American Journal of Applied Science and Technology
31
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VOLUME
Vol.05 Issue 07 2025
PAGE NO.
31-36
10.37547/ajast/Volume05Issue07-05
The Level of Glycated Albumin Is Closely Correlated
with The Level of Glycated Hemoglobin in Patients with
Type 2 Diabetes Mellitus
Sultonova Dildor Bakhshilloyevna
Department of Biochemistry of the Bukhara State Medical Institute named after Abu Ali Ibn Sino assistant, Uzbekistan
Received:
16 May 2025;
Accepted:
12 June 2025;
Published:
14 July 2025
Abstract:
Glycated albumin demonstrates a convincing correlation with glycated hemoglobin levels in patients with
type 2 diabetes mellitus. This indicator allows one to evaluate the state of carbohydrate metabolism, reflecting the
average glucose level over a shorter period of time compared to glycated hemoglobin. Such ratio makes glycated
albumin an important marker for monitoring the course of the disease, especially in cases where it is necessary to
quickly respond to changes in blood glucose levels.
Keywords:
Glycated albumin, glycated hemoglobin, type 2 diabetes mellitus, medium-term glycemic control.
Introduction:
Glycated hemoglobin ( HbA 1c ) is a retrospective
marker that allows determining the average
glycemia
level over the past two to three months and
is currently considered the gold standard in assessing
glycemic control. At the same time, glycated albumin
( GA ) is increasingly recognized as a marker of short-
and medium-term blood sugar control, since its
indicators reflect the glycemic status over a period of
about three weeks. The study was aimed at analyzing
the levels of GA , HbA 1c and fasting glycemia in
patients diagnosed with type 2 diabetes mellitus.
Methods
- Adult patients with type 2 diabetes
mellitus ( n = 135) were randomly selected from the
Diabetes Clinical Center in Cluj-Napoca, Romania,
meeting
inclusion
and
exclusion
criteria.
Commercially available methods for measuring
fasting glucose, GA, HbA1c , and creatinine were used
to evaluate parameters .
Results
- Among the entire group of participants, 62
patients (45.9%) were men. The average age of the
participants was 62.1±8.6 years. The div mass index
was within 31.8±6.1 kg/m², and the average duration
of diabetes was 10.0 (4.0; 15.0) years. Fasting
glycemia was at the level of 162±13.7 mg/ dL , the GA
indicator was 28.0 (21.0; 40.0)%, and the HbA 1c level
was 8.9±2.3%. Data analysis showed a significant
correlation of GA with HbA 1c ( correlation coefficient
r = 0.19 ; p = 0.029 ) and with fasting glycemia ( r =
0.32; p < 0.001). In turn, HbA 1c also demonstrated a
significant relationship with fasting glycemia levels ( r
= 0.40; p < 0.001 ).
Conclusions
- The results of the study confirmed that
GA has a significant correlation with both HbA 1c and
fasting glycemia in patients with type 2 diabetes.
Although HbA 1c remains the standard tool for
monitoring long-term glycemic control in clinical
practice, the use of GA may be useful for assessing
short-term or medium - term control of sugar levels.
This is especially important in cases where HbA 1c
testing is difficult or where rapid clinical decision-
making is required.
Patients with diabetes
are constantly monitored, and
the key indicators of disease control are fasting and
two-hour post-meal blood glucose levels, as well as
glycated hemoglobin (HbA1c). HbA1c, which is a
standard test for assessing the average glucose level
over the past 2-3 months, is not without its
drawbacks. Its results can be distorted by various
factors related to both the patient's health and the
testing technique. This can lead to a discrepancy
between HbA1c values and the actual average
American Journal of Applied Science and Technology
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
glycemia, making it difficult to objectively assess the
effectiveness of diabetes treatment and control. For
example, hemolytic anemia or bleeding can artificially
lower the HbA1c level, while iron deficiency anemia,
thalassemia, or other hemoglobinopathies can lead to
its overestimation.
Thus
, HbA1c results may be inaccurate and may not
reflect the true picture of glycemic control. Due to
these limitations, in recent years, more attention has
been paid to glycated albumin (GA) as an additional,
and in some cases more reliable, indicator of blood
sugar monitoring. GA is formed as a result of non-
enzymatic glycation of albumin, a serum protein.
Unlike HbA1c, which reflects the average glucose
level over a long period (2-3 months), GA provides
information on short- and medium-term changes in
blood sugar levels. This is due to the half-life of
albumin, which is approximately three weeks. This
time interval allows for a more up-to-date picture of
glycemic control.
The key advantage of GA
is its independence from
factors that affect the accuracy of HbA1c
measurement. Since GA is not bound to erythrocytes
(red blood cells), its level is not affected by blood
diseases such as hemolytic anemia, bleeding, iron
deficiency
anemia,
thalassemia
and
other
hemoglobinopathies. This makes GA a particularly
valuable tool in the diagnosis and treatment of
diabetes in patients with these diseases, when HbA1c
results may be unreliable. In such cases, GA helps to
get a more accurate picture of the average glycemia
and the effectiveness of the therapy. Moreover, GA
can be especially useful for patients with large
fluctuations in blood glucose levels, which is typical
for some forms of diabetes. Glycemic instability
complicates the interpretation of HbA1c results,
while GA, reflecting a shorter period of time, provides
a more accurate assessment of the current situation.
GA may also
be preferable in patients with a high risk
of hypoglycemia (a sharp decrease in blood sugar
levels), since it allows for prompt monitoring of the
dynamics of glycemic changes and adjustment of
treatment. Finally, GA may be an indispensable tool
in patients with progressive chronic kidney disease.
Renal insufficiency can significantly affect the
accuracy of HbA1c measurements, while GA,
although it may change slightly with renal
dysfunction, remains a more informative indicator
than HbA1c in these complex clinical situations. Thus,
the use of GA in combination with HbA1c allows for a
more complete and objective picture of glycemic
control in patients with diabetes mellitus, especially
in complex clinical situations when standard
monitoring
methods
may
be
insufficiently
informative. The choice between the use of GA and
HbA1c, or their combined use, should be based on
individual patient characteristics and the clinical
situation. This allows the physician to make the most
informed decision on treatment tactics and ensure
the best blood glucose control for each specific
patient.
The aim of the study
was to comprehensively analyze
glycated hemoglobin (HbA1c), glycated albumin (GA),
and fasting glucose levels in patients with type 2
diabetes mellitus. This was an observational rather
than interventional study, meaning that we did not
interfere with the treatment of patients but only
collected and analyzed existing data. Participants
were randomly recruited from the adult population
hospitalized at the Clinical Center for Diabetes,
Nutrition, and Metabolic Diseases in Cluj-Napoca,
Romania, between 2013 and 2018. A total of 135
patients (n=135) with a confirmed diagnosis of type 2
diabetes mellitus participated in the study. Diagnosis
of type 2 diabetes mellitus and associated chronic
complications was performed strictly according to the
criteria established by the American Diabetes
Association (ADA) [1]. It is important to note that this
organization is an authoritative source in the field of
diabetology , and the use of its criteria ensures
uniformity and scientific validity of the diagnostic
process. At the same time, standard criteria were
used to determine hypertension: blood pressure (BP)
of 140/90 mm Hg and above, or the use of
antihypertensive drugs [1]. This implies that
hypertension was diagnosed both by the results of BP
measurements and by the presence of drug
treatment.
To ensure the reliability of the
study results, patients
with a number of specific conditions that could distort
the HbA1c and HA indicators were excluded from the
sample. Such conditions include various unstable
clinical conditions requiring emergency medical care,
hematological diseases (e.g., anemia of various
etiologies, thalassemia), malignant neoplasms at any
stage,
nephrotic
syndrome,
liver
cirrhosis,
hyperthyroidism and hypothyroidism. In addition,
patients with an estimated glomerular filtration rate
(SFR) of less than 30 ml/min/1.73 m², which indicates
a significant decrease in kidney function, were
excluded from the study. The presence of such
diseases could affect the accuracy of the data
obtained, so the exclusion of these patients was a
necessary step to ensure the validity of the results.
Also excluded from the study were patients taking
steroid drugs, having blood transfusions within six
months before the start of the study, as well as
pregnant and lactating women [3,4]. These factors
American Journal of Applied Science and Technology
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
could have significantly affected the HbA1c and GA
levels, distorting the study results and complicating
the interpretation of the data obtained. Inclusion of
these patients in the study could have led to incorrect
data and incorrect conclusions.
The study was conducted in full compliance with the
provisions of the World Medical Association
Declaration of Helsinki (2000 edition, Edinburgh) and
current institutional guidelines. The study protocol
was reviewed in advance and approved by the local
Ethics Committee of the Iuliu University of Medicine
and Pharmacy. Hatieganu , located in Cluj-Napoca,
Romania. This ensures that the study was conducted
in compliance with the highest standards of ethical
correctness and all necessary measures to protect the
rights of participants. Before any actions related to
data collection, each patient was thoroughly
informed about the objectives of the study, its
methods, possible risks and potential benefits.
Obtaining written informed consent was a mandatory
condition for participation, which ensured voluntary
and informed inclusion in the research process. This
approach guaranteed the correctness of both the
research process itself and its final results.
The study participants had their height, weight, waist
circumference (fasting, in light clothing, without
shoes) measured and their BMI calculated. Blood
pressure and heart rate were measured with the BP-
8800C automatic device on both arms after 10
minutes of rest in a sitting position. Fasting venous
blood was collected from each patient to determine
glucose, HbA1c, complete blood count and creatinine
levels. The analysis was performed in the Central
Laboratory of the Cluj County Emergency Hospital
using reagents and a Beckman Coulter AU480
analyzer. Glucose was determined by the hexokinase
method,
HbA1c
–
by
the
turbidimetric
immunoinhibition method. Serum samples were
frozen for further analysis of glycated albumin (GA)
levels, which were measured by the QuantILab ®
enzymatic method and expressed as a percentage of
the total albumin. Creatinine was determined
colorimetrically, and SCF was calculated using the
CKD-EPI equation. Calibration standards and controls
with a coefficient of variation of less than 2% were
used in laboratory studies.
Statistical analysis was performed using IBM SPSS
Statistics version 22.0. The Kolmogorov-Smirnov test
was used to check the normality of distribution of
continuous variables. All data were checked for
outliers using the interquartile range and 2.2
coefficient. Results were displayed as mean ±
standard deviation or median with 25th and 75th
percentiles. Descriptive method with numerical
values and percentages was also used. Correlation
between parameters was estimated using Spearman
or Pearson coefficients with the accepted significance
level of p < 0.05. The Spearman and Pearson
correlation coefficients are statistical measures used
to assess the strength and direction of the
relationship between two variables. The Pearson
correlation coefficient measures a linear relationship,
while the Spearman (rank) correlation coefficient
measures a monotonic relationship, which may be
linear or nonlinear.)
Demographic and clinical characteristics
of the
participants. The mean age was 62.1 ± 8.6 years, with
45.9% being male. Active smokers were 11.9% of the
participants; the mean duration of diabetes was 10
years and that of hypertension was 11 years.
Correlation of glycated albumin (GA) with glycated hemoglobin (HbA1c).
American Journal of Applied Science and Technology
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
Correlation
of glycated albumin (GA)
with fasting glycemia.
Correlation of
glycated hemoglobin (HbA1c) with
fasting glycemia
.
GA was found to correlate significantly with both
HbA1c and fasting glycemia in patients with type 2
diabetes included in our observational study. This
significant correlation found between GA and HbA1c
confirms that GA is an indicator of protein glycation
as well as HbA1c and that GA is directly dependent on
the effect of glucose on protein. GA and HbA1c are
parameters that reflect blood glucose control, but at
different time periods. HbA1c measurement is
considered the gold standard for monitoring average
glycemic levels over the past 2
–
3 months [1], while
GA reflects glycemic control over the past 3 weeks [4].
Previous studies have shown that GA correlates with
American Journal of Applied Science and Technology
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
both HbA1c and fasting glycemic values and that
short-term glycemic assessment may be useful as an
adjunct to HbA1c measurement [10
–
12].
The low strength of correlation between GA and
HbA1c reported in our study may be explained by the
time course of glycemic control reflected by each of
these parameters. This is thought to be because GA
reflects a shorter-term glycemic control status
compared to HbA1c [10]. In a prospective study,
changes in GA were more pronounced than changes
in HbA1c, while the highest GA levels did not
correspond to HbA1c levels [13]. However, a strong
correlation between HbA1c and GA has been
reported in cross-sectional studies involving
participants without known diabetes [14] and in
patients with type 2 diabetes [15].
The low correlation between GA and HbA1c could be
further explored if postprandial glucose data were
available. GA is thought to better reflect postprandial
glycemia and glucose fluctuations than HbA1c.
Studies show that fasting glycemia has a stronger
relationship with GA and HbA1c than postprandial
values. However, we were unable to evaluate this
correlation in our study due to insufficient data. It is
also important that the study population was selected
using criteria to avoid bias. GA may be useful for
assessing glucose levels in certain patient
populations, as it more quickly reflects the average
glycemic status.
Blood sugar control in patients with diabetes reduces
the risk of chronic complications. Intensive treatment
with insulin or antidiabetic drugs slows down the
development of microangiopathies in type 1 and type
2 diabetes. Studies have shown that lower HbA1c
levels are associated with a lower incidence of
complications. The relationship between HbA1c and
GA has also been noted in other studies such as DCCT
and ARIC. In our observational study, no significant
associations
were
found
between
chronic
complications and these parameters. In addition, GA
may be more valuable in predicting the success of
therapy at an early stage of treatment compared to
HbA1c. Our work has limitations: small sample size
and lack of consistent glycemic data.
CONCLUSIONS
GA was significantly correlated with both HbA1c and
fasting glucose in patients with type 2 diabetes.
Although HbA1c is recognized as the reference test
for monitoring diabetes control, GA may be a useful
additional biomarker for short- and medium-term
blood glucose fluctuations, which is especially
important in situations where the HbA1c test may be
biased or even unreliable, or when earlier clinical
decision making is required.
Glycated albumin measurement was funded by
Medist SA, Romania.
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