Glycated Albumin Levels Research Articles

Usefulness of Glycated Albumin Levels in Predicting the Maternal or Neonatal Complications of Gestational Diabetes Mellitus during Late Pregnancy in South Korea: A Retrospective Study.

Gestational diabetes can lead to complications in pregnant women and neonates. Maternal glycated albumin levels during late pregnancy may help predict complications in both mothers and neonates. This study was conducted in 120 singleton pregnant women diagnosed with gestational diabetes who visited Trinium Woman's Hostipal between July 1, 2020, and June 30, 2022. In this study, the patients' medical records were retrospectively analyzed. Gestational diabetes was diagnosed using a two-step testing method, and glycated albumin tests were performed during the third trimester of pregnancy. The optimal cutoff value of glycated albumin for predicting maternal complications during pregnancy and neonatal complications was determined using the receiver operating characteristic curve. A total of 45 patients developed maternal complications, with cesarean section (39 patients) due to fetal cephalopelvic disproportion being the most common. As for the neonatal complications, eight neonates were macrosomic or overweight, while 15 neonates required neonatal intensive care unit admission. Additionally, 13 patients had concurrent complications affecting both the mother and neonate. The glycated albumin level in patients with complications was 12.87%, which was significantly higher than that in patients without complications (glycated albumin, 11.67%) (P<0.001). The optimal cutoff value of glycated albumin for predicting maternal and neonatal complications was 12.45%. The sensitivity, specificity, and Youden index were 66.7 %, 86.7%, and 0.534, respectively. The third trimester glycated albumin test in mothers with gestational diabetes provides limited predictive value for maternal and neonatal complications.

5176 Time In Range Preferred Over A1c And Fructosamine To Monitor Glycemic Control In Sickle Cell Disease

Abstract Disclosure: A. Patel: None. B. Simon: None. Introduction: In sickle cell disease, hemoglobin A1c is unreliable due to anemia, hemolysis, transfusions, and increased red blood cell turnover. In this population, plasma glucose should be used to make a diagnosis of diabetes, but there are no reliable long-term measures of glycemic control. Measures of serum protein glycation such as fructosamine are often used as markers of short-term control[1]. Continuous glucose monitoring (CGM) time in range (TIR) may offer another more reliable metric of control in this population2. Case: A 58-year-old male presented to the office for uncontrolled type 2 diabetes mellitus. His medical history included sickle cell anemia (Hb SS disease), hypertension, monoclonal gammopathy, and priapism. He was diagnosed with type 2 diabetes mellitus approximately one year prior based on a fructosamine level of 470 umol/L (0-285 umol/L) and elevated fasting glucose level of 128 mg/dL. He started metformin 500 mg daily. Three months later, repeat fructosamine was 401 umol/L, and metformin was increased. Months later, fructosamine levels remained elevated at 419 umol/L; metformin was increased to 2 grams daily and he was referred to endocrinology. The patient was given a CGM (Freestyle Libre 2 system, Abbott Diabetes Care) as an additional method to assess control. CGM showed an excellent 2-week TIR (70-180mg/ dL) of 98%. Repeat fructosamine after 2 weeks of CGM wear was elevated at 500 umol/L. It was hypothesized that the history of IgG kappa monoclonal gammopathy was falsely elevating his fructosamine level. A glycated albumin level was 13.5% (10.7-13.5%). The patient was advised to discontinue his metformin. Four months later, his glycated albumin remained in range, and a 2-week TIR was 100%. Discussion: This case demonstrates how sickle cell disease and monoclonal gammopathy affect laboratory values typically used to diagnose and monitor type 2 diabetes. Fructosamine, a measure of non-enzymatic glycation of serum proteins, is non-specific2. Increased protein from monoclonal gammopathy (giving more protein glycation sites) was the probable cause of the persistently elevated fructosamine, leading to overtreatment of what may not have been a true diagnosis of diabetes. This case also demonstrates the value of CGM, with glucose values and TIR indicating near normoglycemia. Diagnostic CGM may be a useful measure of glucose control in patients with hemoglobinopathies.

Salivary glycated albumin could be as reliable a marker of glycemic control as blood glycated albumin in people with diabetes

AimsMeasurements of diabetes-related biomarkers are necessary to assess glycemic control. The commonly used finger-prick blood glucose and HbA1c measurements are invasive, as is blood glycated albumin (GA) measurement. Therefore, we developed a non-invasive method, namely, measurement of the salivary GA with high accuracy using a high-performance liquid chromatography (HPLC) method. MethodsWe recruited participants with diabetes mellitus admitted to The University of Tokyo Hospital. Blood and saliva samples were collected at three time points (fasting and 2-hour postprandial at admission and fasting at discharge). After partial purification using an antibody-based column, the samples were subjected to GA measurement by HPLC method. ResultsAmong the 56 participants with diabetes mellitus enrolled in the study, there was a correlation between the GA levels measured in blood and saliva at the three time points described above (n = 45, R2 = 0.985, P < 0.001; n = 48, R2 = 0.973, P < 0.001; n = 51, R2 = 0.979, P < 0.001). Multiple regression analysis revealed the associations were maintained even after adjustments for age, BMI, and nephropathy stage. ConclusionsThis exploratory research revealed that the salivary GA levels by this method were accurate and might be able to replace blood GA measurement. The home salivary GA measurement is expected to be developed that may reduce the burden and complications in people with diabetes mellitus and improve the quality of life.

Study on the Clinical Application of Nutritional Management Combined with Clinical Monitoring of Glycated Albumin in Diabetic Nephropathy Dialysis Patients

Objective: To explore the clinical application of nutritional management combined with clinical monitoring of glycated albumin (GA) in diabetic nephropathy (DN) dialysis patients. Methods: A total of 20 diabetic nephropathy dialysis patients admitted to the People’s Hospital of Guandu District from January 2022 to February 2023 were included in the study. They were randomly divided into a conventional group (n = 10) and an observation group (n = 10). The study evaluated the blood glucose control, nutritional status, dialysis efficacy, and quality of life scores of both groups. Results: Before the intervention, there were no significant differences in fasting plasma glucose (FPG), GA, serum albumin, body mass index (BMI), dialysis efficiency values, urea clearance rate, or quality-of-life scores between the two groups (P &gt; 0.05). After the intervention, the observation group showed significantly lower FPG and GA levels, higher serum albumin, dialysis efficiency values, urea clearance rate, and improved quality-of-life scores compared to the conventional group (P &lt; 0.05), with no difference in BMI (P &gt; 0.05). Conclusion: Nutritional management combined with clinical monitoring of glycated albumin has a significant effect on the clinical application of diabetic nephropathy dialysis patients. It can effectively improve patients’ blood glucose control and nutritional status, reduce the risk of complications, and enhance the quality of life, demonstrating clinical value for broader application.

Relationship Between Average Glucose Levels and HbA1c Differs Across Racial Groups: A Substudy of the GRADE Randomized Trial.

To determine whether the relationship between average glucose (AG) levels and hemoglobin A1c (HbA1c) differs across racial/ethnic groups. We performed a prospective substudy of GRADE, a comparative effectiveness randomized trial conducted in 36 centers in the U.S. A total of 1,454 of the 5,047 participants in the GRADE cohort, including 534 non-Hispanic White (NHW), 389 non-Hispanic Black (NHB), and 327 Hispanic White patients and 204 patients of other racial/ethnic backgrounds, were included in the substudy. Continuous glucose monitoring (CGM) performed for 10 days was used to calculate AG10. Immediately after CGM, HbA1c and glycated albumin were measured. Fasting plasma glucose (FPG) and glucose area under the curve (AUC) were derived from a 75-g oral glucose tolerance test. The relationship between AG10 and HbA1c was significantly different for NHB compared with NHW patients and those of other racial/ethnic groups. HbA1c levels were 0.2-0.6 percentage points higher in NHB than in NHW patients for AG10 levels from 100 to 250 mg/dL. For an HbA1c of 7%, AG10 was 11 mg/dL higher for NHW than for NHB patients. Similar findings were observed across races for relationships of FPG and AUC with HbA1c and for glucose measurements with glycated albumin levels. Differences in the relationship between AG10 and HbA1c across racial groups remained after adjustments for any demographic or other differences between racial/ethnic subgroups. The relationship between several measures of glucose with HbA1c and glycated albumin consistently differed across races. These findings should be considered in setting treatment goals and diagnostic levels.

Glucose metabolism and smaller hippocampal volume in elderly people with normal cognitive function

We investigated associations of glycemic measures, and insulin resistance and secretion measures with hippocampal and subfield volumes. In this cross-sectional study, 7400 community-dwelling participants underwent brain MRI and health checkups between 2016 and 2018. Hemoglobin A1c (HbA1c), glycated albumin (GA), homeostasis model assessment for insulin resistance (HOMA-IR), and HOMA of percent β-cell function (HOMA-β) were evaluated. The associations of each measure with a smaller volume of the hippocampus and twelve hippocampal subfields were investigated. As a result, higher HbA1c or GA and lower HOMA-β levels were significantly associated with smaller volumes in multiple hippocampal subfields. Furthermore, even when we analyzed non-diabetic individuals, substantial associations remained between higher GA or lower HOMA-β levels and smaller volumes of the whole hippocampus or the fimbria. Our findings indicate that postprandial glucose fluctuations, postprandial hyperglycemia, and low insulin secretion have a specific effect on the development of smaller hippocampal volume, suggesting that primary prevention of diabetes and/or sufficient glucose control are important for the prevention of dementia.

Glycated albumin levels are associated with adverse stroke outcomes in patients with acute ischemic stroke in China.

Glycated albumin (GA) is a biomarker monitoring glycemia 2-4 weeks before stroke onset. This study was designed to explore the association between GA levels with poststroke outcomes in patients with acute ischemic stroke or transient ischemic attack (TIA). Participants with ischemic stroke or TIA who had a baseline GA measurement were included in the Third China National Stroke Registry study. The effect of GA on stroke recurrence, poor functional outcomes, and combined vascular events was examined during the 1-year follow-up period. Multivariate Cox and logistic regression models were performed to evaluate the association. Discrimination tests were used to examine the incremental predictive value of GA when incorporating it into the conventional model. A total of 3861 participants were enrolled. At the 3-month follow-up, the elevated GA level was associated with an increased risk of poor functional outcomes (adjusted odds ratio [OR], 1.45; 95% confidence interval [CI], 1.01-2.09). A similar increase was observed for stroke recurrence (adjusted hazard ratio [HR], 1.56; 95% CI, 1.09-2.24), poor functional outcomes (adjusted OR, 1.62; 95% CI, 1.07-2.45), and combined vascular events (adjusted HR, 1.55; 95% CI, 1.09-2.20) at the 1-year follow-up. In nondiabetic patients, the association between GA and poor functional outcomes was more pronounced (adjusted OR, 1.62; 95% CI, 1.05-2.50). Adding GA into the conventional model resulted in slight improvements in predicting poor functional outcomes (net reclassification improvement [NRI]: 12.30% at 1 year). This study demonstrated that elevated GA levels in serum were associated with stroke adverse outcomes, including stroke recurrence, poor functional outcomes, and combined vascular events, in patients with ischemic stroke or TIA.

Glycated albumin may have a complementary role to glycated hemoglobin in glucose monitoring in childhood acute leukemia.

Glycated hemoglobin (HbA1c) as a glycemic index may have limited value in pediatric patients with acute leukemia as they often present with anemia and/or pancytopenia. To address this issue, we evaluated the usefulness of glycated albumin (GA) as a glycemic monitoring index in pediatric patients with acute leukemia. Medical records of 25 patients with type 2 diabetes mellitus (T2DM), 63 patients with acute leukemia, and 115 healthy children from Seoul St. Mary's Hospital, The Catholic University of Korea, were retrospectively investigated for serum GA, HbA1c, and fasting blood glucose (FBG) levels, along with demographic data. GA, HbA1c, and FBG levels did not differ between the control and acute leukemia groups. In the T2DM group, positive correlations were observed among GA, HbA1c, and FBG (P<0.01). Although GA level was not associated with the HbA1c level in the control group, GA and HbA1c levels showed a positive correlation in the acute leukemia group (P=0.045). Regression analysis revealed GA and HbA1c levels to be positively correlated in the acute leukemia and T2DM groups even after adjusting for age, sex, and body mass index z-score (P=0.007, P<0.01). GA may be a useful complementary parameter to HbA1c for glycemic monitoring in pediatric patients with acute leukemia, similar to its use in patients with T2DM.

Circulating glycated albumin levels and gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is characterized by glucose intolerance that is first diagnosed during pregnancy, making it the most common complication associated with this period. Early detection and targeted treatment of GDM can minimize foetal exposure to maternal hyperglycaemia and subsequently reduce the associated adverse pregnancy outcomes. Previous studies have inconsistently suggested that the level of glycated albumin (GA) might predict GDM. To review and synthesize existing evidence to evaluate the relationship between GA levels and the development of GDM. We sought to compare GA levels between GDM and control groups in this meta-analysis by systematically searching the Web of Science, PubMed, Cochrane Library, and Embase databases for articles published up to June 2023. The analysis utilized the weighted mean difference (WMD) as the primary metric. The data were meticulously extracted, and the quality of the included studies was assessed. Additionally, we conducted a subgroup analysis based on study region and sample size. We assessed heterogeneity using I 2 statistics and evaluated publication bias through funnel plots. Additionally, trim-and-fill analysis was employed to detect and address any potential publication bias. The meta-analysis included a total of 11 studies involving 5477 participants, comprising 1900 patients with GDM and 3577 control individuals. The synthesized results revealed a notable correlation between elevated GA levels and increased susceptibility to GDM. The calculated WMD was 0.42, with a 95% confidence interval (95%CI) ranging from 0.11 to 0.74, yielding a P value less than 0.001. Concerning specific GA levels, the mean GA level in the GDM group was 12.6, while for the control group, it was lower, at 11.6. This discrepancy underscores the potential of GA as a biomarker for assessing GDM risk. Moreover, we explored the levels of glycated haemoglobin (HbA1c) in both cohorts. The WMD for HbA1c was 0.19, with a 95%CI ranging from 0.15 to 0.22 and a P value less than 0.001. This observation suggested that both GA and HbA1c levels were elevated in individuals in the GDM group compared to those in the control group. Our meta-analysis revealed a substantial correlation between elevated GA levels and increased GDM risk. Furthermore, our findings revealed elevated levels of HbA1c in GDM patients, emphasizing the significance of monitoring both GA and HbA1c levels for early GDM detection and effective management.

Periodontal tissue susceptibility to glycaemic control in type 2 diabetes.

To assess the direct effect of intensive glycaemic control on periodontal tissues in patients with diabetes mellitus. Twenty-nine patients with type 2 diabetes were enrolled and hospitalized to receive a 2-week intensive glycaemic control regimen. We observed and analysed the systemic and oral disease indicators before and after treatment and clarified the indicators related to periodontal inflammation. A significant reduction in glycaemic and periodontal parameters, including glycated albumin levels and periodontal inflamed surface area (PISA), was observed after treatment. The changes in PISA per tooth, indicative of periodontal healing, exhibited a bimodal distribution; the patients were divided into two groups on this basis. Correlations were observed between the changes in PISA per tooth and fasting plasma glucose, acetoacetic acid, and beta-hydroxybutyrate levels in the PISA-improved group. Significantly lower levels of C-peptide, coefficient of variation of R-R interval, and ankle-brachial pressure index were observed before treatment in the PISA non-improved group. Glycaemic control treatment can effectively improve periodontitis in patients with type 2 diabetes, even in the absence of specific periodontal treatments. However, the periodontal responsiveness to glycaemic control treatment depends on the systemic condition of the patient.

Association between glycated albumin and adverse outcomes in patients with heart failure.

Diabetes mellitus is a traditional risk factor for heart failure (HF), and glycated albumin (GA) is a marker to assess short-term glycemic control. Whether GA has prognostic significance in patients with HF remains unclear. A total of 717 patients with HF were enrolled in the prospective cohort study. Patients were grouped by the normal upper limit of GA (17%). Kaplan-Meier analysis and Cox proportional hazards regression were used to evaluate the association between GA and prognosis. During a mean follow-up of 387 days, 232 composite endpoint events of hospitalization for HF or all-cause death occurred. Kaplan-Meier analysis showed a higher rate of adverse events in the higher GA group (GA >17%; log-rank test P < 0.001). GA was an independent predictor of adverse events, both as a continuous variable (per 1% change: hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.00-1.06, P = 0.030) and as a categorical variable (GA >17%: HR 1.36, 95% CI 1.03-1.80, P = 0.032). Restricted cubic splines showed a linear association between GA and adverse events (P for non-linearity = 0.231). There was no significant difference in adverse outcome risk between those with diabetes and GA ≤17% and those without diabetes, whereas the prognosis was worse in those with diabetes and GA >17% (HR 1.56, 95% CI 1.16-2.11, P = 0.004). Compared to the group with normal levels of GA and glycated hemoglobin, the group with GA >17% and glycated hemoglobin >6.5% had a higher risk of adverse events (HR 1.49, 95% CI 1.06-2.10, P = 0.022). GA was an independent predictor of HF prognosis. Combining GA and glycated hemoglobin might improve the predictive power of adverse outcomes in patients with HF.

Efficacy of Self-Review of Lifestyle Behaviors with Once-Weekly Glycated Albumin Measurement in People with Type 2 Diabetes: A Randomized Pilot Study.

Lifestyle management, including appropriate modifications of nutrition, exercise, and medication behaviors, is essential for optimal glycemic control. The absence of appropriate monitoring methods to validate the lifestyle change may hinder the modification and continuation of behaviors. In this study, we evaluated whether once-weekly glycated albumin (GA) measurement received via a smartphone application could improve glycemia management in patients with type 2 diabetes mellitus by supporting self-review and modification of lifestyle behaviors. This open-label, randomized controlled, single-center study in Japan with an 8-week intervention period was conducted in individuals with type 2 diabetes mellitus and HbA1c levels between 7.0 and 9.0% (53‒75mmol/mol). The intervention was once-weekly home monitoring of GA with a daily self-review of lifestyle behaviors using a smartphone application, in addition to conventional treatment. A total of 98 participants (72.0% males; age 63.2 ± 11.4years; HbA1c 7.39 ± 0.39% [57.3 ± 4.3mmol/mol]) were randomly assigned to the intervention or control group. Significant decreases of the GA and HbA1c levels from the baseline to the last observation day were observed in the intervention group (- 1.71 ± 1.37% [- 39.1 ± 31.3mmol/mol] and - 0.32 ± 0.32% [- 3.5 ± 3.5mmol/mol], respectively). Significant decreases of the body weight, waist circumference, and caloric expenditure (p < 0.0001 and p = 0.0003, p = 0.0346, respectively), but not of the caloric intake (p = 0.678), were also observed in the intervention group as compared with the control group. Self-review of lifestyle behaviors in combination with once-weekly GA home testing received via a smartphone application might potentially benefit glycemic management in people with type 2 diabetes mellitus. jRCTs042220048.

Test characteristics of glycated albumin in the diagnosis of gestational diabetes mellitus

This study determined the test characteristics of glycated albumin in the diagnosis of gestational diabetes mellitus. The gold standard for diagnosing gestational diabetes mellitus is the oral glucose tolerance test which requires patient preparation, drinking of glucose solution, and multiple sample collections. A possible alternative biomarker for the diagnosis of gestational diabetes is glycated albumin does not require patient preparation and only one sample is collected. Glycated albumin levels are higher among Black Americans than in Caucasians.The study involved 200 pregnant women attending the antenatal clinic at the University of Port Harcourt Teaching Hospital. The diagnosis of gestational diabetes mellitus was made using the World Health Organization 2013 diagnostic criteria. The test characteristics of glycated albumin were determined using the area under the curve of the receiver operator characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value. The prevalence of gestational diabetes mellitus was 9.0%. The area under the receiver operator characteristic curve for glycated albumin was 0.8 (95% CI 0.7-0.9; p=0.0001). The sensitivity and specificity of glycated albumin were 83.3% and 86.8% respectively. The positive predictive value was 38.5% and the negative predictive value was 98.1%. Glycated albumin has high sensitivity, specificity, and negative predictive values and therefore, can be used as a preliminary test for gestational diabetes mellitus.

The Effect of Moringa Leaf Ethanol Extract with Glycated Albumin in Wistar Rats Type 2 Diabetes Mellitus Model

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by elevated plasma glucose levels. Gold standard of DM diagnosis is through HbA1c examination. The American Diabetes Association (ADA) and European Association Diabetes Study (EASD) recommend glycated albumin as an alternative biomarker in diagnosing DM. One of the DM therapies can use herbal plants, namely Moringa (Moringa oleifera Lam.). This study aimed to determine the effect of ethanol extract of Moringa leaves (Moringa oleifera Lam.) on glycated albumin levels in wistar strain white rats (Rattus norvegicus) model of diabetes mellitus induced by streptozotocin-nicotinamide. This is an experimental research with post test control group method. Subjects were 36 rats divided into 6 groups. At the end of the study, rats were examined for GA levels using the ELISA method. Data were analyzed using JASP and One-Way Anova test followed by post hoc test. The lowest reduction in glycated albumin levels was found in the group of rats given 300 mg of Moringa leaf ethanol extract (34,397±2,564). One-way anova test showed a significant difference (p&lt;0.05), post hoc test obtained significant differences in each group (p&lt;0.05). There is an effect of moringa leaf ethanol extract on glycated albumin levels in white rats (Rattus norvegicus) model of diabetes mellitus induced by streptozotocin-nicotinamide.

Baseline glycated albumin level and risk of type 2 diabetes mellitus in Healthy individuals: a retrospective longitudinal observation in Korea

Glycated albumin (GA) reflects glycemic status for the past three weeks. GA level demonstrates a strong correlation with HbA1c level and is used as an adjunctive biomarker for diagnosis and monitoring of type 2 diabetes mellitus (T2DM). In this study, we validated the predictive performance of baseline GA for development of T2DM in healthy individuals in Korea. From August 2013 to September 2014, the medical records of 3,771 healthy Koreans were retrospectively reviewed. Each participant was categorized into tertiles based on initial GA level. During the follow-up period through May 2020, study participants were evaluated for T2DM using HbA1c, fasting glucose level, and a self-reported diagnosis history. Baseline GA level by tertile (T1 to T3) was 10.4 ± 0.8% (mean ± SD), 12.1 ± 0.3%, and 13.7 ± 0.9%, respectively. The median follow-up was 5.97 years, during which 4.9% (186 of 3,771) of the participants developed T2DM. After adjusting for confounding factors, the hazard ratio for the development of T2DM in the highest GA level group (T3) compared to the reference group (T1) was 2.46 (95% CI, 1.7 to 3.58, p < 0.001 for trend) with a Harrell’s C index of 0.80 (95% CI, 0.76 to 0.83). Also, within highest group of baseline HbA1c and FG levels, higher GA levels were associated with an increased HRs for T2DM. In conclusion, Our study confirms that the risk of T2DM increases with baseline GA level. Additional follow-up of the cohort is warranted to investigate the correlations between GA and other clinical indicators including diabetic complications.

Utilize multi-metabolic parameters as determinants for prediction of skeletal muscle mass quality in elderly type2 diabetic Chinese patients

BackgroundSarcopenia, an age-related disorder characterized by loss of skeletal muscle mass and function, is recently recognized as a complication in elderly patients with type 2 diabetes mellitus (T2DM). Skeletal muscles play a crucial role in glycemic metabolism, utilizing around 80% of blood glucose. Accordingly, we aimed to explore the relationship between glucose metabolism and muscle mass in T2DM.MethodsWe employed the AWGS 2019 criteria for diagnosing low muscle mass and 1999 World Health Organization (WHO) diabetes diagnostic standards. This study included data of 191 individuals aged 60 and above with T2DM of Shanghai Pudong Hospital from November 2021 to November 2022. Fasting C-peptide (FPCP), fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (PPG) and postprandial 2-hour C-peptide (PPCP), glycated hemoglobin A1c (HbA1c), glycated albumin (GA), serum lipids spectrum, renal and hepatic function, hemoglobin, and hormone were measured. Based on the findings of univariate analysis, logistic regression and receiver operating characteristic (ROC) curves were established.ResultsParticipants with low muscle mass had significantly lower alanine and aspartate aminotransferase, and both FPCP and PPCP levels (P < 0.05). Compared with those without low muscle mass, low muscle mass group had significantly higher FPG, HbA1c, GA levels (P < 0.05). Body fat (BF, OR = 1.181) was an independent risk factor for low muscle mass. PPCP (OR = 0.497), BMI (OR = 0.548), and female (OR = 0.050) were identified as protective factors for low skeletal muscle. The AUC of BMI was the highest, followed by the PPCP, gender and BF (0.810, 0.675, 0.647, and 0.639, respectively), and the AUC of the combination of the above four parameters reached 0.895.ConclusionsIn this cross-sectional study, BMI, Female, and PPCP associated with T2DM were protective factors for low muscle mass. BF was associated with T2DM and risk factor for low muscle mass.

Glycated Albumin and Adverse Clinical Outcomes in Patients With CKD: A Prospective Cohort Study

Rationale & ObjectiveHbA1c is widely used to estimate glycemia, yet it is less reliable in patients with chronic kidney disease (CKD). There is growing interest in the complementary use of glycated albumin (GA) to improve glycemic monitoring and risk stratification. However, whether GA associates with clinical outcomes in a non-dialysis dependent CKD population remains unknown. Study DesignProspective cohort study. Setting& Participants: 3110 participants with CKD from the Chronic Renal Insufficiency Cohort study. ExposureBaseline GA levels. OutcomesIncident end-stage kidney disease (ESKD), cardiovascular disease (CVD) events, and all-cause mortality. Analytical ApproachCox proportional hazards regression. ResultsParticipant characteristics included mean age 59.0 (SD 10.8) years; 1357 (43.6%) female; 1550 (49.8%) with diabetes. The median GA was 18.7 (interquartile range, 15.8-23.3)%. During an average 7.9-year follow-up, there were 980 ESKD events, 968 CVD events, and 1084 deaths. Higher GA levels were associated with greater risks of all outcomes, regardless of diabetes status: hazard ratios for ESKD, CVD, and death among participants with the highest quartile compared with quartile 2 (reference) were 1.42 (95%CI, 1.19-1.69), 1.67 (CI, 1.39-2.01), and 1.63 (CI, 1.37-1.94), respectively. The associations with CVD and death appeared J-shaped, with increased risk also seen at the lowest GA levels. Among patients with coexisting CKD and diabetes, the associations of GA with outcomes remained significant even after adjusting for HbA1c. For each outcome, we observed a significant increase in the fraction of new prognostic information when both GA and HbA1c were added to models. LimitationsLack of longitudinal GA measurements; HbA1c measurements were largely unavailable in participants without diabetes. ConclusionsAmong patients with CKD, GA levels were independently associated with risks of ESKD, CVD, and mortality, regardless of diabetes status. GA added prognostic value to HbA1c among patients with coexisting CKD and diabetes.

Effect of Sugar-Free Jelly on Glycemic Metabolism and Its Potential Health Benefits in Non-Diabetic Adults.

Excessive sugar consumption provides energy but has little nutritional value, contributing to the prevalence of obesity. Hence, "sugar-free" products using artificial or natural sweeteners, including sugar alcohols, have become popular. Accordingly, safety concerns and curiosity have arisen. Therefore, this study used a double-blind, crossover design to compare the effects of commercial sugar-free and sugar jellies (control) on the glycemic response in 16 adults without diabetes. Blood samples were collected to measure blood glucose, insulin, glucagon, ghrelin, C-peptide, glycated hemoglobin, and glycated albumin levels, and an oral glucose tolerance test was performed. Questionnaires on satiety and intestinal health were also administered. Sugar-free jellies resulted in significantly lower glucose and insulin levels and a reduced area under the curve while showing higher glucagon levels than the controls. Moreover, the sugar-free jelly initially resulted in the greater secretion of ghrelin; however, after 2 h, the control jelly resulted in higher ghrelin. No significant differences were observed in gut quotient, C-peptide, glycated hemoglobin, and glycated albumin levels. In conclusion, substituting sugar jelly with sugar-free jelly may induce lower blood glucose and insulin levels and higher glucagon levels, indicating a better ability to control glucose metabolism. Appetite was not stimulated by sugar-free jelly consumption.

Association between glycated albumin and sudden death in patients undergoing hemodialysis

BackgroundThe frequency of sudden death and its risk factors in patients undergoing hemodialysis are unknown. This study was performed to examine the association between glycated albumin (GA) and sudden death in Japanese patients undergoing hemodialysis.MethodsIn total, 260 patients undergoing hemodialysis aged ≥18 years were retrospectively followed for a mean of 4.6 years. The patients’ serum GA levels were divided into tertiles, and the patients’ sex, age, albumin level, C-reactive protein (CRP) level, and cardiothoracic ratio (CTR) were selected as adjustment factors. A logistic regression model was used to calculate the odds ratio (OR) for the occurrence of sudden death by GA level.ResultsNinety-one patients died during follow-up. Of the 91 deaths, 23 (25.2%) were defined as sudden deaths. Compared with non-sudden death cases, sudden death cases were significantly younger (p = 0.002) and had a higher proportion of men (p = 0.03), a higher proportion of diabetes (p = 0.008), and higher GA levels (p = 0.023). Compared with patients with the lowest GA levels (<15.2%), those with the highest GA levels (≥18.5%) had a sex- and age-adjusted OR for sudden death of 5.40 [95% confidence interval (CI): 1.35–21.85]. After adjusting for the albumin level, CRP level, and CTR in addition to sex and age, the OR for sudden death of patients with the highest GA levels increased to 6.80 (95%CI: 1.64–28.08); the relationship did not change.ConclusionSerum GA levels were significantly associated with sudden death in patients undergoing hemodialysis.

Two patients with α-chain hemoglobin variant Hb Q-Iran detected by measuring hemoglobin A1c using the variant mode of the HA-8180V HPLC analyzer.

Hemoglobin variants are often discovered when hemoglobin A1c (HbA1c) levels measured with a high-performance liquid chromatography (HPLC) system in fast mode are found to be low. The HA-8180V HPLC analyzer by Arkray offers two measurement modes: fast mode (FM) and variant mode (VM). Two Japanese patients with α-chain variant Hb Q-Iran detected incidentally after analyses with the HA-8180V in VM showed an abnormal peak, are presented. The first patient was a man in his 70s, and the second patient was a man in his 50s. Both were non-diabetic, but their results from HbA1c measurement in VM showed an abnormal peak. The VM-HbA1c, FM-HbA1c, and HbA1c measured by enzymatic assay and glycated albumin levels of the two patients were all within the reference ranges. They were diagnosed as having Hb Q-Iran (α2-75Asp → His) by globin gene analysis. It is difficult to detect α-chain hemoglobin variants based on abnormal FM-HbA1c levels, but measuring HbA1c in VM is useful for efficiently detecting hemoglobin variants.