2. Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Germany.
Background: Glycated albumin (GA) represents a better marker of glycemic control than HbA1c in patients with renal failure. Studies on the clinical impact of GA in patients with normal or moderately impaired renal function (CKD stages 1-3) are sparse. The present study investigates the relationship between GA and HbA1c in this patient group and the ability of both biomarkers to predict vascular complications.
Methods: A total of 380 type 2 diabetic patients were followed – up during a median time of 4.7 years in a prospective, monocentric cohort study. Following parameters were measured at 6-12 month intervals: GA, HbA1c, NT-pro-BNP and further routine laboratory parameters; clinical status regarding treatment modality and onset of cardiovascular, cerebrovascular, peripheral vascular, renal, and ophthalmological events as well as death by any cause.
Results: GA showed a strong positive correlation with HbA1c (r=0.71, 95% CI 0.61 to 0.75), with little dependence on patient gender, age, renal function and anemia. No association was found between the two biomarkers and risk of cardiovascular and cerebrovascular events. The risk of peripheral vascular events significantly increased with increasing HbA1c (Pval=0.002, HR=1.45) and showed a borderline association with increasing GA (Pval=0.06, HR=1.09). A strong association was found between GA and onset of renal events (Pval=0.01, HR=1.15).
Conclusions: GA and HbA1c measurements are correlated in diabetic patients with CKD stages 1-3. The association with macroangiopathic complications is stronger for HbA1c than for GA values. GA levels predict particularly well renal events.
Keywords: Diabetes, glycated albumin, glycated hemoglobin, cardiovascular complications, diabetic nephropathy, diabetic retinopathy