Use of glycated albumin for the identification of diabetes in subjects from northeast China

Abstract

BACKGROUND Metabolic memory is important for the diagnosis and treatment of diabetes in the early stage, and in maintaining blood glucose concentrations within the normal range. The clinical diagnosis of diabetes mellitus is currently made using fasting plasma glucose, 2 h-plasma glucose (2h-PG) during a 75 g oral glucose tolerance test, and hemoglobin A1c (HbA1c) level. However, the fasting plasma glucose test requires fasting, which is a barrier to screening, and reproducibility of the 2h-PG level is poor. HbA1c is affected by a shortened red blood cell lifespan. In patients with anemia and hemoglobinopathies, the measured HbA1c levels may be inaccurate. Compared with HbA1c, glycated albumin (GA) is characterized by more rapid and greater changes, and can be used to diagnose new-onset diabetes especially if urgent early treatment is required, for example in gestational diabetes. In this study, we provided cutoff values for GA and evaluated its utility as a screening and diagnostic tool for diabetes in a large high-risk group study. AIM To evaluate the utility of GA in identifying subjects with diabetes in northeast China, and to assess the diagnostic accuracy of the proposed GA cutoff in the diagnosis of diabetes mellitus. METHODS This cross-sectional study included 1935 subjects, with suspected diabetes or in high-risk groups, from 2014 to 2015 in the Second Affiliated Hospital of Harbin Medical University (Harbin, China). The use of GA to identify diabetes was investigated using the area under the receiver operating characteristic curve (AUC). The GA cutoffs were derived from different 2h-PG values with hemoglobin A1c cutoffs used as a calibration curve. RESULTS The GA cutoff for the diagnosis of diabetes mellitus was 15.15% from the receiver operating characteristic (ROC) curve. ROC analysis demonstrated that GA was an efficient marker for detecting diabetes, with an AUC of 90.3%. CONCLUSION Our study supports the use of GA as a biomarker for the diagnosis of diabetes.

Novel insights about albumin in cardiovascular diseases: Focus on heart failure

“…chronic renal failure, recent transfusion, pregnancy), and/or to monitor short-term glycemic fluctuations in patients with poor metabolic control (American Diabetes Association, 2021; Giglio et al, 2020). Indeed, GA reflects mean glycemia over approximately 2-3 weeks and, compared with glycated hemoglobin by more rapid and greater changes, not influenced by red blood cell lifespan (Li et al, 2021). Interestingly, Chen et al (2017) demonstrated that, in diabetic patients on hemodialysis, high GA measurements are significantly associated with increased mortality, in contrast to an inconsistent association between higher glycated hemoglobin values and mortality risk, thus highlighting the need to monitor and optimize glycemic levels especially in the patient population with disorders affecting erythrocyte life span.…”

The Burden of Impaired Serum Albumin Antioxidant Properties and Glyco-Oxidation in Coronary Heart Disease Patients with and without Type 2 Diabetes Mellitus

“…GLY-HSA is now considered a clinical biomarker of glycemic control, even if its use is restricted to those clinical conditions in which the levels of glycated hemoglobin (HbA1c) do not reflect glycemic status (i.e., pregnancy, chronic renal failure, or transfusion), or to the evaluation of short-term glycemic fluctuations in patients with poor metabolic control. Indeed, GLY-HSA reflects mean glycemia over approximately 2–3 weeks and, compared with HbA1c is not influenced by red blood cell lifespan [ 20 ]. However, as stated by the International and National Recommendations, it cannot be used yet for the diagnosis of diabetes [ 21 , 22 ].…”