Glycated Albumin- A possible choice of marker for early diagnosis of Pre-diabetes

• Author Details:   
• Rajeev Kumria ^*
• Shilpa Raina
• Athira Sasidharan
• Ramesh Bhaskaran

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Diabetes has emerged as a major challenge worldwide with the number of Diabetics and pre-diabetics growing at an alarming pace. While more is being understood about the long-term impacts and the pathophysiology of diabetes related complications such as Diabetic retinopathy, Diabetic Kidney Disease, Cardio-metabolic changes, more understanding is needed for a goal directed management program to prevent the descent towards these complications. The obvious approach would be to catch the diabetics while still in their pre-diabetes phase. While both HbA1c and fasting plasma Glucose levels have served well over time, it is now imperative that more exploration is needed to find biomarkers for different clinical purposes and phases in managing Diabetes. There are situations in which HbA1c and FGP do not serve as the best markers due to other underlying conditions which directly impact the biochemistry of these biomarkers. Conditions that shorten erythrocyte life cycle, conditions like anemia directly impacting Hemoglobin level will directly impact the level of HbA1c. Under all these conditions HbA1c will not be an ideal biomarker for diagnosis of pre-diabetes, diabetes and monitoring of long term glycemic control. Some other candidate biomarkers for the intermediate term glycemic control are Fructosamine and Glycated Albumin; both are constituents of Advanced Glycation end products. While both have shown promise in several studies Glycated Albumin a key constituent of Fructosamine is better in terms of assay standardization, assay automation and clinical deployment. Another big advantage of Glycated Albumin is that the rate of Glycation is nearly four (4) times higher than that of HbA1c making it much more sensitive to adverse changes in long term Glycemic Control. As Albumin has a turnover of 4-5 weeks, Glycated Albumin works to ascertain intermediate term Glycemic Control of 2-3 weeks or a month at the most. This is useful in many scenarios where therapeutic dose adjustment is needed. It is also important to catch the diabetics young as the longer life expectancy, increasing incidence of diabetes predisposes a large section of diabetics to long-term diabetic complications like retinopathy, kidney disease, neuropathy diabetic foot etc., this puts a grave stress on the patient as well as the healthcare system. Glycated Albumin holds lot of promise as a Biomarker for Pre-diabetes diagnoses due to its sensitivity compared to HbA1c. Glycated Albumin can also be deployed in all cases where HbA1c may not be an ideal candidate for monitoring glycemic control. A new consensus needs to emerge on the selection of optimal biomarkers for diabetes. This paper aims to research and summarize the available information and data on Glycated Albumin’s utility in diabetes and pre-diabetes management.

Keywords: World Health Organization (WHO), Glycated Albumin, Cardiovascular disease (CVD)