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The Impact of Glycated Albumin in Diabetes Management and Diabetic Nephropathy

Can glycated albumin provide better positive predictive value than A1c in incidence of diabetic nephropathy?

The incidence of diabetes is increasing at a rapid rate despite novel approaches in glucose-lowering drugs. Uncontrolled diabetes leading to end-organ damage is one of the biggest concerns in healthcare. Various macrovascular and microvascular complications arise from persistently elevated glucose levels. Diabetic neuropathy, retinopathy, and nephropathy often affect patients with diabetes of which the latter has been considered the major cause of end-stage renal disease and death in this patient population. The incidence of renal disease is increasing and it is estimated that at least 35% of patients receiving dialysis are patients with poorly controlled diabetes whose disease has worsened kidney functions. In order to obtain adequate control, clinicians rely on laboratory readings, such as A1c. However, obtaining these readings is not always an adequate measure of glycemic control in patients with diabetes who suffer from other diseases that affect red blood cells and hemoglobin. Previous studies have expanded on these concerns and have found other enzymatic processes that can help track diabetes management and progression to diabetic nephropathy. These research studies have expanded on the evidence supporting the use of glycated albumin to hemoglobin HbA1c ratio as a determinant of postprandial blood glucose and pancreatic beta cell secretory functions.

Tiegang Li and colleagues at Shengjing Hospital of China Medical University, have expanded on this topic and focused on looking at glycated albumin as a marker of intermediate glycation and as the means to better understand the progression of diabetic nephropathy. Hence, they sought to investigate glycemic monitoring and the function of glycated albumin in diabetic nephropathy. The main objective of the study was to understand the association between serum levels of glycated albumin, glycated albumin to HbA1c ratio and the presence of diabetic nephropathy. In this cross-sectional study, patients were assessed for lipid abnormalities, body mass index (BMI), blood pressure, mean blood glucose, HbA1c levels, glycated albumin to HbA1c ratio, renal function, presence of retinopathy, and medication use. A total of 206 patients with type 2 diabetes were separated into two groups; a diabetic nephropathy group and another group with non-diabetic nephropathy.

After randomization, there were no statistical differences in the baseline characteristics between both groups (p<0.05). After analysis, there was a positive correlation between glycated albumin and HbA1c to blood glucose levels in both groups (diabetic nephropathy: r=0.644, p=0.021 and non-diabetic nephropathy r=0.611, p=0.013). Via univariate logistic regression analysis, Li and colleagues saw an independent association between glycated albumin (OR=1.82; 95% CI 1.26-2.37, p=0.017) and glycated albumin to HbA1c ratio (OR=1.42; 95% CI 1.18-2.07, p=0.026) to the incidence of diabetic nephropathy. Finally, through multiple logistic regression, no direct association was observed between the occurrence of diabetic nephropathy and glycated albumin, glycated albumin to HbA1c ratio, duration of type 2 diabetes, systolic blood pressure, and retinopathy. Glycosylation indicators did seem to have an impact on incidence of diabetic nephropathy.

In conclusion, Li and colleagues saw that glycated albumin and glycated albumin to HbA1c ratio can provide a stronger predicting value than HbA1c alone in diabetes management. One major advantage of this study is that it is one of the first studies conducted to better understand the relationship between glycated albumin, glycated albumin to HbA1c ratio as a better predictor of diabetic nephropathy. These values seem to be independent to the presence of diabetic nephropathy in type 2 diabetes patients. Nonetheless, the number of patients with end-stage renal disease was minimal. Further research should focus on expanding the use of these biomarkers in the setting of end-stage renal disease and type 2 diabetes patients. Larger studies are needed to establish a stronger relationship between glycated albumin and the ratio of glycated albumin to hemoglobin A1c.

Practice Pearls:

  • The role of hemoglobin A1c in patients with end-stage renal disease can be affected by variable erythrocyte fluctuations.
  • Glycated albumin to hemoglobin A1c ratios can be a good predictor of glycemic control in the presence of diabetic nephropathy due to its close relationship between glucose levels after meals and pancreatic beta cell secretory function.
  • Glycated albumin may not have a positive predictive value in the incidence of diabetic nephropathy.

References:

Parrinello, Christina M., and Elizabeth Selvin. “Beyond HbA1c and Glucose: The Role of Nontraditional Glycemic Markers in Diabetes Diagnosis, Prognosis, and Management.” Current diabetes reports 14.11 (2015): 548. PMC. Web.

Wang, Nana, Xu, Zhen, Han, Ping, and Li, Tiegang. “ Glycated albumin and ratio of glycated albumin to hemoglobin are good indicators of diabetic nephropathy in type 2 diabetes mellitus.” Diabetes/Metabolism Research and Reviews (2016). Web

 

Pablo A. Marrero-Núñez – USF College of Pharmacy Student Delegate –  Doctor of Pharmacy Candidate 2017 – University of South Florida – College of Pharmacy