Glycated albumin in diabetes mellitus: a meta-analysis of diagnostic test accuracy

Abstract

Objectives Guidelines recommend the diagnosis of diabetes should be based on either plasma glucose or glycated hemoglobin (HbA1C) findings. However, lately studies have advocated glycated albumin (GA) as a useful alternative to HbA1c. We conducted a systematic review and meta-analysis to determine the overall diagnostic accuracy of GA for the diagnosis of diabetes. Content We searched for articles of GA diabetes diagnostic accuracy that were published up to August 2021. Studies were selected if reported an oral glucose tolerance test as a reference test, measured GA levels by enzymatic methods, and had data necessary for 2 × 2 contingency tables. A bivariate model was used to calculate the pooled estimates. Summary This meta-analysis included nine studies, totaling 10,007 individuals. Of those, 3,106 had diabetes. The studies showed substantial heterogeneity caused by a non-threshold effect and reported different GA optimal cut-offs for diagnosing diabetes. The pooled diagnostic odds ratio (DOR) was 15.93 and the area under the curve (AUC) was 0.844, indicating a good level of overall accuracy for the diagnosis of diabetes. The effect of the GA threshold on diagnostic accuracy was reported at 15.0% and 17.1%. The optimal cut-off for diagnosing diabetes with GA was estimated as 17.1% with a pooled sensitivity of 55.1% (95% CI 36.7%–72.2%) and specificity of 94.4% (95% CI 85.3%–97.9%). Outlook GA has good diabetes diagnostic accuracy. A GA threshold of 17.1% may be considered optimal for diagnosing diabetes in previously undiagnosed individuals.

Glycated albumin in the detection of diabetes during COVID-19 hospitalization

“…As far as we know, this is the first study that evaluated the diagnostic accuracy of GA to detect diabetes in hospitalized individuals with COVID-19. However, our findings are supported by studies conducted in the general population that demonstrated very good GA performance for diabetes diagnosis [26][27][28][29][30]. In a systematic review and meta-analysis of diagnostic test accuracy, we showed that GA performed very well for diabetes diagnosis by oral glucose tolerance test with/without HbA1c in the non-hospitalized general population [26].…”

“…Consequently, all tests are equally appropriate to diagnose diabetes. In our study, the adequate cut-off to detect newly diagnosed diabetes was slightly higher than those reported in general population, where GA ranged between 15% to 18% to identify diabetes [26][27][28][29][30]. We did not explore time to admission from onset of COVID-19-related symptoms for this study.…”

“…GA reflects short-term mean glycaemia (2-3 weeks), rather than 2-3 months observed for HbA1c [25]. Unlike HbA1c, GA is haemoglobin/erythrocyte independent, but their performance in the diagnosis of diabetes in the general population is similar [26][27][28][29][30]. Therefore, it is advocated that GA is a useful alternative to HbA1c under conditions where the latter does not reflect glycaemic status precisely.…”

Design and clinical application of a risk prediction model for diabetic foot

“…Glycated hemoglobin reflects blood glucose control over the past three months. If a patient has high levels of glycated hemoglobin, it indicates poor blood glucose control, which in turn activates various pathways such as the polyol pathway, advanced glycation end products, and hexosamine pathway, further exacerbating endothelial cell damage in the lower limb blood vessels and worsening vascular injury [22,23]. Hyperlipidemia and atherosclerosis are local pathologic changes that occur after vascular damage.…”

Discovery of age-related early-stage glycated proteins based on deep quantitative serum glycated proteome analysis

“…Detecting early-stage glycation is vital for early monitoring and better intervention in aging-related deterioration [10] . Some well-known early-stage glycated markers, such as glycated hemoglobin and glycated albumin, have been utilized as indicators for blood glucose control monitoring, while early-stage glycated transferrin shows potential for monitoring blood glucose control and early diagnosis of diabetic nephropathy [ 15 , 20 , 21 ]. These findings underscore the importance of studying early-stage glycated proteins in biological processes.…”