Yoshiuchi Kazutomi, Matsuhisa Munehide, Katakami Naoto, Nakatani Yoshihisa, Sakamoto Kenya, Matsuoka Takaaki, Umayahara Yutaka, Kosugi Keisuke, Kaneto Hideaki, Yamasaki Yoshimitsu, Hori Masatsugu
Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan.
Endocr J. 2008 Jul;55(3):503-7. doi: 10.1507/endocrj.k07e-089. Epub 2008 Apr 30.
To determine the impact of blood glucose profile, involving fluctuation and excursion of blood glucose levels, on glycated proteins, we evaluated the association among the daily profile of blood glucose, and glycated albumin (GA) and HbA1c levels in patients with type 1 diabetes (n = 93) and type 2 diabetes (n = 75). GA levels were strongly correlated with HbA1c levels in type 1 (r = 0.85, P<0.0001) and type 2 diabetes (r = 0.61, P<0.0001), respectively. HbA1c levels were similar between patients with type 1 and type 2 diabetes, while GA levels were significantly higher in type 1 diabetes. Thus the ratio of GA levels to HbA1c levels was significantly higher in type 1 diabetes than that in type 2 diabetes (3.32 0.36 vs. 2.89 0.44, p<0.001). The degrees of GA levels and HbA1c levels correlated with maximum and mean blood glucose levels in patients with type 1 and type 2 diabetes. Stepwise multivariate analysis revealed that GA levels independently correlated with maximum blood glucose levels in type 1 diabetes (F = 43.34, P<0.001) and type 2 diabetes (F = 41.57, P<0.001). HbA1c levels also independently correlated with maximum blood glucose levels in type 1 diabetes (F = 34.78, P<0.001), as well as being correlated with mean blood glucose levels in type 2 diabetes (F = 11.28, P<0.001). In summary, GA could be a better marker for glycemic control than glycated hemoglobin in diabetic patients, especially for evaluating glycemic excursion, which is considered to be a major cause of diabetic angiopathy.
为了确定血糖波动及血糖水平异常升高的血糖特征对糖化蛋白的影响，我们评估了1型糖尿病患者（n = 93）和2型糖尿病患者（n = 75）的日常血糖特征与糖化白蛋白（GA）及糖化血红蛋白（HbA1c）水平之间的关联。在1型糖尿病（r = 0.85，P<0.0001）和2型糖尿病（r = 0.61，P<0.0001）中，GA水平分别与HbA1c水平显著相关。1型糖尿病和2型糖尿病患者的HbA1c水平相似，而1型糖尿病患者的GA水平显著更高。因此，1型糖尿病患者的GA水平与HbA1c水平之比显著高于2型糖尿病患者（3.32±0.36 vs. 2.89±0.44，p<0.001）。1型和2型糖尿病患者的GA水平及HbA1c水平与最高和平均血糖水平相关。逐步多因素分析显示，GA水平在1型糖尿病（F = 43.34，P<0.001）和2型糖尿病（F = 41.57，P<0.001）中均与最高血糖水平独立相关。HbA1c水平在1型糖尿病中也与最高血糖水平独立相关（F = 34.78，P<0.001），在2型糖尿病中与平均血糖水平相关（F = 11.28，P<0.001）。总之，对于糖尿病患者，GA可能是比糖化血红蛋白更好的血糖控制指标，尤其是在评估血糖波动方面，血糖波动被认为是糖尿病血管病变的主要原因。
