Glycated albumin and ratio of glycated albumin to glycated hemoglobin are good indicators of diabetic nephropathy in type 2 diabetes mellitus

Background We investigated the association between serum levels of glycated albumin (GA), glycated hemoglobin (HbA(1c)), and GA: HbA1c ratio and the presence of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). Methods Two hundred six consecutive patients with T2DM were enrolled from the endocrinology ward at Shengjing Hospital of China Medical University and classified into 2 groups: DN group (n = 71) and non-diabetic nephropathy (non-DN) group (n = 135). Results The DN group showed significantly higher GA and GA: HbA(1c) values compared with the non-DN group. After univariate logistic regression, GA, GA: HbA(1c), HbA(1c), age, T2DM duration, systolic blood pressure, diastolic blood pressure, triglycerides, mean blood glucose (from 7 blood glucose checks), and presence of retinopathy were selected for advanced analysis. A multivariate logistic regression analysis was performed to examine the association between the presence of DN and these variables. Glycated albumin, GA: HbA(1c), duration, systolic blood pressure, mean blood glucose, and retinopathy (but not HbA(1c)) were identified as independent variables that predicted the presence of DN. We then fitted the areas under the curve of GA: HbA(1c) and GA (0.811 and 0.754, respectively) separately using a receiver operating characteristic curve analysis. Both were better than HbA1c (0.580). We defined the cutoff value of GA: HbA(1c) as 2.71 (sensitivity 0.676, specificity 0.778) and that of GA as 17.5% (sensitivity 0.761, specificity 0.644) for the prediction of DN in patients with T2DM. Conclusions The GA: HbA(1c) ratio and GA may be superior to HbA(1c) associated with the presence of DN.