Glycated albumin in the detection of diabetes during COVID-19 hospitalization.

BACKGROUND: Diabetes has emerged as an important risk factor for COVID-19 adverse outcomes during hospitalization. We investigated whether the measurement of glycated albumin (GA) may be useful in detecting newly diagnosed diabetes during COVID-19 hospitalization. METHODS: In this cross-sectional test accuracy study we evaluated HCPA Biobank data and samples from consecutive in-patients, from 30 March 2020 to 20 December 2020. ROC curves were used to analyse the performance of GA to detect newly diagnosed diabetes (patients without a previous diagnosis of diabetes and admission HbA1c ≥6.5%). RESULTS: A total of 184 adults (age 58.6 ± 16.6years) were enrolled, including 31 with newly diagnosed diabetes. GA presented AUCs of 0.739 (95% CI 0.642-0.948) to detect newly diagnosed diabetes. The GA cut-offs of 19.0% was adequate to identify newly diagnosed diabetes with high specificity (85.0%) but low sensitivity (48.4%). CONCLUSIONS: GA showed good performance to identify newly diagnosed diabetes and may be useful for identifying adults with the condition in COVID-19-related hospitalization.

Is there a role for glycated albumin in the diagnosis of gestational diabetes mellitus?

BACKGROUND: Studies in the general population have advocated glycated albumin (GA) as a useful alternative to glycated haemoglobin (HbA1c) under conditions wherein the latter does not reflect glycaemic status accurately. There are few studies in other populations, especially in pregnant women. Therefore, the aim of this study was to assess the clinical utility of GA in the diagnosis of gestational diabetes mellitus (GDM). MATERIALS AND METHODS: This diagnostic test accuracy study was performed in 149 Brazilian women at 24-28 weeks of gestation referred for an oral glucose tolerance test (OGTT) in a tertiary university hospital. Receiver Operating Characteristic (ROC) curves were used to access the performance of GA and HbA1c in the diagnosis of GDM by the reference OGTT. RESULTS: GDM by OGTT (IADPSG criteria) was detected in 18.8% of participants. According to ROC analysis, the area under the curve (AUC) for GA was 0.531 (95% CI: 0.405-0.658, p = 0.065) lower than that for HbA1c [0.743 (95% CI: 0.636-0.849; p ≤ 0.001] for the detection of GDM (p = 0.004). The equilibrium cut-off value for GA was 12.6%; sensitivity and specificity in this cut-off point were 53.6% and 54.2%, respectively. CONCLUSIONS: GA at 24-28 weeks of gestation does not have ability to correctly discriminate those with and without GDM. In summary, the lack of sensitivity found in our results do not support the solely use of GA in the diagnosis of GDM.

The usefulness of glycated albumin for post-transplantation diabetes mellitus after kidney transplantation: A diagnostic accuracy study.

BACKGROUND: There is no study evaluating the use of glycated albumin (GA) for the detection of post-transplantation diabetes mellitus (PTDM) in kidney transplant recipients. We evaluated the overall accuracy of GA at four months after kidney transplantation. METHODS: Diagnostic test accuracy study including 134 kidney transplant recipients without pre-existing diabetes. Receiver operator characteristic (ROC) curve was used to estimate sensitivity, specificity, likelihood ratios and area under the curve (AUC) for GA, considering oral glucose tolerance test (OGTT) and/or glycated hemoglobin (HbA1c) as reference criteria. RESULTS: Thirty-three patients were diagnosed with PTDM by OGTT and/or HbA1c ≥ 6.5%. GA showed moderate accuracy to detect PTDM [AUC 0.673 (95% CI 0.557-0.789, p < 0.01)]. The use of OGTT and/or HbA1c ≥ 6.2% increased the number of PTDM cases from 33 to 38, and AUC was 0.713 (95% CI 0.608-0.819, p < 0.01). GA ≥ 17% showed specificity close to 90% when OGTT and/or HbA1c ≥ 6.5% were used as reference tests. CONCLUSIONS: GA showed low diagnostic accuracy for the detection of PTDM at the fourth month after transplantation. The use of a single GA point is not enough for the screening and diagnosis of PTDM; however, GA ≥ 17% presented high specificity to rule in the disease after kidney transplantation.

Glycated albumin as a diagnostic tool in diabetes: An alternative or an additional test?

INTRODUCTION: Studies have revealed that glycated albumin (GA) is a useful alternative to HbA1c under conditions wherein the latter does not reflect glycaemic status accurately. Until now, there are few studies with non-Asians subjects that report on the validity of GA test in diagnosis of type 2 diabetes mellitus (DM). Thus, the aim of this study was to assess the clinical utility of GA in diagnosis of DM. MATERIALS AND METHODS: This diagnostic test accuracy study was performed in 242 Brazilian individuals referred for OGTT in a tertiary university hospital. ROC curves were used to access the performance of GA and HbA1c in the diagnosis of DM by oral glucose tolerance test (OGTT). RESULTS: OGTT, HbA1c and GA were performed in all 242 participants (40.5% male, age 54.4 ± 13.0 years [mean ± SD], body mass index 28.9 ± 6.3 kg/m2). DM by OGTT was detected in 31.8% of individuals. The equilibrium threshold value of GA ≥14.8% showed sensitivity of 64.9% and specificity of 65.5% for the diagnosis of DM. The AUC for GA [0.703 (95% CI 0.631-0.775)] was lower than for HbA1c [0.802 (95% CI 0.740-0.864)], p = 0.028. A GA value of 16.8% had similar accuracy for detecting DM as defined by HbA1c ≥6.5% (48 mmol/mol) with sensitivity of 31.2% and specificity of 93.3% for both tests. However, GA detects different subjects from those detected by HbA1c and OGTT. CONCLUSIONS: GA detected different individuals with DM from those detected by HbA1c, though it showed overall diagnostic accuracy similar to HbA1c in the diagnosis of DM. Therefore, GA should be used as an additional test rather than an alternative to HbA1c or OGTT and its use as the sole DM diagnostic test should be interpreted with caution.