title: Serum Glycated Albumin to Guide the Diagnosis of Diabetes Mellitus.
abstract: In the diagnosis of diabetes mellitus, hemoglobin A1c (HbA1c) is sometimes measured to determine the need of an oral glucose tolerance test (OGTT). However, HbA1c does not accurately reflect glycemic status in certain conditions. This study was performed to test the possibility that measurement of serum glycated albumin (GA) better assesses the need for OGTT. From 2006 to 2012, 1559 subjects not known to have diabetes or to use anti-diabetic medications were enrolled. Serum GA was measured, and a 75-g OGTT was then performed to diagnose diabetes. Serum GA correlated significantly to age (r = 0.27, p<0.001), serum albumin (r = -0.1179, age-adjusted p = 0.001), body mass index (r = -0.24, age-adjusted p<0.001), waist circumference (r = -0.16, age-adjusted p<0.001), and plasma GA (r = 0.999, p<0.001), but was unaffected by diet (p = 0.8). Using serum GA at 15% for diagnosis of diabetes, the sensitivity, specificity, and area under the receiver-operating characteristic curve were 74%, 85%, and 0.86, respectively. Applying a fasting plasma glucose (FPG) value of < 100 mg/dL to exclude diabetes and of ≥ 126 mg/dL to diagnose diabetes, 14.4% of the study population require an OGTT (OGTT%) with a sensitivity of 78.8% and a specificity of 100%. When serum GA value of 14% and 17% were used to exclude and diagnose diabetes, respectively, the sensitivity improved to 83.3%, with a slightly decrease in specificity (98.2%), but a significant increase in OGTT% (35%). Using combined FPG and serum GA cutoff values (FPG < 100 mg/dL plus serum GA < 15% to exclude diabetes and FPG ≥ 126 mg/dL or serum GA ≥ 17% to diagnose diabetes), the OGTT% was reduced to 22.5% and the sensitivity increased to 85.6% with no change in specificity (98.2%). In the diagnosis of diabetes, serum GA measurements can be used to determine the need of an OGTT.
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wan-Chen
authors.initials: WC
authors.lastname: Wu
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan.
authors.forename: Wen-Ya
authors.initials: WY
authors.lastname: Ma
authors.affiliation: Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Jung-Nan
authors.initials: JN
authors.lastname: Wei
authors.affiliation: Department of Health Management Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Tse-Ya
authors.initials: TY
authors.lastname: Yu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Mao-Shin
authors.initials: MS
authors.lastname: Lin
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shyang-Rong
authors.initials: SR
authors.lastname: Shih
authors.affiliation: Division of Clinical Pathology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
authors.forename: Cyue-Huei
authors.initials: CH
authors.lastname: Hua
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ying-Jhu
authors.initials: YJ
authors.lastname: Liao
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Lee-Ming
authors.initials: LM
authors.lastname: Chuang
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hung-Yuan
authors.initials: HY
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D001786:Blood Glucose; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012709:Serum Albumin; 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