (eGFR) was calculated according to the Cockgroft-Gault formula, HbA1c was measured by HPLC and GA was measured using a commercially available kit (LUCICA GA-L kit; Asahi Kasei Pharma, Tokyo, Japan), as was 1,5-AG (GlycoMark kit; GlycoMark, New York, NY, USA), as described previously.…”

RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020

“…[ 3 ] Additionally, HbA1c has been recognized as marker to assess secondary vascular complications due to metabolic derailments in susceptible individuals. [ 2 4 5 ] However, given ethnic differences in sensitivity and specificity of HbA1c population-specific cut-offs might be necessary. [ 6 7 ] Moreover, measuring HbA1c is expensive as compared to FPG assessments and standardization of measurement techniques and laboratories are poorly practiced across the country.…”

“…[ 3 ] Patients with T2DM, especially those with PVD, are at high risk for many types of typical and atypical infections due to immune dysfunction, DN and poor circulation. [ 4 ] Furthermore, skin breakdown in patients with advanced diabetes and PVD provides a portal of entry for bacteria. Longer duration of diabetes and poor glycaemic control causes increased risk of pneumonia related hospitalizations in diabetes subjects due to compromised immune system of the host.…”

“… Several factors have been implicated for infections in diabetes, of which, altered immunity is the most predominant one. [ 4 8 ] Other predisposing factors increasing susceptibility to infections include diabetes related complications, frequent catheterization and dialysis in chronic renal failure patients. Evidence that these immunological defects can be corrected through good glycaemic control support the importance of close monitoring of infectious diseases in subjects with diabetes.…”