Vol 6, No 4 (2017)
Review article
Published online: 2017-11-17
Is HbA1c the only choice? Alternative biomarkers for glycaemic control assessment
DOI: 10.5603/DK.2017.0023
Clin Diabetol 2017;6(4):136-141.
Abstract
A rise in concentrations of glycated proteins occurs in diabetic patients; glycated hemoglobin is the most significant parameter, a ‘gold standard’ for glycaemic control. Other serum proteins also become glycated, i.a albumins and immunoglobulins. In practice, Fructosamine and glycated albumin are used. However, some conditions influence HbA1c concentrations, hence the search for alternative biomarkers for glycaemia monitoring. Glycated albumin (GA) appears to be the most promising, as its assessment enables both faster detection of changes in glycaemia control in cases of poor metabolic discipline and documentation of glyceamic control improvement, after appropriate treatment is implemented. This may be important mostly in patients scheduled for surgical, cardiosurgical or orthopedic procedures, which are sometimes postponed because of inadequate glycaemia control. Monitoring GA in particular groups of patients (i.a during pregnancy, with renal insufficiency or haematologic comorbidities) reflects glycaemic control levels more accurately than HbA1c.
Keywords: diabetesHbA1cglycated albumin
References
- Henrichs HR. HbA1c—Glycated Hemoglobin and Diabetes Mellitus. J Diabetes Sci Technol. 2010; 4: 494–495.
- Sacks DB, Arnold M, Bakris GL, et al. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clinical Chemistry. 2011; 57(6): e1–e47.
- Selvin E, Steffes MW, Zhu H, et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med. 2010; 362(9): 800–811.
- Hoelzel W, Miedema K. Development of a reference system for the international standardization of HbA1c/glycohemoglobin determinations. J Int Fed Clin Chem. 1996; 8(2): 62–4, 66.
- Little RR. Glycated hemoglobin standardization--National Glycohemoglobin Standardization Program (NGSP) perspective. Clin Chem Lab Med. 2003; 41(9): 1191–1198.
- Zalecenia kliniczne dotyczące postępowania u chorych na cukrzycę 2017 Stanowisko Polskiego Towarzystwa Diabetologicznego. Diab Klin. 2017; 3(Sup. A): A1–A81.
- Koenig RJ, Peterson CM, Kilo C, et al. Hemoglobin AIc as an indicator of the degree of glucose intolerance in diabetes. Diabetes. 1976; 25(3): 230–232.
- Eberhardt MS, Lackland DT, Wheeler FC, et al. Is race related to glycemic control? An assessment of glycosylated hemoglobin in two South Carolina communities. J Clin Epidemiol. 1994; 47(10): 1181–1189.
- Kirk JK, Bell RA, Bertoni AG, et al. Ethnic disparities: control of glycemia, blood pressure, and LDL cholesterol among US adults with type 2 diabetes. Ann Pharmacother. 2005; 39(9): 1489–1501.
- Herman WH, Ma Y, Uwaifo G, et al. Diabetes Prevention Program Research Group. Differences in A1C by race and ethnicity among patients with impaired glucose tolerance in the Diabetes Prevention Program. Diabetes Care. 2007; 30(10): 2453–2457.
- Pani LN, Korenda L, Meigs JB, et al. Effect of aging on A1C levels in individuals without diabetes: evidence from the Framingham Offspring Study and the National Health and Nutrition Examination Survey 2001-2004. Diabetes Care. 2008; 31(10): 1991–1996.
- Gallagher EJ, Le Roith D, Bloomgarden Z. Review of hemoglobin A(1c) in the management of diabetes. J Diabetes. 2009; 1(1): 9–17.
- Hosseini MS, Rostami Z, Saadat A, et al. Anemia and microvascular complications in patients with type 2 diabetes mellitus. Nephrourol Mon. 2014; 6(4): e19976.
- Wu AC, Lesperance L, Bernstein H. Screening for iron deficiency. Pediatr Rev. 2002; 23(5): 171–178.
- Kim C, Bullard KM, Herman WH, et al. Association between iron deficiency and A1C Levels among adults without diabetes in the National Health and Nutrition Examination Survey, 1999-2006. Diabetes Care. 2010; 33(4): 780–785.
- Koga M, Saito H, Mukai M, et al. Influence of iron metabolism indices on glycated haemoglobin but not glycated albumin levels in premenopausal women. Acta Diabetol. 2010; 47 Suppl 1: 65–69.
- Wajcman H. Hemoglobin disorders: Epidemiology. http://rbc.gs-im3.fr/DATA/The%20HW_CD/EnglEpidemio.html (2009 Jan 13).
- Rohlfing CL, Connolly SM, England JD, et al. The effect of elevated fetal hemoglobin on hemoglobin A1c results: five common hemoglobin A1c methods compared with the IFCC reference method. Am J Clin Pathol. 2008; 129(5): 811–814.
- Shigeru S, Masafumi K. Glycemic control indicators in patients with neonatal diabetes mellitus. World J Diabetes. 2014; 5: 198–220.
- Vos FE, Schollum JB, Coulter CV, et al. Red blood cell survival in long-term dialysis patients. Am J Kidney Dis. 2011; 58(4): 591–598.
- Ng JM, Jennings PE, Laboi P, et al. Erythropoetin treatment significantly alters measured glycated haemoglobin (HbA1c). Diabet Med. 2008; 25(2): 239–240.
- Ng JM, Cooke M, Bhandari S, et al. The effect of iron and erythropoietin treatment on the A1C of patients with diabetes and chronic kidney disease. Diabetes Care. 2010; 33(11): 2310–2313.
- Speeckaert M, Van Biesen W, Delanghe J, et al. European Renal Best Practice Guideline Development Group on Diabetes in Advanced CKD. Are there better alternatives than haemoglobin A1c to estimate glycaemic control in the chronic kidney disease population? Nephrol Dial Transplant. 2014; 29(12): 2167–2177.
- Ribeiro RT, Macedo MP, Raposo JF. HbA1c, Fructosamine, and Glycated Albumin in the Detection of Dysglycaemic Conditions. Curr Diabetes Rev. 2016; 12(1): 14–19.
- True MW. Circulating biomarkers of glycemia in diabetes management and implications for personalized medicine. J Diabetes Sci Technol. 2009; 3(4): 743–747.
- Selvin E, Rawlings AM, Grams M, et al. Fructosamine and glycated albumin for risk stratification and prediction of incident diabetes and microvascular complications: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study. Lancet Diabetes Endocrinol. 2014; 2(4): 279–288.
- Mittman N, Desiraju B, Fazil I, et al. Serum fructosamine versus glycosylated hemoglobin as an index of glycemic control, hospitalization, and infection in diabetic hemodialysis patients. Kidney Int Suppl. 2010(117): S41–S45.
- Shafi T, Sozio SM, Plantinga LC, et al. Serum Fructosamine and Glycated Albumin and Risk of Mortality and Clinical Outcomes in Hemodialysis Patients. Diabetes Care. 2012; 36(6): 1522–1533.
- Rondeau P, Bourdon E. The glycation of albumin: structural and functional impacts. Biochimie. 2011; 93(4): 645–658.
- Arasteh A, Farahi S, Habibi-Rezaei M, et al. Glycated albumin: an overview of the In Vitro models of an In Vivo potential disease marker. J Diabetes Metab Disord. 2014; 13: 49.
- Koga M. Glycated albumin; clinical usefulness. Clin Chim Acta. 2014; 433: 96–104.
- Abidin D, Liu L, Dou C, et al. An improved enzymatic assay for glycated serum protein. Analytical Methods. 2013; 5(10): 2461.
- Kohzuma T, Yamamoto T, Uematsu Y, et al. Basic performance of an enzymatic method for glycated albumin and reference range determination. J Diabetes Sci Technol. 2011; 5(6): 1455–1462.
- Kohzuma T, Koga M. Lucica GA-L glycated albumin assay kit: a new diagnostic test for diabetes mellitus. Mol Diagn Ther. 2010; 14(1): 49–51.
- Yoshiuchi K, Matsuhisa M, Katakami N, et al. Glycated albumin is a better indicator for glucose excursion than glycated hemoglobin in type 1 and type 2 diabetes. Endocr J. 2008; 55(3): 503–507.
- Koga M, Murai J, Saito H, et al. Glycated albumin and glycated hemoglobin are influenced differently by endogenous insulin secretion in patients with type 2 diabetes. Diabetes Care. 2010; 33(2): 270–272.
- Phelps RL, Honig GR, Green D, et al. Biphasic changes in hemoglobin A1c concentrations during normal human pregnancy. Am J Obstet Gynecol. 1983; 147(6): 651–653.
- Worth R, Potter JM, Drury J, et al. Glycosylated haemoglobin in normal pregnancy: a longitudinal study with two independent methods. Diabetologia. 1985; 28(2): 76–79.
- Hashimoto K, Noguchi S, Morimoto Y, et al. A1C but not serum glycated albumin is elevated in late pregnancy owing to iron deficiency. Diabetes Care. 2008; 31(10): 1945–1948.
- Rohlfing CL, Wiedmeyer HM, Little RR, et al. Defining the relationship between plasma glucose and HbA(1c): analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care. 2002; 25(2): 275–278.
- Koga M, Kasayama S, Kanehara H, et al. CLD (chronic liver diseases)-HbA1C as a suitable indicator for estimation of mean plasma glucose in patients with chronic liver diseases. Diabetes Res Clin Pract. 2008; 81(2): 258–262.
- Bando Y, Kanehara H, Toya D, et al. Association of serum glycated albumin to haemoglobin A1C ratio with hepatic function tests in patients with chronic liver disease. Ann Clin Biochem. 2009; 46(Pt 5): 368–372.
- Inaba M, Okuno S, Kumeda Y, et al. Osaka CKD Expert Research Group. Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol. 2007; 18(3): 896–903.
- Peacock TP, Shihabi ZK, Bleyer AJ, et al. Comparison of glycated albumin and hemoglobin A(1c) levels in diabetic subjects on hemodialysis. Kidney Int. 2008; 73(9): 1062–1068.
- Shen Y, Lu L, Ding FH, et al. Association of increased serum glycated albumin levels with low coronary collateralization in type 2 diabetic patients with stable angina and chronic total occlusion. Cardiovasc Diabetol. 2013; 12: 165.
- Shen Y, Pu LiJ, Lu L, et al. Glycated albumin is superior to hemoglobin A1c for evaluating the presence and severity of coronary artery disease in type 2 diabetic patients. Cardiology. 2012; 123(2): 84–90.
- Song SOk, Kim KJ, Lee BW, et al. Serum glycated albumin predicts the progression of carotid arterial atherosclerosis. Atherosclerosis. 2012; 225(2): 450–455.
- Pan J, Li Q, Zhang L, et al. Serum glycated albumin predicts the progression of diabetic retinopathy--a five year retrospective longitudinal study. J Diabetes Complications. 2014; 28(6): 772–778.
- Park SuB, Kim SS, Kim InJ, et al. Variability in glycated albumin levels predicts the progression of diabetic nephropathy. J Diabetes Complications. 2017; 31(6): 1041–1046.
- Ding FH, Lu L, Zhang RY, et al. Impact of elevated serum glycated albumin levels on contrast-induced acute kidney injury in diabetic patients with moderate to severe renal insufficiency undergoing coronary angiography. Int J Cardiol. 2013; 167(2): 369–373.
- Yamanouchi T, Akanuma Y. Serum 1,5-anhydroglucitol (1,5 AG): new clinical marker for glycemic control. Diabetes Res Clin Pract. 1994; 24 Suppl: S261–S268.
- Kilpatrick ES, Keevilt BG, Richmond KL, et al. Plasma 1,5-anhydroglucitol concentrations are influenced by variations in the renal threshold for glucose. Diabet Med. 1999; 16(6): 496–499.
- Selvin E, Steffes MW, Ballantyne CM, et al. Racial differences in glycemic markers: a cross-sectional analysis of community-based data. Ann Intern Med. 2011; 154(5): 303–309.
- Nathan DM, McGee P, Steffes MW, et al. DCCT/EDIC Research Group. Relationship of glycated albumin to blood glucose and HbA1c values and to retinopathy, nephropathy, and cardiovascular outcomes in the DCCT/EDIC study. Diabetes. 2014; 63(1): 282–290.
- Yoon Hj, Lee Yh, Kim SoRa, et al. Glycated albumin and the risk of micro- and macrovascular complications in subjects with type 1 diabetes. Cardiovasc Diabetol. 2015; 14: 53.