Glycated albumin and the risk of micro- and macrovascular complications in subjects with Type 1 Diabetes

Abstract

BackgroundWe investigated the relationship between the glycemic indices glycated albumin (GA) and glycated hemoglobin (HbA1c) and the progression of diabetic vascular complications [diabetic nephropathy (DN) and carotid artery atherosclerosis (CAA)] in subjects with type 1 diabetes (T1D).MethodsA total of 154 participants with a median follow-up of 2.8 years were enrolled in this retrospective longitudinal study. We recruited T1D subjects who had regularly measured urine albumin-creatinine ratios and estimated glomerular filtration rates, as well as tested HbA1c and GA levels consecutively every 3 or 6 months. A subgroup of 54 subjects was measured repeated carotid intima-media thickness (IMT).ResultsWe classified subjects into the DN progression (Group I; n = 30) with either deteriorated stages of chronic kidney disease (n = 18) or albuminuria progression (n = 17), and the non-progression (Group II; n = 124). In multiple logistic regression analyses, baseline albuminuria (odds ratio [OR] = 2.64, 95 % confidence interval [CI] = 1.03–6.74), mean GA levels (OR = 2.03, 95 % CI = 1.27–3.26) were significantly associated with progression of DN. However, there was no association with mean HbA1c (OR = 0.98, 95 % CI = 0.62–1.54). In a subgroup analysis for follow-up measurements of carotid IMT, age was independently associated with the presence of plaque and the mean IMT. However glycemic indices were not significantly associated with CAA.ConclusionsMean GA levels were more closely associated with DN progression than mean HbA1c in subjects with T1D. However, they were not associated with the CAA.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-015-0219-y) contains supplementary material, which is available to authorized users.

Glycated albumin and ratio of glycated albumin to glycated hemoglobin are good indicators of diabetic nephropathy in type 2 diabetes mellitus

“…This is supported by another experiment conducted in Korean patients with type 1 diabetes mellitus. Glycated albumin levels, rather than HbA 1c , were associated with DN . In our experiment, we included Chinese patients with T2DM and confirmed that GA had a stronger indicative power than HbA 1c , and that HbA 1c was not associated with presence of DN in T2DM.…”

Estimation of glycaemic control in the past month using ratio of glycated albumin to HbA1c

“…Nayak et al [10] reported that there was biological variability in the glycation gap despite its long-term consistency in an individual, and this biological variability would be measurable under conditions of relatively stable glycaemic control. Recent reports proposed the use of glycated albumin [11,12] and glycated albumin/HbA 1c ratio as indices of chronic diabetic complications independently of HbA 1c [13,14]. We observed that the individual mean value of the glycated albumin/HbA 1c ratio over time showed long-term consistency and a highly significant inverse correlation with the glycation gap when using simultaneous measurement of HbA 1c and glycated albumin instead of fructosamine [15].…”

Glycated albumin: a potential biomarker in diabetes

“…In another smaller study with 154 type 1 DM patients followed over 2.8 years, the progression to nephropathy was associated only with GA and not with A1C. The authors did not find association between these two glycemic markers and the cardiovascular outcomes (58).…”

“…However, there is still controversy if mean glycemia itself or glycemic variability is the main determining factor for chronic damage in DM (16). Recent studies have evaluated the predictive potential value of tests that are more associated with the short term glycemia and that can be used as alternative markers for A1C, such as GA (8,16,17,58).…”