Improved Monitoring of the Hyperglycemic State in Type 1 Diabetes Patients by Use of the Glycoalbumin/HbA1c Ratio

Abstract

Generally, the level of glycoalbumin (GA) is approximately 3 times higher than that of HbA1c. However, in type 1 diabetic patients, we often find an even higher GA/HbA1c ratio of nearly 3.5. Therefore, this study was performed to examine the significance of a higher GA/HbA1c ratio. METHODS: 17 type 1 diabetic patients were enrolled in part 1 of the study and divided into two groups, one with a higher and the other with a lower GA/HbA1c ratio. In both groups, the correlation between GA or HbA1c level and each "4-point" capillary glucose level was analyzed. 80 type 1 diabetic patients were enrolled in part 2 of the study and the relationship between mean GA/HbA1c ratio in the past year and degree of diabetic retinopathy was analyzed. RESULTS: In part 1 of the study, we found positive correlations between GA and bedtime capillary glucose levels and between HbA1c and bedtime capillary glucose levels in the higher GA/HbA1c group (r = 0.86, p = 0.023; r = 0.95, p = 0.012, respectively), but not in the lower GA/HbA1c group. In part 2 of the study, a significant positive correlation between GA/HbA1c ratio and severity of retinopathy could be observed (r = 0.269, p = 0.017). CONCLUSIONS: A higher GA/HbA1c ratio may reflect a postprandial hyperglycemic state and simultaneous monitoring of GA and HbA1c may improve the management of diabetic patients.

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].…”

Efficacy and Safety of Insulin Glulisine in Intensive Insulin Therapy: Bolus Insulin Adjust Nice Control by apiDRA Study (BANDRA Study)

“…We believe that the improved glycemic control after switching from Lis to Glu is mainly attributable to the reduced postprandial glucose deviations owing to the above-mentioned differences in the PK and PD properties between Lis and Glu. Our hypothesis is also partly supported by the non-significant reduction in the GA/HbA1c ratio, known to be a marker for postprandial glycemic excursion [18] [19]. The significant improvement in patients' satisfaction indicated by the DTSQ was probably associated with the improvement in blood glucose level control and the convenience of the simultaneous injection of Glu and Gla using the same injection devices (SoloSTAR ® ).…”

Serum glycated albumin to haemoglobin A1C ratio can distinguish fulminant type 1 diabetes mellitus from type 2 diabetes mellitus

“…22 Instead, HbA 1C is useful for the differential diagnosis of FT1DM and AT1DM, because HbA 1C levels are nearly normal or slightly elevated in FT1DM patients and, on the other hand, they are usually extremely high in AT1DM patients.…”