title: Serum albumin-adjusted glycated albumin reflects glycemic excursion in diabetic patients with severe chronic kidney disease not treated with dialysis.
abstract: OBJECTIVE
  Diabetic patients with severe chronic kidney disease (CKD) not treated with dialysis falsely show low levels of HbA1c and GA due to renal anemia and proteinuria, respectively. Recently, we reported that serum albumin-adjusted GA (adjGA) accurately reflects mean plasma glucose (PG) in these patients. It is considered that GA reflects not only mean PG but also glycemic excursion; therefore, in the present study we investigated whether adjGA reflects glycemic excursion in these patients.
  
  
  METHODS
  Thirty type 2 diabetic patients with severe CKD not treated with dialysis were enrolled in the present study. PG was monitored by seven times a day, and indicators of glycemic excursion [SD, max PG, ΔPG, M value, J index, and mean amplitude of glucose excursion (MAGE)] were calculated. The correlations between HbA1c, GA or adjGA and indicators of glycemic excursion were investigated.
  
  
  RESULTS
  HbA1c showed no significant correlation with indicators of glycemic excursion. GA was significantly correlated with them except for ΔPG. adjGA was significantly and strongly associated with them except for MAGE. GA, but not adjGA, showed a significant positive correlation with serum albumin.
  
  
  CONCLUSIONS
  adjGA was not influenced by serum albumin and showed a significant correlation with indicators of glycemic excursion in diabetic patients with severe CKD not treated with dialysis. These results suggest that adjGA could be useful for indicating glycemic control in diabetic patients with severe CKD not treated with dialysis.
authors.affiliation: Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Fukami
authors.affiliation: Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Shibata
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Nakayama
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan.
authors.forename: Seiya
authors.initials: S
authors.lastname: Okuda
authors.affiliation: Department of Internal Medicine, Kawanishi City Hospital, Hyogo 666-0915, Japan. Electronic address: m-koga@kawanishi-city-hospital.com.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Koga
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D017127:Glycation End Products, Advanced; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis*; D012720:Severity of Illness Index; D000093423:Glycated Serum Albumin
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin
keywords: Diabetic nephropathy; End-stage renal disease; Glycated albumin; Glycemic excursion; HbA1c