Glycated albumin levels in the third trimester of women with gestational diabetes mellitus are associated with adverse pregnancy-related outcomes

BACKGROUND

Glycated albumin (GA) levels have been considered as a promising biomarker for estimating glycemic control during pregnancy, but the relationship between GA levels and the incidence of adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) remains unclear. Our study aimed to investigate the relationship between GA levels during the third trimester and 13 different adverse pregnancy-related outcomes among women with GDM in China.

METHODS

We retrospectively extracted clinical data from the medical records of 819 pregnant women with GDM who underwent prenatal examinations and child delivery at the Affiliated Hospital of Qingdao University between January 2022 and October 2022. The cohort was divided into GA-high (GA-H) and GA-low (GA-L) groups based on the median GA level of 10.6%. Then, the incidence rates of 13 specific adverse pregnancy outcomes were compared between the two groups. Furthermore, we estimated the mean GA levels in pregnant GDM women with or without specific adverse outcomes. Multivariate logistic regression analysis was performed to assess whether the GA levels (high or low) were independent risk factors for specific adverse outcomes in pregnant women with GDM. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of GA levels for the adverse pregnant outcomes in women with GDM. E-value for sensitivity analysis was performed to assess the robustness of the findings to unmeasured confoundings.

RESULTS

We included 819 pregnant women with GDM, whose average age was 33.09 ± 4.47 years, average pre-pregnancy BMI was 23.51 ± 3.67 kg/m2, and the average gestational week in which GDM diagnosed was 24.80 ± 1.79 weeks. The analysis showed that 80.71% (661/819) pregnant women with GDM were associated with adverse pregnancy-related outcomes. Pregnant women in the GA-L group showed higher incidence of the premature rupture of membranes (PROM), whereas those in the GA-H group showed higher incidence of neonatal hypoglycemia. The GA levels showed acceptable clinical performance for predicting neonatal hypoglycemia with an area under the ROC curve (AUC) value of 0.700 (P = 0.010), sensitivity of 71.4%, and specificity of 70.2%. The optimal cut off value for GA was 11.55%.

CONCLUSIONS

This study demonstrated that GA levels were significantly associated with specific adverse pregnancy outcomes, especially PROM and neonatal hypoglycemia. Furthermore, GA levels in the third trimester showed acceptable clinical performance for predicting neonatal hypoglycemia among pregnant women with GDM. In the future, the potential role of GA as a predictor of adverse pregnancy outcomes need to be further confirmed and explored in GDM women.

Glycemic control indicator levels at diagnosis of neonatal diabetes mellitus: Comparison with other types of insulin-dependent diabetes mellitus

BACKGROUND

Neonatal diabetes mellitus (NDM) is a monogenic insulin-dependent diabetes that develops within 6 months of age. The progression of hyperglycemia until diagnosis is unknown. Glycemic control indicators at diagnosis are useful to estimate the extent and duration of hyperglycemia. We recently established that age-adjusted glycated albumin (GA) is a useful indicator of glycemic control, regardless of age.

OBJECTIVE

To compare the levels of various glycemic control indicators at diagnosis between NDM and other types of insulin-dependent diabetes mellitus.

PATIENTS AND METHODS

We included 8 patients with NDM, 8 with fulminant type 1 diabetes (FT1D), and 24 with acute-onset autoimmune type 1 diabetes (T1AD). Plasma glucose, glycated hemoglobin (HbA1c), GA, and age-adjusted GA (calculated as previously reported) were measured and compared.

RESULTS

There were no significant differences in the plasma glucose levels of the group of patients with NDM and those with FT1D or T1AD. HbA1c and GA levels in the NDM group were not significantly different from those in the FT1D group, and both indicators were lower than those in the T1AD group. Age-adjusted GA levels in the NDM group did not differ significantly from those in the T1AD group, but were higher than those in the FT1D group.

CONCLUSIONS

These findings suggest that the time-course of plasma glucose elevation in NDM until diagnosis is similar to that in T1AD. In addition, the high age-adjusted GA value at diagnosis of NDM indicates that this test is useful for assessing chronic hyperglycemia in NDM.

Age-Adjusted Glycated Albumin at Diagnosis is more Correlated with the Product of Age and Plasma Glucose than Plasma Glucose Alone in Patients with Neonatal Diabetes Mellitus

BACKGROUND

We previously showed that glycated albumin (GA) is a useful glycemic control indicator in patients with neonatal diabetes mellitus (NDM), and that age-adjusted GA (Aa-GA) can reflect more accurately glycemic control status. Here, we investigated whether the age at diagnosis influences Aa-GA at diagnosis of NDM.

METHODS

Eight patients with NDM whose GA was measured at diagnosis (age at diagnosis: 39 ± 18 days; GA: 31.3 ± 7.6%; Aa-GA: 47.1 ± 10.3%; plasma glucose: 525 ± 194 mg/dl) were included. Aa-GA was calculated as follows: Aa-GA = GA × 14.0/[1.77 × log-age (days) + 6.65]. Correlations of GA or Aa-GA at diagnosis with its logarithmically transformed age in days (log-age), plasma glucose, and their product were investigated.

RESULTS

GA at diagnosis was not significantly correlated with log-age or plasma glucose. On the other hand, Aa-GA at diagnosis was significantly positively correlated with plasma glucose (R = 0.75, P = 0.031) and was more strongly positively correlated with the product of plasma glucose and log-age (R = 0.82, P = 0.012) although it was not correlated with log-age.

CONCLUSION

Aa-GA at diagnosis is influenced by both age in days and plasma glucose. This finding is likely to show the aspect that age in days is almost equal to diabetes duration because glycemic control indicators including GA reflect the weighted mean of plasma glucose.