Glycated albumin and ratio of glycated albumin to glycated hemoglobin are good indicators of diabetic nephropathy in type 2 diabetes mellitus

Abstract

Background: We investigated the association between serum levels of glycated albumin (GA), glycated hemoglobin (HbA_1c ), and GA:HbA_1c ratio and the presence of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM).

Methods: Two hundred six consecutive patients with T2DM were enrolled from the endocrinology ward at Shengjing Hospital of China Medical University and classified into 2 groups: DN group (n = 71) and non-diabetic nephropathy (non-DN) group (n = 135).

Results: The DN group showed significantly higher GA and GA:HbA_1c values compared with the non-DN group. After univariate logistic regression, GA, GA:HbA_1c , HbA_1c , age, T2DM duration, systolic blood pressure, diastolic blood pressure, triglycerides, mean blood glucose (from 7 blood glucose checks), and presence of retinopathy were selected for advanced analysis. A multivariate logistic regression analysis was performed to examine the association between the presence of DN and these variables. Glycated albumin, GA:HbA_1c , duration, systolic blood pressure, mean blood glucose, and retinopathy (but not HbA_1c ) were identified as independent variables that predicted the presence of DN. We then fitted the areas under the curve of GA:HbA_1c and GA (0.811 and 0.754, respectively) separately using a receiver operating characteristic curve analysis. Both were better than HbA_1c (0.580). We defined the cutoff value of GA:HbA_1c as 2.71 (sensitivity 0.676, specificity 0.778) and that of GA as 17.5% (sensitivity 0.761, specificity 0.644) for the prediction of DN in patients with T2DM.

Conclusions: The GA:HbA_1c ratio and GA may be superior to HbA_1c associated with the presence of DN.

Keywords: diabetic nephropathy; glycated albumin; hemoglobin A1c; ratio of glycated albumin to hemoglobin; type 2 diabetes mellitus.