Glycated albumin as a diagnostic tool in diabetes: An alternative or an additional test?

Abstract

IntroductionStudies have revealed that glycated albumin (GA) is a useful alternative to HbA1c under conditions wherein the latter does not reflect glycaemic status accurately. Until now, there are few studies with non-Asians subjects that report on the validity of GA test in diagnosis of type 2 diabetes mellitus (DM). Thus, the aim of this study was to assess the clinical utility of GA in diagnosis of DM.Materials and methodsThis diagnostic test accuracy study was performed in 242 Brazilian individuals referred for OGTT in a tertiary university hospital. ROC curves were used to access the performance of GA and HbA1c in the diagnosis of DM by oral glucose tolerance test (OGTT).ResultsOGTT, HbA1c and GA were performed in all 242 participants (40.5% male, age 54.4 ± 13.0 years [mean ± SD], body mass index 28.9 ± 6.3 kg/m2). DM by OGTT was detected in 31.8% of individuals. The equilibrium threshold value of GA ≥14.8% showed sensitivity of 64.9% and specificity of 65.5% for the diagnosis of DM. The AUC for GA [0.703 (95% CI 0.631–0.775)] was lower than for HbA1c [0.802 (95% CI 0.740–0.864)], p = 0.028. A GA value of 16.8% had similar accuracy for detecting DM as defined by HbA1c ≥6.5% (48 mmol/mol) with sensitivity of 31.2% and specificity of 93.3% for both tests. However, GA detects different subjects from those detected by HbA1c and OGTT.ConclusionsGA detected different individuals with DM from those detected by HbA1c, though it showed overall diagnostic accuracy similar to HbA1c in the diagnosis of DM. Therefore, GA should be used as an additional test rather than an alternative to HbA1c or OGTT and its use as the sole DM diagnostic test should be interpreted with caution.

Association of Glycated Albumin/Glycosylated Hemoglobin Ratio with Blood Glucose Fluctuation and Long-Term Blood Glucose Control in Patients with Type 2 Diabetes Mellitus

“… 16 , 17 Related studies have also confirmed that GA could better reflect patients’ blood glucose fluctuation than HbA1c. 18 , 19 However, blood glucose fluctuation enhances oxidative stress, 20 leading to a decrease in the lifespan of red cells. 21 The greater the MAGE in patients, the higher the peak blood glucose may be, while hyperglycemia can reduce the fluidity of red cell membranes 22 and reduce the lifespan of red cells, decreasing HbA1c.…”

Recent Updates and Advances in the Use of Glycated Albumin for the Diagnosis and Monitoring of Diabetes and Renal, Cerebro- and Cardio-Metabolic Diseases

“…The GA test provides information on the mean blood glucose concentration in the last 15–20 days before blood collection [ 4 , 6 , 8 , 11 , 19 , 24 ].…”

“…In addition to the use of HbA1c for the diagnosis of diabetes [ 52 ], the use of additional glycated proteins for this diagnosis and its complications has been widely recommended [ 11 ].…”

“…GA, a unique post-translational product of the glycosylation of albumin, has been shown to be a useful biomarker in: (i) clinical conditions in which the dosage of glycated hemoglobin (HbA1c) does not reflect glycemic compensation, such as chronic renal failure, gestational diabetes, dialysis complications, hemorrhages, recent transfusions, hemolytic anemia and hemoglobin variants [ 6 , 9 , 10 , 11 , 12 , 13 ]; (ii) patients with poorly controlled diabetes and with postprandial hyperglycemia in order to monitor short-term glycemic fluctuation [ 14 , 15 ]; (iii) diabetic patients for monitoring therapeutic response [ 16 , 17 , 18 , 19 ]; (iv) detecting prediabetes even in the presence of normoglycemia, which is a priority because the effectiveness of this lifestyle intervention is lost if diabetes has already developed [ 20 , 21 ]. It is well known that fructosamine represents all the circulating glycated proteins, therefore Glycated Albumin is biochemically recognized as a form of fructosamine [ 14 ].…”

“…It is well known that fructosamine represents all the circulating glycated proteins, therefore Glycated Albumin is biochemically recognized as a form of fructosamine [ 14 ]. With the Oral Glucose Tolerance Test (OGTT) as the diagnostic standard [ 11 , 22 ], GA has been shown to be superior to fructosamine alone in detecting hyperglycemic states [ 8 , 23 ]. Moreover, the GA/HbA1c ratio is very important from a diagnostic point of view to detect patients with postprandial hyperglycemia or large glycemic excursion [ 15 , 24 ].…”