Utility of Glycated Albumin as a Biomarker for Glycemic Variability in Diabetes Mellitus
Keywords:
Glycated albumin, glycemic variability, HbA1c, diabetes mellitus, biomarkersAbstract
Introduction: Glycemic variability, characterized by short-term glucose fluctuations, is increasingly recognized as an independent risk factor for diabetes-related complications, including oxidative stress, inflammation, and vascular damage. Traditional markers like hemoglobin A1c (HbA1c) reflect average glucose levels over 2–3 months but fail to adequately capture glycemic variability. Glycated albumin (GA), a glycation product of serum albumin, offers an alternative, reflecting glycemic status over 2–3 weeks and remaining unaffected by factors such as red blood cell turnover. This study evaluates the utility of GA as a biomarker for glycemic variability compared to HbA1c.
Materials and Methods: A cross-sectional study involving 120 participants with type 1 (n=55) or type 2 DM (n=65) was conducted. Glycemic variability metrics, including Mean Amplitude of Glycemic Excursions (MAGE), Coefficient of Variation (CV), and Time in Range (TIR), were derived from self-monitored blood glucose (SMBG) and continuous glucose monitoring (CGM). GA and HbA1c were measured using standardized enzymatic and HPLC assays, respectively. Correlation and ROC analyses assessed the relationship between GA, HbA1c, and glycemic variability.
Results: GA showed stronger correlations with glycemic variability metrics than HbA1c (MAGE: r=0.72 vs. 0.45; CV: r=0.68 vs. 0.39; TIR: r=−0.63 vs. −0.34; all p<0.05). Subgroup analysis revealed GA's superior sensitivity in detecting glycemic excursions in participants with type 1 DM (MAGE: r=0.74) and type 2 DM with comorbidities such as anemia. ROC analysis demonstrated GA's higher predictive accuracy for glycemic variability (AUC=0.89) compared to HbA1c (AUC=0.76).
Conclusion: GA provides a more sensitive measure of short-term glycemic variability than HbA1c, particularly in clinical scenarios where HbA1c may be unreliable, such as anemia or chronic kidney disease. By offering insights into glycemic excursions, GA has the potential to enhance personalized diabetes management, improve patient outcomes, and reduce complications. Future studies should explore its long-term impact on clinical care.
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Baranwal A, Roy S, Kumar A. Nano-(bio) sensors for on-site monitoring: Advancing diagnostics through technological intervention. Front Bioeng Biotechnol. 2024.
Yamada C, Fujimoto K, Toyoda M, et al. Glycated albumin is a more reliable indicator for glycemic control in diabetic patients with anemia or chronic kidney disease. J Diabetes Complications. 2020;34(4):107496. DOI:10.1016/j.jdiacomp.2019.107496.
Kim KJ, Lee BW. The role of glycated albumin as a new glycemic marker. Endocrinol Metab (Seoul). 2012;27(1):49–59. DOI:10.3803/EnM.2012.27.1.49.
Freedman BI, Shihabi ZK, Andries L, et al. Relationship between glycated albumin and hemoglobin A1c in diabetic subjects with advanced nephropathy. Clin Chem. 2002;48(5):801–804.
Hayashi N, Fukui M, Yamazaki M, et al. Discordance between glycated albumin and HbA1c in patients with diabetes and end-stage renal disease. Clin Chim Acta. 2012;413(9-10):744–747. DOI:10.1016/j.cca.2011.12.005.
Koga M. Glycated albumin: Clinical usefulness. Clin Chim Acta. 2014;433:96–104. DOI:10.1016/j.cca.2014.02.011.
Inaba M, Okuno S, Kitatani K, et al. Glycated albumin is a better glycemic indicator than HbA1c in hemodialysis patients with diabetes: A multicenter study. Clin Nephrol. 2007;68(4):239–246. DOI:10.5414/CNP68239.
Yoon HJ, Cho YZ, Lee KY, et al. Glycated albumin and the prediction of cardiovascular events in patients with diabetes mellitus. Diabetes Metab Res Rev. 2019;35(3):e3101. DOI:10.1002/dmrr.3101.
Hirsch IB, Brownlee M. The link between hyperglycemia and diabetic complications: is it the glucose or something else? Diabetes. 2010;59(6):1401–9.
Shimizu R, Kikuchi Y, Sato T, et al. Usefulness of glycated albumin as an indicator of glycemic control status in patients with diabetes undergoing hemodialysis. Diabetes Care. 2008;31(8):1533–7.
Koga M, Murai J, Saito H, et al. Glycated albumin and glycated hemoglobin are influenced differently by endogenous insulin secretion in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2011;91(2):160–5.
Inaba M, Okuno S, Kumeda Y, et al. Glycated albumin is a better indicator for glucose excursion than glycated hemoglobin in type 1 and type 2 diabetes. Endocr J. 2007;54(5):653–8.
Sacks DB, Arnold M, Bakris GL, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2011;57(6):e1–47.
Hsu P, Ai M, Kanda E, et al. Glycated albumin and its role in diabetes: focus on non-traditional situations. Front Endocrinol (Lausanne). 2020;11:604299.
Kim WJ, Kim YG, Park J, et al. Glycated albumin is a useful glycemic control marker in patients with poorly controlled diabetes. Korean Diabetes J. 2010;34(4):220–5
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