Department of Pediatrics, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa 078-8510, Japan.
Diabetologia. 2011 Sep;54(9):2247-53. doi: 10.1007/s00125-011-2211-8. Epub 2011 Jun 5.
AIMS/HYPOTHESIS: It is difficult to use HbA(1c) as an indicator of glycaemic control in patients with neonatal diabetes mellitus (NDM) because of high levels of fetal haemoglobin (HbF) remaining in the blood. In this study, glycated albumin (GA), which is not affected by HbF, and HbA(1c) were compared to evaluate whether they reflect glycaemic control in patients with NDM.
This study included five patients with NDM. Age at diagnosis was 38 ± 20 days. Insulin therapy was started in all patients, and levels of GA, HbA(1c) and HbF were measured monthly for 6 months. One-month average preprandial plasma glucose (aPPG) was calculated using self-monitoring of blood glucose.
Plasma glucose and GA were elevated (29.7 ± 13.1 mmol/l [n = 5] and 33.3 ± 6.9% [n = 3], respectively) but HbA(1c) was within normal limits (5.4 ± 2.6% [35.5 ± 4.9 mmol/mol]; n = 4) at diagnosis. With diabetes treatment, aPPG (r = -0.565, p = 0.002), GA (r = -0.552, p = 0.003) and HbF (r = -0.855, p < 0.0001) decreased with age, whereas HbA(1c) increased (r = 0.449, p = 0.004). GA was strongly positively correlated with aPPG (r = 0.784, p < 0.0001), while HbA(1c) showed no correlation with aPPG (r = 0.221, p = 0.257) and was significantly inversely correlated with HbF (r = -0.539, p = 0.004).
CONCLUSIONS/INTERPRETATION: GA is a useful indicator of glycaemic control in patients with NDM, whereas HbA(1c) is influenced by age-related changes in HbF and does not accurately reflect glycaemic control.
目的/假设：由于新生儿糖尿病（NDM）患者血液中仍存在高水平的胎儿血红蛋白（HbF），因此使用糖化血红蛋白（HbA1c）作为血糖控制的指标较为困难。在这项研究中，比较了不受 HbF 影响的糖化白蛋白（GA）和 HbA1c，以评估它们是否反映了 NDM 患者的血糖控制情况。
本研究纳入了 5 名 NDM 患者。诊断时的年龄为 38 ± 20 天。所有患者均开始接受胰岛素治疗，并在 6 个月内每月测量 GA、HbA1c 和 HbF 水平。使用自我监测血糖计算 1 个月平均餐前血糖（aPPG）。
诊断时，血糖和 GA 升高（分别为 29.7 ± 13.1 mmol/l [n = 5]和 33.3 ± 6.9% [n = 3]），但 HbA1c 在正常范围内（5.4 ± 2.6% [35.5 ± 4.9 mmol/mol]；n = 4）。随着糖尿病治疗，aPPG（r = -0.565，p = 0.002）、GA（r = -0.552，p = 0.003）和 HbF（r = -0.855，p < 0.0001）随年龄降低，而 HbA1c 升高（r = 0.449，p = 0.004）。GA 与 aPPG 呈强正相关（r = 0.784，p < 0.0001），而 HbA1c 与 aPPG 无相关性（r = 0.221，p = 0.257），与 HbF 呈显著负相关（r = -0.539，p = 0.004）。
结论/解释：GA 是 NDM 患者血糖控制的有用指标，而 HbA1c 受 HbF 年龄相关变化的影响，不能准确反映血糖控制情况。
