Serum glycated albumin to haemoglobin A1C ratio can distinguish fulminant type 1 diabetes mellitus from type 2 diabetes mellitus

Abstract

Fulminant type 1 diabetes mellitus (FT1DM), a subtype of type 1 diabetes mellitus, was first reported as a disease entity in 2000. Ketoacidosis at initial onset due to acute pancreatic cell destruction makes early diagnosis and treatment for FT1DM mandatory. In the early period of FT1DM, haemoglobin (Hb)A(1C) levels are not markedly elevated. This study investigated serum glycated albumin (GA), which reflects acute short-term changes in plasma glucose, as a new clinical index for FT1DM at disease onset. Subjects comprised 35 patients with FT1DM who had undergone measurement of HbA(1C) and serum GA at initial visit and 42 patients with type 2 diabetes mellitus (T2DM) with HbA(1C) <8.5% and no history of diabetes treatment as controls. HbA(1C) was significantly lower in FT1DM than in T2DM, whereas serum GA was significantly higher. GA/HbA(1C) ratio was thus significantly higher in FT1DM than in T2DM (3.9 +/- 0.5 versus 2.8 +/- 0.3; P < 0.0001). GA/HbA(1C) ratio was >3.2 in 41 of 42 FT1DM patients (98%), compared with only one of 32 T2DM patients (3%). Serum GA is significantly higher in FT1DM than in T2DM, whereas HbA(1C) is significantly lower. FT1DM can thus be distinguished from untreated T2DM by GA/HbA(1C) ratio at initial visit before treatment for diabetes.