Glycated albumin but not HbA1c reflects glycaemic control in patients with neonatal diabetes mellitus

Abstract

Aims/hypothesis It is difficult to use HbA 1c as an indicator of glycaemic control in patients with neonatal diabetes mellitus (NDM) because of high levels of fetal haemoglobin (HbF) remaining in the blood. In this study, glycated albumin (GA), which is not affected by HbF, and HbA 1c were compared to evaluate whether they reflect glycaemic control in patients with NDM. Methods This study included five patients with NDM. Age at diagnosis was 38±20 days. Insulin therapy was started in all patients, and levels of GA, HbA 1c and HbF were measured monthly for 6 months. One-month average preprandial plasma glucose (aPPG) was calculated using self-monitoring of blood glucose. Results Plasma glucose and GA were elevated (29.7± 13.1 mmol/l [n=5] and 33.3±6.9% [n=3], respectively) but HbA 1c was within normal limits (5.4±2.6% [35.5± 4.9 mmol/mol]; n=4) at diagnosis. With diabetes treatment, aPPG (r=−0.565, p=0.002), GA (r=−0.552, p=0.003) and HbF (r=−0.855, p<0.0001) decreased with age, whereas HbA 1c increased (r=0.449, p=0.004). GA was strongly positively correlated with aPPG (r=0.784, p<0.0001), while HbA 1c showed no correlation with aPPG (r=0.221, p=0.257) and was significantly inversely correlated with HbF (r=−0.539, p=0.004). Conclusions/interpretation GA is a useful indicator of glycaemic control in patients with NDM, whereas HbA 1c is influenced by age-related changes in HbF and does not accurately reflect glycaemic control.

Glycemic control indicators in patients with neonatal diabetes mellitus

“…Therefore, glycemic control in neonatal diabetes mellitus (NDM) was traditionally performed using blood glucose measured by self-monitoring of blood glucose as an indicator, without using a glycemic control indicator. We demonstrated that GA, which is not affected by HbF, reflects glycemic control in NDM and can be used as a glycemic control indicator in NDM [6] . We also obtained various other findings about GA and HbA1c in neonates/infants or NDM.…”

Age-adjusted glycated albumin: a more robust parameter to establish glycaemic control in neonatal diabetes mellitus

“…3 On the other hand, we have also found that GA in healthy infants within one year of age is low and correlated with logarithmically transformed age [log(age)]. 4 However, there is no study to investigate whether the phenomenon that GA is correlated with log(age) is true from infancy to adulthood so far.…”

Age-adjusted glycated albumin accurately reflects blood glucose in patients with neonatal diabetes mellitus: comparison with calculated glycated albumin determined by past blood glucose concentrations

“…3 We have reported that GA is useful for monitoring glycaemic control in NDM patients because GA is not affected by high concentrations of HbF. 6 However, we found that GA is lower relative to blood glucose in NDM patients when compared with patients with child-onset type 1 diabetes mellitus (T1DM). 7 We also provided evidence that GA concentrations in healthy infants are lower than the reference range for adults and are positively correlated with logarithmically transformed age.…”

“…5 Therefore, in NDM patients who show a low concentration of HbA1c because of the influence of HbF, HbA1c cannot be used as a glycaemic control indicator. 6 Similar to HbA1c, glycated albumin (GA) is used as a glycaemic control indicator. 3 We have reported that GA is useful for monitoring glycaemic control in NDM patients because GA is not affected by high concentrations of HbF.…”