Jun Murai

Glycated Albumin and Glycated Hemoglobin Are Influenced Differently by Endogenous Insulin Secretion in Patients With Type 2 Diabetes

OBJECTIVE Glycated albumin (GA) relative to A1C is a useful marker of short-term glycemic control. We investigated whether endogenous insulin secretion in type 2 diabetes has different effects on GA and A1C levels. RESEARCH DESIGN AND METHODS A1C, GA, and GA-to-A1C ratio were compared in 202 type 2 diabetic patients by type of treatment. Effect of β-cell function determined by homeostasis model assessment (HOMA-%β) on GA-to-A1C ratio was examined. In addition, GA-to-A1C ratio was compared between type 2 diabetic patients and 16 patients with type 1 diabetes. RESULTS In type 2 diabetic patients, GA-to-A1C ratio was significantly higher in those treated with insulin than in those treated with diet or oral hypoglycemic agents. HOMA-%β showed a significant inverse correlation with GA-to-A1C ratio. This ratio was higher in type 1 diabetic patients than in type 2 diabetic patients. CONCLUSIONS In diabetic patients with decreased insulin secretion, serum GA levels are higher relative to A1C.

Effects of thyroid hormone on serum glycated albumin levels: Study on non-diabetic subjects

Glycated albumin (GA) is used alongside glycated hemoglobin (HbA(1C)) as an indicator of glycemic control. Although serum GA levels are affected mainly by plasma glucose, they are also influenced by serum albumin metabolism. Thyroid hormone is known to promote albumin catabolism, and it is thus thought to affect serum GA levels. In the present study, the effects of thyroid hormone on serum GA measurements were investigated in patients with thyroid dysfunction. Six patients with untreated hypothyroidism and 17 patients with untreated thyrotoxicosis were investigated. Patients who had anemia or diabetes were excluded. A total of 25 non-diabetic, euthyroid individuals were enrolled as controls. HbA(1C), serum GA, thyroid-stimulating hormone (TSH), free triiodothyronine (T(3)), and free thyroxine (T(4)) levels were measured in all these subjects, and their relationships were examined. Although no intergroup differences were observed for HbA(1C), serum GA was significantly higher among patients with hypothyroidism than controls, and significantly lower among patients with thyrotoxicosis. Serum GA had a significant positive correlation with serum TSH and significant inverse correlations with free T(3) and free T(4). Thyroid hormone levels are inversely associated with serum GA levels. Cautions are necessary when evaluating serum GA levels in patients with thyroid dysfunction.

Usefulness of glycated albumin as an indicator of glycemic control status in patients with hemolytic anemia.

BACKGROUNDnIn patients with hemolytic anemia (HA), glycated hemoglobin (HbA(1C)) presents lower values in relation to glycemia because the lifespan of erythrocytes is shortened, whereas glycated albumin (GA) is not affected. In the present study, we examined the usefulness of GA as an indicator of glycemic control status in patients with HA.nnnMETHODSnWe enrolled 21 patients with HA. A total of 202 patients with type 2 diabetes mellitus (T2DM) without complications were used as controls.nnnRESULTSnWe identified a significant correlation between GA and HbA(1C) in the patients with HA. However, in a comparison between the patients with HA and those with T2DM, the regression line showed a leftward shift in the former group. There was a significant positive correlation between hemoglobin (Hb) and HbA(1C) in the patients with HA (R=0.541, p=0.025), although there was no significant correlation between Hb and GA. There was an inverse correlation between Hb levels and GA/HbA(1C) ratio (R=-0.710, p=0.001). The measured HbA(1C) levels were lower than the HbA(1C) levels estimated from mean plasma glucose levels, whereas the GA/3 levels were close to the estimated HbA(1C) levels.nnnCONCLUSIONSnGA is a useful indicator of glycemic control status in patients with HA.

Serum glycated albumin to haemoglobin A1C ratio can distinguish fulminant type 1 diabetes mellitus from type 2 diabetes mellitus

Background Fulminant type 1 diabetes mellitus (FT1DM), a subtype of type 1 diabetes mellitus, was first reported as a disease entity in 2000. Ketoacidosis at initial onset due to acute pancreatic cell destruction makes early diagnosis and treatment for FT1DM mandatory. In the early period of FT1DM, haemoglobin (Hb)A1C levels are not markedly elevated. This study investigated serum glycated albumin (GA), which reflects acute short-term changes in plasma glucose, as a new clinical index for FT1DM at disease onset. Methods Subjects comprised 35 patients with FT1DM who had undergone measurement of HbA1C and serum GA at initial visit and 42 patients with type 2 diabetes mellitus (T2DM) with HbA1C <8.5% and no history of diabetes treatment as controls. Results HbA1C was significantly lower in FT1DM than in T2DM, whereas serum GA was significantly higher. GA/HbA1C ratio was thus significantly higher in FT1DM than in T2DM (3.9 ± 0.5 versus 2.8 ± 0.3; P < 0.0001). GA/HbA1C ratio was >3.2 in 41 of 42 FT1DM patients (98%), compared with only one of 32 T2DM patients (3%). Conclusions Serum GA is significantly higher in FT1DM than in T2DM, whereas HbA1C is significantly lower. FT1DM can thus be distinguished from untreated T2DM by GA/HbA1C ratio at initial visit before treatment for diabetes.

Serum glycated albumin, but not glycated haemoglobin, is low in relation to glycemia in hyperuricemic men

Measurements of glycated albumin (GA) as well as glycated haemoglobin (HbA1C) have been applied in order to monitor chronic glycemic control in diabetic patients. Since the levels of both glycated proteins are influenced by various factors other than glycemia, cautions are necessary to evaluate such measures in some specific conditions. In this study, we examined the effects of serum uric acid (UA) levels on these glycemic markers. One hundred and ninety-three men with normal glucose tolerance were enrolled in this study. Association of serum UA with BMI, plasma glucose (PG), high sensitivity CRP (hs-CRP), serum GA and HbA1C was analysed. Serum UA showed a significant positive correlation with BMI (Rxa0=xa00.329, Pxa0<xa00.0001) and hs-CRP (Rxa0=xa00.306, Pxa0<xa00.0001). Multivariate analysis revealed serum UA to be a significant positive explanatory variable for hs-CRP. There was a significant positive correlation of serum UA with the 2-h PG after 75xa0g OGTT but not fasting PG. Although there was no correlation of serum UA with HbA1C, serum UA showed a significant inverse correlation with both serum GA (Rxa0=xa0−0.402, Pxa0<xa00.0001) as well as BMI-adjusted serum GA (Rxa0=xa0−0.327, Pxa0<xa00.0001). By multivariate analysis, serum UA was an explanatory variable for serum GA. Serum GA, but not HbA1C, is set lower in relation to plasma glucose levels in hyperglycemic men. This may be caused by microinflammation associated with hyperuricemic state.

Comparison of annual variability in HbA1c and glycated albumin in patients with type 1 vs. type 2 diabetes mellitus.

OBJECTIVEnIt has been suggested that plasma glucose (PG) levels per se and long-term variations in PG levels are associated with diabetic vascular complications. Glycated albumin (GA) reflects shorter-term glycemic control, as well as postprandial PG levels, as compared to HbA1c. In this study, we hypothesized that GA more strongly reflects long-term variations in PG levels than HbA1c, and compared the variability of HbA1c and that of GA in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).nnnMETHODSnThis study included 8 T1DM patients and 48 T2DM patients. Over a 1-year period, HbA1c and GA were measured every month and the mean values and coefficients of variation (CV) for each patient were calculated.nnnRESULTSnIn both T1DM and T2DM patients, the CV of GA was significantly higher than the CV of HbA1c. Both the CV of HbA1c and the CV of GA were significantly higher in the T1DM patients than in the T2DM patients.nnnCONCLUSIONnThe annual variability in GA was greater than that in HbA1c. In addition, the annual variability in HbA1c and that in GA in the T1DM patients were greater than in the T2DM patients. Our findings suggest that GA more accurately reflects long-term variations in PG levels than HbA1c.

Glycated albumin levels are higher relative to glycated haemoglobin levels in gastrectomized subjects

Background In gastrectomized subjects, oral glucose tolerance test often shows marked hyperglycaemia (oxyhyperglycaemia) after glucose loading. Because serum glycated albumin (GA) has been shown to better reflect postprandial and maximum plasma glucose levels, we investigated whether or not the clinical significance of serum GA and glycated haemoglobin (HbA1C) in non-diabetic gastrectomized subjects differs. Methods During health examinations, 62 non-diabetic subjects with a history of gastrectomy and 87 non-diabetic control subjects were selected in the present study. Body mass index (BMI) in the gastrectomy group was significantly lower than in the control group. Results Fasting plasma glucose levels were significantly lower in the gastrectomized subjects than in the control subjects. Although both HbA1C and serum GA were significantly higher in the gastrectomized subjects, there was a significant difference in GA/HbA1C ratio between the gastrectomized subjects and the control subjects. BMI-adjusted serum GA, based on our previous finding of inverse influence of BMI on serum GA, was also significantly higher in the gastrectomized subjects than in the controls. Conclusions Serum GA is higher relative to HbA1C in gastrectomized subjects. This suggests that serum GA may be a better marker than HbA1C for glycaemic excursion in these subjects.

Prediction of near-future glycated hemoglobin levels using glycated albumin levels before and after treatment for diabetes

Aims/Introduction:u2002 In the present study, whether near‐future glycated hemoglobin (A1C) levels could be predicted by changes in glycated albumin (GA) levels before and after treatment for diabetes was investigated.

Habitual intake of dairy products influences serum 1,5-anhydroglucitol levels independently of plasma glucose

1,5-Anhydroglucitol (1,5-AG), a marker of glycemic control state, is reabsorbed via SGLT (sodium glucose cotransporter)-4 (SLC5A9) at renal proximal tubules. SGLT4 is responsible for reabsorption of mannose, fructose, galactose, glucose, and 1,5-AG. Thus, based on our hypothesis that serum 1,5-AG levels are influenced by diet, we investigated whether eating habits influence serum 1,5-AG levels. In total, 330 subjects (158 males and 172 females) with normal glucose tolerance participated. Relationships between serum 1,5-AG levels and eating habits (intake of meats, fish, soybean products, eggs, dairy products, fruit, vegetables, and salt) surveyed by questionnaire were investigated. Stepwise multivariate regression analysis revealed that habitual intake of dairy products was a significant negative explanatory variable for serum 1,5-AG levels. Serum 1,5-AG levels were lower in subjects with habitual intake of dairy products than in those without. On the other hand, HbA(1C), glycated albumin, fasting plasma glucose, and OGTT 2-h plasma glucose were not different between the subjects of these two groups. In conclusion, habitual intake of dairy products was associated with low serum 1,5-AG levels, independently of plasma glucose levels.

Serum glycated albumin levels, but not glycated hemoglobin, is low in relation to glycemia in non-diabetic men with nonalcoholic fatty liver disease with high alanine aminotransferase levels

OBJECTIVESnWe have reported that serum glycated albumin (GA) levels are low in obese subjects, smokers and hyperuricemic subjects in whom high sensitive CRP (hs-CRP) is elevated. Because patients with nonalcoholic fatty liver disease with high alanine aminotransferase (ALT) levels are reported to show high levels of hs-CRP, the relationship between serum ALT and serum GA levels was investigated.nnnDESIGN AND METHODSnThis study comprised 196 non-diabetic men without drinking habit.nnnRESULTSnCompared with the normal ALT group (serum ALT < or =30 U/L; n=158), the high ALT group (serum ALT >30 U/L; n=38) had significantly higher fasting plasma glucose (PG), OGTT 2-h PG and HbA(1C) levels. Meanwhile, serum GA was significantly lower, and hs-CRP was significantly higher in the high ALT group.nnnCONCLUSIONSnThe results obtained indicate that serum GA is under a negative control of hs-CRP in subjects with high ALT without drinking habit.