Do glycoalbumin levels preferentially reflect changes in postprandial glucose excursions?. Issue 9 (13th June 2017)

• Record Type: Journal Article
• Authors: Paul, S. K.; Holman, R. R.
• Is Part Of: Diabetic medicine. Volume 34:Issue 9(2017)
• Page Start: 1284
• Page End: 1290
• Publication Date: 2017-06-13
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13376
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To evaluate whether plasma glycated albumin, which provides an integrated measure of plasma glucose levels over the preceding 2–4 weeks, better reflects changes in postprandial glucose excursions than HbA1c . Methods: People with suboptimum glycaemic control on dual oral therapy were enrolled in the Treating‐to‐Target‐in‐Type 2 diabetes (4‐T) trial, in which participants were randomized to the addition of once‐daily basal insulin, twice‐daily biphasic insulin or thrice‐daily prandial insulin. Glycated albumin levels were assayed enzymatically from baseline and 1‐year fasting plasma samples. We evaluated robust correlations of glycated albumin and HbA1c both with fasting and postprandial glucose levels at these two time points, and with insulin‐induced changes in the postprandial excursion. Results: Requisite data were available for 625 of the participants in the 4‐T trial. Their mean (±sd ) age was 62 ± 10 years and body weight was 85.8 ± 15.9 kg, and their median (interquartile range) diabetes duration was 9 (6, 13) years. Partial correlations at baseline and 1 year between postprandial glucose excursions and glycated albumin/HbA1c, after adjusting for fasting glucose, were 0.27/0.15 and 0.22/0.18, respectively. Glycated albumin, compared with HbA1c, explained 66% more of the variation in postprandial glucose excursions at baseline. At 1 year, postprandial glucose excursions on basal, biphasic and prandial and insulin therapy were reduced by 0.43, 0.78 and 1.88 mmol/l, respectively. These reductions were associated with changes in both glycated albumin and HbA1c ( P < 0.01), with a stronger association for glycated albumin. Conclusion: Changes in glycated albumin and HbA1c reflect changes in postprandial glucose excursions to a similar extent. What's new?: Glycated albumin, which reflects prevailing blood glucose concentrations over the preceding 2–4 weeks, is considered as an alternative marker for glycaemic control in patients with diabetes that preferentially reflects postprandial glycaemia. Based on a small number of individuals, studies have reported association of glycated albumin and HbA1c with pre‐ and postprandial glucose, without considering the inherent dynamic relationship between pre‐ and postprandial glucose levels. This study evaluated if glycated albumin better reflects the insulin‐induced changes in postprandial glucose excursions seen in a large number of individuals with Type 2 diabetes in a long‐term clinical trial setting.