Development of a novel estimation method for hemoglobin A1c using glycated albumin in type 2 diabetes mellitus patients with end-stage renal disease

Akihiko Nakamura; Ryo Kodera; Noriko Sakamoto; Haruyo Ujike; Jun Wada; Kenichi Shikata; Hirofumi Makino

doi:10.1007/s13340-018-0342-6

Development of a novel estimation method for hemoglobin A1c using glycated albumin in type 2 diabetes mellitus patients with end-stage renal disease

Diabetol Int. 2018 Jan 18;9(3):179-188. doi: 10.1007/s13340-018-0342-6. eCollection 2018 Jul.

Authors

Akihiko Nakamura¹, Ryo Kodera^{1

2}, Noriko Sakamoto³, Haruyo Ujike^{4

5}, Jun Wada⁵, Kenichi Shikata², Hirofumi Makino⁶

Affiliations

¹ Osafune Clinic, 332-1 Haji, Osafune, Setouchi, Okayama 701-4264 Japan.
² 2Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata, Kita-ku, Okayama, Japan.
³ Diabetes, Metabolism, and Endocrinology, Shin Kashiwa Clinic, 1-7, Shinkashiwa, Kashiwa, Chiba Japan.
⁴ 4Departments of Nephrology, Kagawa Prefectural Central Hospital, 1-2-1, Asahi, Takamatsu, Kagawa Japan.
⁵ 5Dentistry and Pharmaceutical Sciences, Medicine and Clinical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata, Kita-ku, Okayama, Japan.
⁶ 6Okayama University Hospital, 2-5-1 Shikata, Kita-ku, Okayama, Japan.

Abstract

Aim: We developed a novel estimation method for hemoglobin A1c (HbA1c) in type 2 diabetes (T2D) patients with end-stage renal disease (ESRD). This method is based on the glycated albumin (GA) level.

Methods: Of the 788 Japanese patients with T2D included in this study, 545 had normal renal function (NRF group) and 243 had ESRD. Oral glucose tolerance tests (OGTTs) were performed in 80 subjects. The variables GA, body mass index (BMI), hemoglobin (Hb), and estimated glomerular filtration rate (eGFR) were significantly associated with the GA-to-HbA1c ratio and were used to determine the estimated HbA1c (eHbA1c). One method of estimating HbA1c involved dividing GA by the GA-to-HbA1c ratio predicted from the estimated regression equation; the estimated HbA1c obtained in this manner was denoted eHbA1c-1.

Results: eHbA1c-1 (%) = GA × [4.688 - 18.833 × GA^-1 - 0.015 × BMI - 0.037 × Hb (- 0.002 × eGFR for patients without ESRD)]^-1; adjusted R ² = 0.676 for actual HbA1c. The sensitivity of eHbA1c-1 was better than that of GA for diabetes diagnosis using the 75-g OGTT. There were no differences in the slope of eHbA1c-1 versus GA and the variance of eHbA1c-1 between the ESRD and NRF groups. eHbA1c-1 was not associated with Hb, erythropoiesis-stimulating agent use, or ESRD concomitance.

Conclusions: eHbA1c-1 may be a useful parameter for estimating HbA1c in T2D patients with ESRD.

Keywords: End-stage renal disease; Glycated albumin; Hemoglobin A1c; Type 2 diabetes.