Glycated albumin is superior to glycated hemoglobin for glycemic control assessment at an early stage of diabetes treatment: A multicenter, prospective study.

AIMS: This study was to determine whether serum glycated albumin (GA) was a better indicator of glycemic control than hemoglobin A1c (HbA1c) when starting a new treatment regimen for type 2 diabetes. METHODS: Newly diagnosed type 2 diabetes patients, or patients who had poor glycemic control with oral hypoglycemic agents, were enrolled at 10 hospitals in Beijing. Serum GA, HbA1c, fasting blood glucose (FBG), and C-peptide were assayed on Days 0, 14, 28, and 91 after treatment. RESULTS: Four hundred ninety-nine patients were enrolled. Mean FBG, GA and HbA1c decreased significantly in patients at Days 14, 28, and 91. In patients with improved glycemic control, the reduction of GA and HbA1c levels was 10.5±13.3% vs. 5.1±5.4% on Day 14, 16.0±13.4% vs. 9.0±7.0% on Day 28, and 18.0±16.7% vs. 18.3±9.4% on Day 91, respectively, compared with baseline values. Changes in GA on Day 14, 28 and 91 were all closely correlated with changes in HbA1c on Day 91. Change in GA on Day 14 was correlated with treatment effectiveness evaluated by HbA1c on Day 91. CONCLUSIONS: GA may be a useful marker for assessing glycemic control at an early stage of new diabetes treatment and assist in guiding adjustments to treatment and therapy.

Glycated albumin may be a choice, but not an alternative marker of glycated hemoglobin for glycemic control assessment in diabetic patients undergoing maintenance hemodialysis.

BACKGROUND: It has been suggested that glycated hemoglobin (HbA1c) underestimate the actual glycemic control levels in maintenance hemodialysis (MHD) patients, because of anemia and the using of erythropoietin (EPO); it was recommended that glycated albumin (GA) should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbA1c in this research by referring to mean plasma glucose (MPG) in diabetes mellitus (DM) patients undergoing MHD or not. METHODS: MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbA1c, albumin (ALB), GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbA1c was done among the groups of MHD patients with DM (n=88) and without DM (NDM; n=90), and non-MHD ones with DM (n=102) using MPG for an actual glycemic control standard. RESULTS: In these 3 groups, only for DM patients' (whether undergoing MHD or not), GA and HbA1c correlated with MPG significantly (P < 0.01). Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts (2.418 vs. 2.329) and slopes (0.053 vs. 0.057) were very close to each other. On the contrary, regression curves of HbA1c did not coincide in the two groups, because variance of the slopes (0.036 vs. 0.052) were relatively large. Through comparing receiver operating characteristic (ROC) areas under the curve (AUC), it could be understood that the assessment performances of GA and HbA1c in MHD patients were lower than those in non-MHD ones, and assessment performance of HbA1c in MHD patients was better than GA (P < 0.05). In addition, the effects of Hb and EPO dose on HbA1c, or that of ALB on GA were unobvious in our study. CONCLUSIONS: Actual glycemic control level in MHD patients with DM may be underestimated by HbA1c, and it could be avoided by GA; however, glycemic evaluating performance of HbA1c may be still better than that of GA. Therefore, HbA1c should not be replaced completely although GA can be used as a choice to monitor glycemic level.