Recent Advances in Clinical Application of GA/HbA1c Ratio

doi:10.12114/j.issn.1007-9572.2019.00.316

Abstract

Abstract: Glycated albumin（GA） reflects the mean level of blood glucose within 2-3 weeks，and glycated hemoglobin（HbA1c） reflects the mean blood glucose level within 2 to 3 months.GA/HbA1c ratio with shorter half-life，reflects the glycemic fluctuation shorter than the circulating half-life of GA，is a new glycemic control indicator for diabetic patients，which can be used in the diagnosis of fulminant type 1 diabetes，determination of the islet cell function，screening and diagnosis of diabetes，diagnosis of diabetic nephropathy and diabetic retinopathy，and predicting cognitive impairment in the elderly.GA/HbA1c ratio in combination with other glycemic indicators can reflect blood glucose level more accurately.

Key words: Hemoglobin A, glycosylated；Glycated albumin；Ratio of glycated albumin to glcated hemoglobin；Blood glucose；Diabetes mellitus

摘要： 糖化白蛋白（GA）反映近2~3周的血糖水平，糖化血红蛋白（HbA1c）反映近2~3个月的血糖状况，糖化白蛋白与糖化血红蛋白比值（GA/HbA1c）的t1/2短，能够反映比GA周期更短的血糖波动情况，是监测糖尿病患者血糖控制的新型指标，可用于诊断暴发性1型糖尿病、胰岛细胞功能、糖尿病筛查及诊断、糖尿病肾病及糖尿病视网膜病变，也是老年人认知功能障碍的预测指标。GA/HbA1c与各项血糖监测指标互补，可以更加准确地反映血糖水平。

关键词: 血红蛋白A, 糖基化, 糖化白蛋白, 糖化白蛋白与糖化血红蛋白比值, 血糖, 糖尿病

ZHANG Donghong,LI Qiang. Recent Advances in Clinical Application of GA/HbA1c Ratio　[J]. Chinese General Practice, 2020, 23(17): 2105-2109. DOI: 10.12114/j.issn.1007-9572.2019.00.316.
张东红,李强. 糖化白蛋白与糖化血红蛋白比值的临床应用进展[J]. 中国全科医学, 2020, 23(17): 2105-2109. DOI: 10.12114/j.issn.1007-9572.2019.00.316.

References

［1］ANGUIZOLA J，MATSUDA R，BARNABY O S，et al．Review：glycation of human serum albumin［J］．Clin Chim Acta，2013，425：64-76．DOI：10.1016/j.cca.2013.07.013.
［2］KOGA M，INADA S，NAKAO T，et al．The glycated albumin（GA） to HbA1c ratio reflects shorter-term glycemic control than GA：analysis of patients with fulminant type 1 diabetes［J］．J Clin Lab Anal，2017，31（1）：e22023．DOI：10.1002/jcla.22023.
［3］IMAI T，OIKAWA Y，SHIMADA A.Improved monitoring of the hyperglycemic state in type 1 diabetes patients by use of the glycoalbumin/HbA1c ratio［J］．Rev Diabet Stud，2007，4（1）：44-48．DOI：10.1900/RDS.2007.4.44.
［4］SUMITANI S，MORITA S，DEGUCHI R，et al．Metformin decreases glycated albumin to glycated haemoglobin ratio in patients with newly diagnosed type 2 diabetes［J］．Ann Clin Biochem，2015，52（Pt 1）：76-81．DOI：10.1177/0004563214522984.
［5］HE X X，MO Y F，MA X J，et al．Associations of body mass index with glycated albumin and glycated albumin/glycated hemoglobin A1c ratio in Chinese diabetic and non-diabetic populations［J］．Clin Chim Acta，2018，484：117-121．DOI：10.1016/j.cca.2018.05.044.
［6］HUH J H，KIM K J，LEE B W，et al．The relationship between BMI and glycated albumin to glycated hemoglobin（GA/A1c） ratio according to glucose tolerance status［J］．PLoS One，2014，9（2）：e89478．DOI：10.1371/journal.pone.0089478.
［7］MO Y F，MA X J，LI H，et al．Relationship between glycated albumin and glycated hemoglobin according to glucose tolerance status：a multicenter study［J］．Diabetes Res Clin Pract，2016，115：17-23．DOI：10.1016/j.diabres.2016.03.003.
［8］FUKUI M，TANAKA M，HASEGAWA G，et al．Association between serum bioavailable testosterone concentration and the ratio of glycated albumin to glycated hemoglobin in men with type 2 diabetes［J］．Diabetes Care，2008，31（3）：397-401．DOI：10.2337/dc07-1898.
［9］KOGA M，MURAI J，SAITO H，et al．Glycated albumin and glycated hemoglobin are influenced differently by endogenous insulin secretion in patients with type 2 diabetes［J］．Diabetes Care，2010，33（2）：270-272．DOI：10.2337/dc09-1002.
［10］MATSUMOTO H，MURASE-MISHIBA Y，YAMAMOTO N，et al．Glycated al C virus related liver fibrosis［J］．World J Hepatol，2012，4（1）：11-17．DOI：10.4254/wjh.v4.i1.11.
［11］KOGA M，MURAI J，SAITO H，et al．Serum glycated albumin to haemoglobin A（1C） ratio can distinguish fulminant type 1 diabetes mellitus from type 2 diabetes mellitus［J］．Ann Clin Biochem，2010，47（Pt 4）：313-317．DOI：10.1258/acb.2010.009234.
［12］FUKUI M，TANAKA M，TODA H，et al．Risk factors for development of diabetes mellitus，hypertension and dyslipidemia［J］．Diabetes Res Clin Pract，2011，94（1）：e15-18．DOI：10.1016/j.diabres.2011.07.006.
［13］KOGA M，SHIMIZU I，MURAI J，et al．The glycated albumin to HbA1c ratio is elevated in patients with fulminant type 1 diabetes mellitus with onset during pregnancy［J］．J Med Invest，2013，60（1/2）：41-45.
［14］YOSHIUCHI K，MATSUHISA M，KATAKAMI N，et al．Glycated albumin is a better indicator for glucose excursion than glycated hemoglobin in type 1 and type 2 diabetes［J］．Endocr J，2008，55（3）：503-507.
［15］SAISHO Y，TANAKA K，ABE T，et al．Lower beta cell function relates to sustained higher glycated albumin to glycated hemoglobin ratio in Japanese patients with type 2 diabetes［J］．Endocr J，2014，61（2）：149-157.
［16］LEE J W，KIM H J，KWON Y S，et al．Serum glycated albumin as a new glycemic marker in pediatric diabetes［J］．Ann Pediatr Endocrinol Metab，2013，18（4）：208-213．DOI：10.6065/apem.2013.18.4.208.
［17］TAKAI M，ANNO T，KAWASAKI F，et al．Association of the glycemic fluctuation as well as glycemic control with the pancreatic β-cell function in japanese subjects with type 2 diabetes mellitus［J］．Intern Med，2019，58（2）：167-173．DOI：10.2169/internalmedicine.1053-18.
［18］LEE J E，LEE J W，FUJII T，et al．The ratio of estimated average glucose to fasting plasma glucose level is superior to glycated albumin，hemoglobin A1c，fructosamine，and GA/A1c ratio for assessing β-cell function in childhood diabetes［J］．Biomed Res Int，2014，2014：370790．DOI：10.1155/2014/370790.
［19］KIM D，KIM K J，HUH J H，et al．The ratio of glycated albumin to glycated haemoglobin correlates with insulin secretory function［J］．Clin Endocrinol（Oxf），2012，77（5）：679-683．DOI：10.1111/j.1365-2265.2011.04312.x.
［20］ADAWAY J E，KEEVIL B G，OWEN L J.Liquid chromatography tandem mass spectrometry in the clinical laboratory［J］．Ann Clin Biochem，2015，52（1）：18-38．DOI：10.1177/0004563214557678.
［21］MASUMOTO N，OTSUKI H，IWAKAWA S，et al．Effects of alogliptin on the ratio of glycated albumin to HbA1c in patients with type 2 diabetes mellitus［J］．Diabetol Int，2017，8（2）：212-217．DOI：10.1007/s13340-016-0298-3.
［22］OMORI K，NOMOTO H，NAKAMURA A，et al．Reduction in glucose fluctuations in elderly patients with type 2 diabetes using repaglinide：a randomized controlled trial of repaglinide vs sulfonylurea［J］．J Diabetes Investig，2019，10（2）：367-374．DOI：10.1111/jdi.12889.
［23］SONG S O，KIM K J，LEE B W，et al．Serum glycated albumin predicts the progression of carotid arterial atherosclerosis［J］．Atherosclerosis，2012，225（2）：450-455．DOI：10.1016/j.atherosclerosis.2012.09.005.
［24］WANG N N，XU Z，HAN P，et al．Glycated albumin and ratio of glycated albumin to glycated hemoglobin are good indicators of diabetic nephropathy in type 2 diabetes mellitus［J］．Diabetes Metab Res Rev，2017，33（2）：e2843．DOI：10.1002/dmrr.2843.
［25］UMAYAHARA Y，FUJITA Y，WATANABE H，et al．Association of glycated albumin to HbA1c ratio with diabetic retinopathy but not diabetic nephropathy in patients with type 2 diabetes［J］．Clin Biochem，2017，50（6）：270-273．DOI：10.1016/j.clinbiochem.2016.11.032.
［26］SHIRAIWA T，KANETO H，MIYATSUKA T，et al．Post-prandial hyperglycemia is an important predictor of the incidence of diabetic microangiopathy in Japanese type 2 diabetic patients［J］．Biochem Biophys Res Commun，2005，336（1）：339-345．DOI：10.1016/j.bbrc.2005.08.158.
［27］KINOSHITA T，SHIMODA M，SANADA J，et al．Association of GA/HbA1c ratio and cognitive impairment in subjects with type 2 diabetes mellitus［J］．J Diabetes Complicat，2016，30（8）：1452-1455．DOI：10.1016/j.jdiacomp.2016.08.008.
［28］MATTISHENT K，LOKE Y K.Bi-directional interaction between hypoglycaemia and cognitive impairment in elderly patients treated with glucose-lowering agents：a systematic review and meta-analysis［J］．Diabetes Obes Metab，2016，18（2）：135-141．DOI：10.1111/dom.12587.
［29］ZHONG Y，JIN J，XU C C，et al．GA to HbA1C ratio，but not HbA1C is associated with cognition in Chinese nondiabetic old adults［J］．Aging & Mental Health，2015，19（9）：853-857．DOI：10.1080/13607863.2014.977773.
［30］TAMURA Y，KIMBARA Y，YAMAOKA T，et al．White matter hyperintensity in elderly patients with diabetes mellitus is associated with cognitive impairment，functional disability，and a high glycoalbumin/glycohemoglobin ratio［J］．Front Aging Neurosci，2017，9：220．DOI：10.3389/fnagi.2017.00220.
［31］MUKAI N，OHARA T，JUN H T，et al．Alternative measures of hyperglycemia and risk of Alzheimer's disease in the community：the hisayama study［J］．J Clin Endocrinol Metab，2017，102（8）：3002-3010．DOI：10.1210/jc.2017-00439.
［32］JUNG C H，LEE B，CHOI D H，et al．Association of grade of non-alcoholic fatty liver disease and glycated albumin to glycated hemoglobin ratio in patients with type 2 diabetes mellitus［J］．Diabetes Res Clin Pract，2017，125：53-61．DOI：10.1016/j.diabres.2016.12.017.
［33］KITAMURA T，OTSUKI M，TAMADA D，et al．Serum albumin-adjusted glycated albumin is an adequate indicator of glycemic control in patients with Cushing's syndrome［J］．Clin Biochem，2014，47（18）：279-282．DOI：10.1016/j.clinbiochem.2014.09.007.
［34］MIYAMOTO H，TAO X R，KOHZUMA T，et al．Influences of anemia，kidney disease，thyroid dysfunction，and liver disease on the ratio of glycated albumin to hemoglobin A1c［J］．J Diabetes Sci Technol，2018，12（5）：1082-1083．DOI：10.1177/1932296818767452.
［35］NAKAGAMI T.Hyperglycaemia and mortality from all causes and from cardiovascular disease in five populations of Asian origin［J］．Diabetologia，2004，47（3）：385-394．DOI：10.1007/s00125-004-1334-6.
［36］KOTANI K，SAKANE N，MIYAMOTO M，et al．Influence of smoking habits on the GA/HbA1c ratio in patients with type 1 diabetes mellitus［J］．Med Princ Pract，2010，19（5）：415-417．DOI：10.1159/000316385.
［37］YOON H J，LEE Y H，KIM K J，et al．Glycated albumin levels in patients with type 2 diabetes increase relative to HbA1c with time［J］．Biomed Res Int，2015，2015：576306．DOI：10.1155/2015/576306.
［38］AIZAWA N，ENOMOTO H，IMANISHI H，et al．Elevation of the glycated albumin to glycated hemoglobin ratio during the progression of hepatitis C virus related liver fibrosis［J］．World J Hepatol，2012，4（1）：11-17．DOI：10.4254/wjh.v4.i1.11.

[1]	Husheng LI, Feng HUANG, Yuting GAO, Yiyan WANG, Jiaqi WANG, Jing WU. Association of Preoperative Glycosylated Hemoglobin with the Prognosis of Adult Patients Undergoing Cardiac Surgery: a Meta-analysis [J]. Chinese General Practice, 2022, 25(17): 2135-2144.
[2]	Shili SHANG, Zijuan SUN, Lina BI, Wenjing ZHOU, Daiyu SHEN, Jingshan CHEN, Sha LUO, Yuerong FENG, Qian YANG, Jun LI. Influencing Factors of Anemia in Patients with Diabetic Kidney Disease [J]. Chinese General Practice, 2022, 25(12): 1464-1469.
[3]	YU Yuanyuan，XUE Qidan，WANG Shuang，YU Xiaosong，WU Bin. Abnormal Changes of Serum Thyroid Hormones and Antibodies in Type 2 Diabetic Patients　 [J]. Chinese General Practice, 2021, 24(3): 316-321.
[4]	ZHONG Yuling，FAN Haozhi，ZHANG Ru，WANG Hongliang，ZHANG Wei，TIAN Ting，WANG Qingqing，ZHANG Liuxin，WANG Jie. Associations between HbA1c Glycation Index and Risk of Chronic Complications of Diabetes Mellitus　 [J]. Chinese General Practice, 2020, 23(3): 276-280.
[5]	DU Fawang，LI Ling，WU Qiang，CHEN Dandan，WU Yueting，WANG Jiren，CHEN Baolin. Relationship between Acute-to-chronic Glycemic Ratio and Poor Short-term Prognosis in Patients with Acute Myocardial Infarction　 [J]. Chinese General Practice, 2020, 23(15): 1873-1878.
[6]	GONG Hui，TANG Huashan，ZHANG Bo，ZHANG Tao，HUA Yingxue，SONG Daoping，YAN Weili. Measurement Frequency and Target Meeting Rate of Glycosylated Hemoglobin in Diabetics with Lean Six Sigma Management　 [J]. Chinese General Practice, 2020, 23(13): 1699-1704.
[7]	LIAO Shi-bo，HUANG Shu-yu，WU Min，ZOU Yi，ZHU Zhao，LI Ling，HUANG Gao，XIANG Cheng. Relationship of External Insulin and Fasting Insulin Level in Patients with Type 2 Diabetes Mellitus Patients　 [J]. Chinese General Practice, 2018, 21(23): 2790-2794.