Increased Serum Glycated Albumin Level is Associated With the Presence and Severity of Coronary Artery Disease in Type 2 Diabetic Patients

Li, Pu; Lü, Lin; Shen, Wei Feng; Zhang, Qi; Zhang, Rui Yan; Zhang, Jian Sheng; Hu, Jian; Zheng, Yang; Ding, Feng; Chen, Qiu Jin; Shen, Jie; Fang, Dan; Sheng, Lei

doi:10.1253/circj.71.1067

Cited by 86 publications

(59 citation statements)

References 25 publications

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“…in fact, Pu et al have reported that an increase of ga independent of hba 1c is associated with the presence and severity of coronary artery disease in type 2 diabetic patients [24]. however, the present study has several limitations.…”

Section: Discussionmentioning

confidence: 64%

Relationship between Clinical Markers of Glycemia and Glucose Excursion Evaluated by Continuous Glucose Monitoring (CGM).

et al. 2010

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Abstract. in order to evaluate the relationship between clinical markers of glycemia and glucose excursion, we performed 48-hour continuous glucose monitoring (Cgm) in 43 diabetic patients. For the clinical markers, hba1c, glycoalbumin (ga), and 1,5-anhydroglucitol (1,5-ag) were measured, and for the parameters of glucose excursion from Cgm, average glucose (ag), standard deviation of glucose (SD), the area under the curve for glucose levels >180 mg/dL (auC>180), and the difference between the maximum and minimum glucose levels during 48 hours (ΔG48hr) were analyzed. all patients were treated without any changes of the dosages of oral anti-diabetic agents or insulin for at least the previous 6 months with coefficient of variation (CV) of HbA1c less than 4 %. in results, while hba1c did not show any single correlation with ag, SD, auC>180, or ΔG48hr, both GA and 1,5-AG were significantly related to all these parameters. Furthermore, GA significantly correlated to all CGM parameters, and SD significantly correlated to GA in multiple regression analyses. These results suggest that ga may be a different marker from hba1c for diabetic complications, because ga, but not hba1c, may reflect not only short-term average glucose but also fluctuation of glucose.Key words: glycoalbumin, glycated hemoglobin, 1,5-anhydroglucitol, Continuous glucose monitoringThe sTAble frAcTion of glycated hemoglobin (hba 1c ) is routinely measured in the majority of patients with diabetes around the world, since hba 1c reflects the mean glucose level over the preceding 3 months [1]. hba 1c is not only used to determine whether a patient's metabolic control has been maintained within the target range, but also to estimate the risk of chronic diabetic complications in each patient. Previous the large-scale prospective studies of diabetic patients have used hba 1c as a marker of glycemic control to evaluate the association of consistent hyperglycemia with the development or progression of chronic diabetic complications [2,3]. however, recent studies have indicated that postprandial hyperglycemia or fluctuations of the glucose level may be an independent risk factor for macrovascular complications in diabetic patients, which cannot be evaluated by measuring hba 1c alone [4]. Since hba 1c is a marker of the average level of glycemia, it does not reflect acute glucose fluctuations and is poorly correlated with glucose excursions [5]. Therefore, in order to assess the risk of diabetic complications, especially macrovascular complications, it may be necessary to evaluate not only the mean level of glycemic control, but also the extent of glucose excursions such as glucose fluctuations or postprandial elevation of glucose.To assess daily blood glucose excursions, portable devices for self-monitoring of blood glucose (Smbg) are now widely used by insulin-treated diabetic patients. although such devices are helpful, the number of measuring times is limited. Recently, a continuous subcutaneous glucose monitoring (Cgm) device was developed to evaluate the...

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Section: Discussionmentioning

confidence: 64%

Relationship between Clinical Markers of Glycemia and Glucose Excursion Evaluated by Continuous Glucose Monitoring (CGM).

et al. 2010

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“…Hyperglycemia is one of the main mechanisms involved in the development of complications in diabetic patients. Previous studies (27)(28)(29) demonstrated the association of high glycated hemoglobin levels with the severity of the CAD and with poorer outcome after percutaneous coronary angioplasty. Recently, Anand et al (30) showed that suboptimal glycemic control is a risk factor for coronary artery calcification progression.…”

Section: Vessel Shrinkage and Atherosclerosismentioning

confidence: 99%

Vessel Shrinkage as a Sign of Atherosclerosis Progression in Type 2 Diabetes

et al. 2009

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OBJECTIVE-The aim of this study was to determine the natural history of vascular remodeling of atherosclerotic plaques in patients with type 2 diabetes and the predictors of vessel shrinkage.RESEARCH DESIGN AND METHODS-In this serial intracoronary ultrasound (IVUS) study, 237 coronary segments from 45 patients enrolled in the DIABETES I, II, and III trials were included. Quantitative volumetric IVUS analyses (motorized pullbacks at 0.5 mm/s) were performed in the same coronary segment after the index procedure and at the 9-month follow-up. Nontreated mild lesions (angiographic stenosis Ͻ25%) with Ն0.5 mm plaque thickening and length of Ն5 mm assessed by IVUS were included. Vessel shrinkage was defined as a ⌬external elastic membrane area/⌬plaque area Ͻ 0. Statistical adjustment by multiple segments and multiple lesions per patient was performed.RESULTS-Vessel shrinkage was identified in 37.1% of segments and was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 Ϯ 4 mm 2 vs. non-vessel shrinkage, 11 Ϯ 4 mm 2 ; P ϭ 0.04). Independent predictors of vessel shrinkage were insulin requirements (odds ratio 4.6 [95% CI 1.40 -15.10]; P ϭ 0.01), glycated hemoglobin (1.5 [1.05-2.10]; P ϭ 0.02), apolipoprotein B (0.96 [0.94 -0.98]; P Ͻ 0.001), hypertension (3.7 [1.40 -10.30]; P ϭ 0.009), number of diseased vessels (5.6 [2.50 -12.50]; P Ͻ 0.001), and prior revascularization (17.5 [6.50 -46.90]; P Ͻ 0.001).CONCLUSIONS-This serial IVUS study suggests that progression of coronary artery disease in patients with type 2 diabetes may be mainly attributed to vessel shrinkage. Besides, vessel shrinkage is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis. Diabetes 58:209-214, 2009 C oronary artery remodeling is a phenomenon by which vessel dimension changes in response to atherosclerotic plaque accumulation. This concept was initially described by Glagov et al. (1) in a postmortem, histopathological study and confirmed by in vivo studies using intracoronary ultrasound (IVUS) analysis (2-7). Two different patterns of coronary remodeling have been described: a compensatory enlargement of the vessel in response to an increase of atherosclerotic plaque (positive remodeling) and a failure to enlarge or even vessel shrinkage (negative remodeling). The latter is a common finding in coronary stenosis of diabetic patients (8,9). In cross-sectional studies, negative remodeling has been associated with coronary risk factors, such as hypertension (5) and smoking (4), with the type of plaque (2,7) (calcified, hard plaques), and with metabolic control in diabetic patients (10 -12). In most studies, remodeling has been evaluated only at a single time point. Therefore, the natural history of this process has not been properly addressed. In addition, remodeling index has been assessed by comparing vessel dimension at target site and that at the most normal-looking cross-section within 10 mm from the lesion taken as reference segment (2-7). Howev...

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“…Recently, it has been revealed that GA is an index that predicts the development of coronary artery disease (CAD) as well as its severity [30,31]. The relationship between GA and diabetic vascular complications will be further investigated.…”

Section: Postprandial Hyperglycemiamentioning

confidence: 99%

Clinical impact of glycated albumin as another glycemic control marker

2010

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Abstract. It is known that glycation among various proteins is increased in diabetic patients compared with non-diabetic subjects. Currently, among these glycated proteins, glycated hemoglobin (HbA 1C ) is used as the gold standard index of glycemic control in clinical practice for diabetes treatment. However, HbA 1C does not accurately reflect the actual status of glycemic control in some conditions where plasma glucose changes during short term, and in patients who have diseases such as anemia and variant hemoglobin. In comparison, another index of glycemic control, glycated albumin (GA), more accurately reflects changes in plasma glucose during short term and also postprandial plasma glucose. Although GA is not influenced by disorders of hemoglobin metabolism, it is affected by disorders of albumin metabolism. This review summarizes diseases and pathological conditions where GA measurement is useful. These include the status of glycemic control changes during short term, diseases which cause postprandial hyperglycemia, iron deficiency anemia, pregnancy, chronic liver disease (liver cirrhosis), chronic renal failure (diabetic nephropathy), and variant hemoglobin.

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Increased Serum Glycated Albumin Level is Associated With the Presence and Severity of Coronary Artery Disease in Type 2 Diabetic Patients

Abstract: An increased serum level of glycated albumin is associated with the presence and severity of CAD, and may be useful in screening patients with T2DM.

Cited by 86 publications

References 25 publications

Relationship between Clinical Markers of Glycemia and Glucose Excursion Evaluated by Continuous Glucose Monitoring (CGM).

Relationship between Clinical Markers of Glycemia and Glucose Excursion Evaluated by Continuous Glucose Monitoring (CGM).

Vessel Shrinkage as a Sign of Atherosclerosis Progression in Type 2 Diabetes

Clinical impact of glycated albumin as another glycemic control marker

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