| Objective: Diabetes mellitus(DM) is a chronic systemic metabolic disease and has an increasing incidence year by year. At present, time point glucose and glycated hemoglobin A1c(Hb A1c) are widely used for glucose monitoring in clinical. But sometimes, these two detection methods can not accurately reflect the change of patients’ blood glucose level, such as the outbreak type of type 1 diabetes, iron deficiency anemia, etc[1]. Glycated albumin(GA) is an important indicator of diabetes and more sensitive to the change of blood glucose than Hb A1 c. GA can reflects changes in plasma glucose during a short term(past 2 to 3 weeks) [2]. This research evaluates the clinical value of GA measured by enzymatic method in type 2 diabetes patients with low serum albumin and explores its correlation and advantage with both fasting blood glucose(FPG) and Hb A1 c.Method: 164 patients with type 2 diabetes mellitus(T2DM) were recruited to our study from the Department of Endocrinology and Nephrology during July 2013 to May 2014. The group consisted of 89 cases males and 75 females with a mean age of(52.66±9.51) years old. There were 132 cases of type 2 diabetes patients and 32 cases of diabetic patients with lower serum albumins(serum albumin<38 g/L) in this group. All the patients were selected with the 1999 WHO diabetes diagnosis and classification criteria, han Chinese in hebei area and no relationship to each other. All the patients were excluded anemia, pregnancy, liver dysfunction(ALT and AST exceeds the upper limit reference), thyroid disease, diabetes patients with acute complications and glucocorticoids therapy. At the same time 145 healthy subjects were recruited for normal control group(NC) from the health examination center in our hospital, including 80 males and 65 females with a mean age of(52.51±8.24) years old. As Han people without diabetes, hypertension, cardiovascular and kidney disease history in Hebei, they were unrelated to each other. Record all subjects with gender, age, height, body weight and body mass index(BMI). All participants signed informed consent form. They all comply with the regulations of medical ethics.According to the presence of diabetes, all entrants were divided into two groups as diabetic group(group DM, n=164) and normal control group(group NC, n=145). The determination of GA, FPG and Hb A1 c in DM group were made at the second day and after 2 weeks’ treatment for analysis. According to the serum albumin level, divided all subjects into two groups:(1) low albumin group(group LA, n=32), 18 cases of male, 14 cases of female, age(52.56±9.63);(2) normal albumin group(group NA, n=277), among which 151 were male, 126 were female, age(52.59±8.66). FBG was tested with a glucose-oxidase method by using an automatic biochemical analyzer. GA was determined by enzymatic method using a liquid chemistry system(GA assay, Asahi kasei core, Tokyo, Japan) in a clinical autoanalyzer. Hb A1 c was measured by high performance liquid chromatography(HPLC).All the experimental data dealt with SPSS 22.0 statistical software. After testing for normality, all data were expressed as mean±SD values. Correlation coefficients were calculated by simple regression analysis, and the differences in means between the two groups were analyzed by t test. The correlation analysis between GA with Hb A1 c, FPG and ALB using liner regression and analysis of covariance. The level of significance was 0.05.Results:1 Results between group DM and group NC:(1) Compare group DM with group NC, there were no significant differences in height, weight, sex and age(All P>0.05). There was significant difference in BMI(P<0.05);(2) Compared with group NC, the levels of GA, FPG and Hb A1 c in group DM were significantly increased before treatment(All P<0.01);(3) In group DM, GA, FPG and Hb A1 c were significantly decreased after 2 weeks’ treatment(All P<0.01);(4) In group NC, positive correlations were found between GA with FPG(r=0.159, P<0.05) and Hb A1c(r=0.870, P<0.01); In group DM, positive correlations were found between GA with FPG(r=0.694, P<0.01) and Hb A1c(r=0.918, P<0.01) before treatment; After 2 weeks’ treatment, positive correlations were found between GA with FPG(r=0.387, P<0.01) and Hb A1c(r=0.789, P<0.01) in group DM;(5) In group DM, the regression equation of GA changed before and after treatment with GA before treatment is Y=0.45X-7.58. The regression equation of Hb A1 c changed with Hb A1 c before treatment is Y=0.29X-1.77. The regression equation of FPG changed with FPG before treatment is Y=0.91X-5.77. The slope of the GA is less than FPG(0.45vs0.91) and greater than Hb A1c(0.45vs0.29). 2 Results between group LA and group NA:(1) Compare group LA with group NA, there were no significant differences in sex, age, height, weight and BMI(All P>0.05);(2) Compared with group NA, the levels of GA, FPG and Hb A1 c in group LA were significantly increased(All P<0.05), the levels of ALB was significantly decreased(P<0.01);(3) In group NA, positive correlations were found between GA with FPG(r=0.809, P<0.01) and Hb A1c(r=0.961, P<0.01);(4) In group LA, positive significant correlations were found between GA with FPG(r=0.722, P<0.01) and Hb A1c(r=0.938, P<0.01);(5) The regression equation of GA and Hb A1 c in NA group is Y=2.93X-0.16, for group LA, the equation is Y=2.64X+2.18. Interaction effect detection show that the slopes have no statistical difference(F=3.209, P>0.05);(6) By analysis of covariance analysis in group LA and group NA, the probability of concomitant variable Hb A1 c was(F=3452.150, P<0.01) suggesting that Hb A1 c has a significant impact to GA level. The probability of ALB was(F=0.241, P>0.05) suggesting that the ALB has no significant impact to GA level.Conclusions: 1 GA measured by liquid enzymatic method has highly correlation with both FPG and Hb A1 c, and good reflection to the blood glucose. GA can be used for glucose monitoring in patients with type 2 diabetes mellitus. 2 GA measured by liquid enzymatic method is able to reflect the blood glucose in 2-3 weeks. Its sensitivity of changes in glucose is better than Hb A1 c, and has a better stability than time point glucose. 3 GA measured by liquid enzymatic method is not affected by the level of ALB. GA can correctly reflect short-term blood glucose levels in patients. |
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