Abstract
AimSerum albumin concentration is associated with both type 2 diabetes and metabolic syndrome (MetS). We sought to investigate whether baseline serum albumin and change in serum albumin could be independent risk factors for prediabetes in subjects without MetS. We further examined the effect of serum albumin on progression to overt diabetes in subjects who developed prediabetes.MethodsAmong 10,792 participants without diabetes and MetS who consecutively underwent yearly health check-ups over six years, 9,807 subjects without incident MetS were enrolled in this longitudinal retrospective study. The risk of developing prediabetes (impared fasting glucose or hemoglobin A1c) was analyzed according to baseline and percent change in serum albumin concentration using Cox regression analysis. Serial changes in serum albumin concentration were measured from baseline to one year before prediabetes diagnosis, and then from the time of prediabetes diagnosis to progression to overt diabetes or final follow-up.ResultsA total of 4,398 incident cases of prediabetes developed during 35,807 person-years (median 3.8 years). The hazard ratio for incident prediabetes decreased as percent change in serum albumin concentration (quartiles and per 1%) increased in a crude and fully adjusted model. However, baseline serum albumin concentration itself was not associated with prediabetic risk. Serum albumin levels kept increasing until the end of follow-up in prediabetic subjects who returned to normal glycemic status, whereas these measures did not change in prediabetic subjects who developed type 2 diabetes. Serum albumin concentration measured at the end of follow-up was the highest in the regression group, compared to the stationary (p = 0.014) or progression groups (p = 0.009).ConclusionsIncrease in serum albumin concentration might protect against early glycemic deterioration and progression to type 2 diabetes even in subjects without MetS.
Highlights
Serum albumin is the most abundant plasma protein and it provides oncotic pressure, transports bilirubin and other hormones [1], and serves as an extracellular antioxidant agent [2,3,4]
The hazard ratio for incident prediabetes decreased as percent change in serum albumin concentration increased in a crude and fully adjusted model
Baseline serum albumin concentration itself was not associated with prediabetic risk
Summary
Serum albumin is the most abundant plasma protein and it provides oncotic pressure, transports bilirubin and other hormones [1], and serves as an extracellular antioxidant agent [2,3,4]. Based on the potential antioxidant properties of serum albumin, emerging evidence indicates that serum albumin concentration might be associated with metabolic disorders such as type 2 diabetes and metabolic syndrome (MetS). Low serum albumin concentration enhanced the risk for incident type 2 diabetes [5,6,7]; inverse correlations have been reported as well [8]. Previous studies that investigated associations between serum albumin and diabetes included subjects with MetS at baseline or incident MetS during the follow-up period, indicating that some portion of the included participants was already susceptible to developing type 2 diabetes, or that independent association between serum albumin and diabetes was partially interrupted by incident MetS before diabetes development. The association between serum albumin and glycemic alteration in subjects without evident insulin resistance has rarely been examined
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