Glycated Albumin is a Better Indicator for Glucose Excursion than Glycated Hemoglobin in Type 1 and Type 2 Diabetes

Abstract

Abstract. To determine the impact of blood glucose profile, involving fluctuation and excursion of blood glucose levels, on glycated proteins, we evaluated the association among the daily profile of blood glucose, and glycated albumin (GA) and HbA1c levels in patients with type 1 diabetes (n = 93) and type 2 diabetes (n = 75). GA levels were strongly correlated with HbA1c levels in type 1 (r = 0.85, P<0.0001) and type 2 diabetes (r = 0.61, P<0.0001), respectively. HbA1c levels were similar between patients with type 1 and type 2 diabetes, while GA levels were significantly higher in type 1 diabetes. Thus the ratio of GA levels to HbA1c levels was significantly higher in type 1 diabetes than that in type 2 diabetes (3.32 ± 0.36 vs. 2.89 ± 0.44, p<0.001). The degrees of GA levels and HbA1c levels correlated with maximum and mean blood glucose levels in patients with type 1 and type 2 diabetes. Stepwise multivariate analysis revealed that GA levels independently correlated with maximum blood glucose levels in type 1 diabetes (F = 43.34, P<0.001) and type 2 diabetes (F = 41.57, P<0.001). HbA1c levels also independently correlated with maximum blood glucose levels in type 1 diabetes (F = 34.78, P<0.001), as well as being correlated with mean blood glucose levels in type 2 diabetes (F = 11.28, P<0.001). In summary, GA could be a better marker for glycemic control than glycated hemoglobin in diabetic patients, especially for evaluating glycemic excursion, which is considered to be a major cause of diabetic angiopathy.

The ratio of glycated albumin to hemoglobin A1c measured in IFCC units accurately represents the glycation gap

“…As limitations of this study, both GA and the GA/ A1C ratio are reported to be affected by diabetes type [19][20][21][22] and obesity [20,[22][23][24]. A similar tendency was also reported for the G-gap [6,7].…”

“…However, given that approximately 50% of A1C is produced during the 30-35 days prior to measurement, both GA and A1C are affected by any significant alteration in plasma glucose during this period. The GA/A1C ratio may thus reflect worsening or improving fluctuations in glycemic control over the short term [21,22]. Some previous authors have argued that a high GA/A1C ratio is associated with postprandial glucose excursion, early progression to insulin therapy in type 2 diabetes, or other events [35,36].…”

“…The GA/A1C ratio is thus affected by short-term blood glucose fluctuations [18]. The GA/ A1C ratio is also reported to be affected by diabetes type [19][20][21][22], obesity [23,24], and other factors such as a short time after the initial treatment of diabetes [20,[22][23][24]. GA can be affected by liver and kidney diseases disturbing albumin metabolism and A1C can be affected by hemoglobinopathy, anemia, and other disorders [16].…”

Evaluation of Glycemic Variability in Well-Controlled Type 2 Diabetes Mellitus

“…Some studies reported that glycosylated serum proteins or glycated albumin (GA) is a better marker for evaluating glucose excursion in diabetes than HbA1c. 12,13 However, few studies have evaluated the association between FA and postprandial hyperglycemia or glycemic fluctuations.…”

Glycated albumin: a potential biomarker in diabetes

“…Compared to A1C, GA is more suitable to monitor the beginning of drug therapy in DM (55), and also to control the dose and change of medication (51), since its levels diminish faster than A1C in intensive treatment (19). Paroni and cols.…”