Glycated Albumin for Glycemic Control in T2DM Population: A Multi-Dimensional Evaluation

Clinical utility of glycated albumin and 1,5-anhydroglucitol in the screening and prediction of diabetes: A multi-center study

BACKGROUND

Despite being the gold standard, the use of glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) for diagnosing dysglycemia is imperfect. In particular, a low level of agreement between HbA1c and FPG in detecting prediabetes and diabetes has led to difficulties in clinical interpretation. Glycated albumin (GA) and 1,5-anhydroglucitol (1,5-AG) may potentially serve as biomarkers for the detection and prediction of diabetes, as well as glycemic monitoring.

AIM

To explore the diagnostic performance of GA and 1,5-AG for screening dysglycemia; assess whether they can be used for glycemic monitoring in Chinese morbidly-obese patients; and examine their predictive ability for incident diabetes in a Chinese community-based cohort.

METHODS

GA and 1,5-AG concentrations were measured in 462 morbidly-obese patients from the Obese Chinese Cohort (OCC). A sub-group of diabetes subjects (n = 24) was prospectively followed-up after bariatric surgery. Differences between baseline and post-surgery biomarker values were converted to percentage change from baseline to assess the response to glycemic control. Predictive ability of the biomarkers was assessed in 132 incident diabetes cases and 132 matched non-diabetes controls in the community-based Cardiovascular Risk Factor Prevalence Study (CRISPS). A prediction model was developed and compared with clinical models based on conventional risk factors.

RESULTS

GA exhibited an excellent diagnostic value with an area under the receiver operating characteristic curve (AUC) of 0.919 (95%CI: 0.884-0.955) for identifying diabetes and a high agreement in the classification of diabetes with both FPG and HbA1c in the OCC. GA demonstrated the fastest response to glycemic control. In CRISPS, the 'B3A' prediction model, which consisted of body mass index (BMI) and 3 biomarkers (HbA1c, GA and 1,5-AG), achieved a comparable predictive value [AUC (95%CI): 0.793 (0.744-0.843)] to that of a clinical model comprising BMI, HbA1c, FPG and 2-hour glucose (2hG) [AUC (95%CI): 0.783 (0.733-0.834); DeLong P value = 0.736]. The 'B3A' was significantly superior to a clinical model including BMI, HbA1c, FPG and triglycerides [AUC (95%CI): 0.729 (0.673-0.784); DeLong P value = 0.027].

CONCLUSION

GA and 1,5-AG have the potential to act as robust biomarkers for the screening and risk prediction of diabetes. FPG and 2hG may be replaced by GA and 1,5-AG in future diabetes predictions.

Prevalence of poor glycemic control and the monitoring utility of glycated albumin among diabetic patients attending clinic in tertiary hospitals in Dodoma, Tanzania: A cross-sectional study protocol

The burden of diabetes is rising in developing countries, and this is significantly linked to the increasing prevalence of poor glycemic control. The cost of glycated haemoglobin (HbA1c) testing is a barrier to timely glycemic assessments, but newer tests such as glycated albumin may be cheaper and tempting alternatives. Additional research must ascertain if glycated albumin (GA) can act as a viable supplement or alternative to conventional HbA1c measurements for glycemic control in diabetic individuals. GA as a biomarker is an emerging area of interest, particularly for those who display unreliable HbA1c levels or cannot afford the test. This study aims to investigate the prevalence of poor glycemic control in outpatient diabetic patients and the utility of glycated albumin in this population's monitoring of glycemic control. Method. A cross-sectional study of 203 diabetic patients will be conducted at the Dodoma Regional Referral Hospital and Benjamin Mkapa Hospital from August 1st, 2023, to August 31st, 2024. Patients diagnosed with diabetes mellitus for over six months will be screened for eligibility. Informed consent, history, clinical examination, and voluntary blood sample collection will be obtained from all eligible patients. Glycated Albumin levels will be obtained from the same blood samples collected. The glycemic status of all patients will be defined as per HbA1c, and a level of greater than 7% will considered as a poor control. The analysis will be computed with SPSS version 28.0, and a predictor variable, P<0.05, will be regarded as statistically significant, with the utility of GA determined by plotting the area under the ROC curve and the confusion matrix.

Predicting the response to SGLT-2 inhibitors as add-on therapy to multiple day injection insulin with glycated albumin: a pilot study

BACKGROUND

Achieving optimal glycemic targets is the main therapeutic goal in patients with type 2 diabetes (T2D) mellitus. HbA1c is the reference biomarker for monitoring glycemic control; however, in specific conditions affecting erythrocyte turnover or in patients on multiple daily injection (MDI) insulin regimens, the determination of glycated albumin (GA) may be preferable. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors represent a novel class of antidiabetic drugs that lower plasma glucose concentrations quickly, with insulin-independent mechanisms. Herein, we explored the role of GA in predicting the short-term response to SGLT-2 inhibitors as add-on to MDI insulin.

METHODS

Sixteen patients with long-standing, poorly controlled T2D on MDI insulin starting an SGLT-2 inhibitor were subjected to plasma GA and HbA1c measurements at 30 days intervals for up to 3 months in order to examine the temporal changes of these glycemic biomarkers.

RESULTS

At the end of the study, grossly coincident with the life span of erythrocytes, a significant decrease in median HbA1c was observed, (from 8.7 [range: 8.2-9.3%] at baseline to 7.2 [range: 7.0-7.9%]), with the advantage of less insulin dose requirements. However, significant, and incremental reductions in median GA determinations could be already evident after 30 days (-3.5 [range: -7.5, -2.5%]) and 60 days (-6.4 [range: -10.5, -4.7%]) from the start of SGLT-2 inhibitor treatment and persisted for up to 3 months (-8.6 [range: -12.1, 6.1%]). The decrements of HbA1c observed at the 3-month visit were highly correlated with the concurrent absolute reductions of plasma GA (ρ=0.550, P=0.027), whereas a borderline significance could be demonstrated with reference to reductions in plasma GA at 30 and 60 days.

CONCLUSIONS

Although limited by the small number of participants, these preliminary findings suggest that GA, rather than HbA1c, could represent a useful and reliable biomarker in T2D to monitor the early glucose-lowering effects of antidiabetic drugs with rapid onset of action, such as SGLT-2 inhibitors and MDI insulin.