Use of glycated albumin to distinguish occult diabetes mellitus from stress-induced hyperglycemia in Chinese orthopedic trauma patients.
BACKGROUND
Some nondiabetic trauma patients with hyperglycemia have been found to have occult diabetes mellitus (ODM). We studied whether glycated albumin (GA) was an effective tool for detecting ODM in orthopedic trauma patients with elevated glucose levels.


METHODS
A cross-sectional, sequential case series study of adult patients presenting to the Orthopedic Trauma Center between September 2009 and March 2010 with new limb fractures was performed. Hemoglobin A1c (HbA1c) and GA levels were measured in hyperglycemic patients with no prior diabetes mellitus. A receiver operating characteristic curve was plotted to examine the sensitivity, specificity, and positive and negative predictive values of GA in identifying occult diabetes in hospitalized patients with acute hyperglycemia.


RESULTS
A total of 2,058 trauma patients were screened and 399 patients (19.4%) with no known diabetes mellitus were noted to be hyperglycemic. Of these 399 patients, 38.3% (n = 153) had ODM according to the HbA1c diagnosis cutoff point. GA level was strongly correlated with HbA1c using Pearson's correlation analysis (r = 0.887, p < 0.01). Using logistic regression analysis, GA (odds ratio [OR] = 1.60, p < 0.001) and fasting plasma glucose (OR = 1.974, p < 0.001) were identified as significant risk factors for the diagnosis of ODM. Receiver operating characteristic curve analysis showed that a GA value of 17.5% gave an optimal sensitivity of 73.20% and specificity of 99.12% for distinguishing ODM from stress-induced hyperglycemia.


CONCLUSIONS
Almost 40% of nondiabetic orthopedic trauma patients presenting with hyperglycemia were found to have ODM. A GA value of 17.5%, the optimal cutoff point, could distinguish between ODM and stress-induced hyperglycemia in Chinese orthopedic trauma subjects.


METHODS
II, diagnostic study.
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Jiemin
J
Pan
Jian
J
Zou
Yuqian
Y
Bao
Lei
L
Zhang
Junfeng
J
Han
Junling
J
Tang
Xiaojing
X
Ma
Qing
Q
Li
Weiping
W
Jia
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D017127:Glycation End Products, Advanced; D006031:Glycosylation; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism*; D013314:Stress, Mechanical; D014193:Trauma Centers; D000093423:Glycated Serum Albumin
D001786:Blood Glucose; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin