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Multicenter Study
. 2021 Jul 14;57(7):712.
doi: 10.3390/medicina57070712.

Biomarkers of Glyco-Metabolic Control in Hemodialysis Patients: Glycated Hemoglobin vs. Glycated Albumin

Francesca Gabriela Martino  1 , Marina Vitillo  1 , Massimo Pieri  2 , Giulia Marrone  3   4 , Fabio Gangeri  5 , Ferruccio Ansali  6   7 , Mariarita Dessì  2 , Sergio Bernardini  2 , Nicola Di Daniele  3 , Annalisa Noce  3
Affiliations
Multicenter Study

Biomarkers of Glyco-Metabolic Control in Hemodialysis Patients: Glycated Hemoglobin vs. Glycated Albumin

Francesca Gabriela Martino et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Glycated hemoglobin (HbA1c) dosage is considered the gold standard in glycol-metabolic monitoring, but it presents limits, which can underestimate the glycemia trend. In this regard, it was introduced the glycated albumin (GA). The aim of the study is to verify the predictivity of the GA compared to HbA1c in identifying glyco-metabolic alterations in non-diabetic and diabetic hemodialysis (HD) patients. Materials and Methods: For this purpose, we conducted a multicenter study involving one analysis laboratory and six dialysis centers in the Lazio region (Rome, Italy). Both diabetic and non-diabetic HD patients represent the study population, and the protocol included five time points. Results: The analyzed data highlighted the ability of GA to predict changes in glycemic metabolism in HD patients, and GA values are not significantly influenced, like HbA1c, by dialysis therapy itself and by comorbidities of the uremic state, such as normochromic and normocytic anemia. Thus, GA seems to reflect early glyco-metabolic alterations, both in patients with a previous diagnosis of diabetes and in subjects without diabetes mellitus. As part of this study, we analyzed two HD patients (one diabetic and one non-diabetic) in which GA was more predictive of glycol-metabolic alterations compared to HbA1c. Our study confirms the need to compare classical biomarkers used for the monitoring of glyco-metabolic alterations with new ones, likely more reliable and effective in specific subgroups of patients in which the classic biomarkers can be influenced by the preexisting pathological conditions. Conclusions: In conclusion, our evidence highlights that in uremic patients, GA shows a better ability to predict glyco-metabolic alterations allowing both an earlier diagnosis of DM and a prompt modulation of the hypoglycemic therapy, thus improving the clinical management of these patients.

Keywords: diabetes mellitus; glycated albumin; glycated hemoglobin; glyco-metabolic biomarkers; hemodialysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Design of the study. Abbreviation: HbA1c, glycated hemoglobin.
Figure 2
Figure 2
The ROC curves of GA (panel A) and HbA1c (panel B). Abbreviations: AUC, area under the curve; GA, glycated albumin; HbA1c, glycated hemoglobin; p, p-value; ROC, receiver operating characteristic.
Figure 3
Figure 3
Discrepancies between the GA and HbA1c values in uremic diabetic (panel A) and uremic non-diabetic (panel B) patients. Abbreviations; GA, glycated albumin; HbA1c, glycated hemoglobin.
Figure 4
Figure 4
Percentage of discordant values between GA and HbA1c in Group 1 (uremic diabetic patients) and Group 2 (uremic non-diabetic patients). Abbreviations: GA, glycated albumin; HbA1c, glycated hemoglobin.
See this image and copyright information in PMC

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