title: Variability in glycated albumin levels predicts the progression of diabetic nephropathy.
abstract: OBJECTIVE
  The present study was performed to assess variability in glycated albumin (GA) using a coefficient of variation (CV) to predict the progression of diabetic nephropathy in type 2 diabetic patients, independently of HbA1c and other conventional risk factors.
  
  
  METHODS
  The present study consecutively enrolled 369 patients with type 2 diabetes mellitus from outpatient clinic. During the follow-up period, GA and HbA1c levels were measured repeatedly (≥5 times), and the CV of GA (GA-CV) was calculated for each patient. The patients were divided into two subgroups: Group 1, a MEAN-HbA1c value <7.2% (55mmol/mol); Group 2, a MEAN-HbA1c value ≥7.2% (55mmol/mol). The primary outcome was the renal composite outcome (RCO), which was based on the progression rates of chronic kidney disease and albuminuria and renal death.
  
  
  RESULTS
  The median follow-up period was 33months. The RCO was developed in 109 patients (29.5%). In Group 1, the third highest and highest quartile groups for GA-CV had higher cumulative incidences of the RCO than those of the lowest quartile group (Q4 vs. Q1: HR=5.43, P=0.007, Q3 vs. Q1: HR=5.16, P=0.009). After adjusting for HbA1c levels and other risk factors, the GA-CV remained significantly associated with the development of the RCO. However, Group 2 did not exhibit any significant differences in terms of the cumulative incidence of the RCO among the four GA-CV quartile groups.
  
  
  CONCLUSIONS
  The present findings suggest that variability in GA may be a better predictor of the progression of diabetic nephropathy in type 2 diabetic patients regardless of HbA1c.
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Su Bin
authors.initials: SB
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. Electronic address: injkim@pusan.ac.kr.
authors.forename: In Joo
authors.initials: IJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Yoon Jeong
authors.initials: YJ
authors.lastname: Nam
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Kang Hee
authors.initials: KH
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Yun Kyung
authors.initials: YK
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Sang Heon
authors.initials: SH
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Ihm Soo
authors.initials: IS
authors.lastname: Kwak
authors.affiliation: Endocare Pharmacy, Busan, Republic of Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Lee
authors.affiliation: Kim Yong Ki Internal Medicine Clinic, Busan, Republic of Korea.
authors.forename: Yong Ki
authors.initials: YK
authors.lastname: Kim
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D017127:Glycation End Products, Advanced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis / Q000378:metabolism*; D000093423:Glycated Serum Albumin
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D000093423:Glycated Serum Albumin; C517652:hemoglobin A1c protein, human
keywords: Chronic renal insufficiency; Diabetic nephropathy; Glycated albumin; Glycosylated Hemoglobin A; Type 2 diabetes mellitus