Glycated Albumin Correlates Better with A1C than Fructosamine as a Marker of Intermediate Glycemic Control—A Multicenter Prospective Trial

Abstract

To evaluate the clinical utility of Glycated Albumin (GA) as an intermediate-term marker of glycemic control (preceding 2-3 weeks), we compared the correlation and concordance of GA and fructosamine (FRA) with A1C and mean blood glucose (MBG) measurements. One hundred fifty subjects with type 1 (n=73) and type 2 diabetes (n=77) were assigned to Group 1 (n=98, A1C ≥7.5%, prescribed a change in diabetes therapy) and Group 2 (n=52, A1C <7.5%, remained on stable diabetes therapy). Fasting plasma glucose, GA, FRA, and A1C were measured at 0, 1, 2, 3, 4, 6, 8, 12, 16, 20, and 24 weeks. MBG was calculated using weekly 7-point self-monitored blood glucose (SMBG) profiles throughout the study. Continuous glucose monitoring (CGM) was conducted on 30 participants to confirm the accuracy of MBG calculated by SMBG. Across all subjects, GA correlation with FRA was 0.920; the minimum correlation was 0.863. The estimated mean correlations of GA with A1C and MBG were greater than that of FRA as estimated by mean Pearson correlations using the method of Lorenz. The within-subject correlation between GA and FRA was 0.643 and the correlations for GA with A1C and MBG were significantly greater than those observed for FRA (0.585 vs. 0.395 for A1C p<0.001; 0.548 vs. 0.413 for MBG, p<0.001). To further examine the concordance of GA and FRA with A1C and MBG, a comparison of the Pearson correlations demonstrated that in 56% of subjects GA had a higher correlation with both A1C and MBG than FRA, compared to only 4% of subjects where FRA had higher correlations with both. Overall, GA had a higher Pearson correlation with A1C and MBG in 82% and 70% of subjects, respectively. In conclusion, GA may be a more useful diagnostic test than FRA in clinical situations requiring measurement of intermediate-term glycemic control. Disclosure C. Desouza: Consultant; Self; Novo Nordisk A/S, Sanofi. Research Support; Self; Merck & Co., Inc.. Advisory Panel; Self; Medscape. J. Rosenstock: Advisory Panel; Self; Eli Lilly and Company. Consultant; Self; Eli Lilly and Company. Research Support; Self; Novo Nordisk Inc.. Consultant; Self; Novo Nordisk Inc.. Advisory Panel; Self; Sanofi. Consultant; Self; Sanofi. Advisory Panel; Self; Janssen Pharmaceuticals, Inc.. Consultant; Self; Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Consultant; Self; Intarcia Therapeutics, Inc.. Research Support; Self; Merck & Co., Inc., Pfizer Inc., Sanofi, Novo Nordisk Inc., Bristol-Myers Squibb Company, Eli Lilly and Company, Intarcia Therapeutics, Inc., Genentech, Inc. J.P. Frias: Research Support; Self; AbbVie Inc., Allergan, Amgen Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company. Consultant; Self; CeQur Corporation. Research Support; Self; Cirius Therapeutics, AstraZeneca, Calibra Medical, Elcelyx Therapeutics, Inc.. Consultant; Self; Elcelyx Therapeutics, Inc.. Research Support; Self; Eli Lilly and Company, Genentech, Inc., Ionis Pharmaceuticals, Inc., ICON plc., Janssen Pharmaceuticals, Inc.. Consultant; Self; Johnson & Johnson Diabetes Institute, LLC.. Research Support; Self; Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc.. Consultant; Self; Ligand Pharmaceuticals, Inc.. Research Support; Self; Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Pfizer Inc., Sanofi. Consultant; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Theracos, Inc. S. Hsia: Research Support; Self; Tobira Therapeutics, AstraZeneca, Bayer AG, Cirius Therapeutics, Eli Lilly and Company, Intarcia Therapeutics, Inc., Ionis Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc., Merck & Co., Inc., National Institute of General Medical Sciences, PhaseBio Pharmaceuticals, Inc., Sanofi-Aventis, TaiwanJ Pharmaceuticals Co., Ltd., Theracos, Inc., VTV Therapeutics, Bristol-Myers Squibb Company. L.C. Myers: Speaker's Bureau; Self; AstraZeneca, Novo Nordisk Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi-Aventis. E.J. Klein: None. R. Zhou: None. T. Kohzuma: Employee; Self; Asahi Kasei Corporation. V. Fonseca: Consultant; Self; Abbott. Board Member; Self; American Association of Clinical Endocrinologists. Consultant; Self; Eli Lilly and Company. Stock/Shareholder; Self; Amgen Inc.. Consultant; Self; Asahi Kasei Corporation, AstraZeneca, Novo Nordisk Inc., ADOCIA, Intarcia Therapeutics, Inc., Sanofi-Aventis.