Estimation of glycaemic control in the past month using ratio of glycated albumin to HbA1c

Protein glycation in diabetes mellitus

Diabetes mellitus is the ninth leading cause of mortality worldwide. It is a complex disease that manifests as chronic hyperglycemia. Glucose exposure causes biochemical changes at the proteome level as reflected in accumulation of glycated proteins. A prominent example is hemoglobin A1c (HbA1c), a glycated protein widely accepted as a diabetic indicator. Another emerging biomarker is glycated albumin which has demonstrated utility in situations where HbA1c cannot be used. Other proteins undergo glycation as well thus impacting cellular function, transport and immune response. Accordingly, these glycated counterparts may serve as predictors for diabetic complications and thus warrant further inquiry. Fortunately, modern proteomics has provided unique analytic capability to enable improved and more comprehensive exploration of glycating agents and glycated proteins. This review broadly covers topics from epidemiology of diabetes to modern analytical tools such as mass spectrometry to facilitate a better understanding of diabetes pathophysiology. This serves as an attempt to connect clinically relevant questions with findings of recent proteomic studies to suggest future avenues of diabetes research.

Mean glycosylated hemoglobin in children with type 1 diabetes at King Fahad Medical City, Riyadh, Saudi Arabia

BACKGROUND:

Type 1 diabetes is the third most common chronic disease among teenagers. In Saudi Arabia, there is a gap of knowledge regarding hemoglobin A1C (HbA1c) concentration levels, and adherence to regular follow-up visits by patients. The aim of this study was to determine the mean glycosylated hemoglobin (HbA1c) levels in diabetic children who have been diagnosed with type 1 diabetes and were being followed up at a tertiary care center in Saudi Arabia.

MATERIALS AND METHODS:

This cross-sectional study was conducted among all diabetic children treated at King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. Data were retrieved and analysed during the period from September to December 2018. Diabetic patients of <18 years and who were being followed up at KFMC were included in the study. Data on age, sex, duration of illness, associated comorbidities, antidiabetic regimen, and HbA1c levels were obtained. Student t-test was used to compare quantitative parameters between two groups, and Chi-square employed to test for associations between categorical variables at 5% significance level.

RESULTS:

A total of 510 patients of were included in the study; about 53% were females. The mean HbA1c level was 10.6% and females showed higher HbA1c levels. Data showed a strong correlation between age and HbA1c levels (P < 0.001), with older patients showing higher HbA1c levels. The HbA1c levels also increased as the duration of disease increased. The median number of patient visits to KFMC was two per year. No statistically significant differences were observeed for type of treatment for diabetes. Celiac disease, the most frequent comorbidity, was seen in 50% of patients.

CONCLUSION:

Diabetic children who were followed up at KFMC had high HbA1C level (10.6%), and lower than recommended follow-up visits per year. The treating physicians should educate patients and their legal guardians on the importance of follow-up visits and their role in controlling HbA1C levels, and following healthier lifestyle.

Increasing waist circumference is associated with decreased levels of glycated albumin

BACKGROUND

Glycated albumin (GA) levels are affected by body fat and its distribution. We explored the association of waist circumference (WC) with GA and to assess the extent to which WC influences GA.

METHODS

We recruited 1799 subjects (age 26-82 y) from communities. GA was determined using the enzyme method, and glycated hemoglobin A_1c (HbA_1c) was detected using high-performance liquid chromatography.

RESULTS

Subjects with central obesity had lower GA and GA/HbA_1c than those without (both P < .01). GA and GA/HbA_1c were negatively correlated with central obesity (both P < .01), whereas HbA_1c was not correlated (P = .833). In the euglycemic and hyperglycemic subpopulations, GA and GA/HbA_1c showed decreasing trends as WC levels increased (both P for trends <0.01). WC was a significant negative determinant of GA (P < .05). In the hyperglycemic subpopulation, the GA value decreased by approximately 0.15% for each 5 cm increment in WC regardless of the presence of central obesity.

CONCLUSIONS

The GA value was reduced by approximately 0.15% for each 5 cm increment in WC, suggesting that more attention should be paid to actual blood glucose underestimated by GA in obese people.