Matsumoto Hiroaki, Murase-Mishiba Yuko, Yamamoto Naomune, Sugitatsu-Nakatsukasa Saya, Shibasaki Saeko, Sano Hiroyuki, Terasaki Jungo, Imagawa Akihisa, Hanafusa Toshiaki
The First Department of Internal Medicine, Osaka Medical College, Japan.
Intern Med. 2012;51(11):1315-21. doi: 10.2169/internalmedicine.51.7236. Epub 2012 Jun 1.
Since serum albumin is glycosylated more rapidly than hemoglobin, it is possible that the glycated albumin (GA) to HbA1c ratio (GA: HbA1c ratio) is potentially a more sensitive indicator of blood glucose excursion than HbA1c. The aim of the present study was to assess the clinical usefulness of GA: HbA1c ratio as a marker of daily glucose excursions in patients with type 1 diabetes according to the subtypes; acute onset type 1A, fulminant and slowly progressive type 1 diabetes.
Fifty-six outpatients with type 1 diabetes [16 fulminant, 20 acute-onset type 1A and 20 slowly progressive (SPIDDM)] were recruited consecutively. Each patient performed self-monitoring of blood glucose at seven points a day. The associations among the daily profile of glucose and GA, HbA1c, GA: HbA1c ratio were examined across and within the subtypes of type 1 diabetes.
GA and GA: HbA1c ratio were each independently correlated with mean amplitude of glucose excursion (MAGE) in patients with type 1 diabetes (F=27.53, p<0.001 and F=13.02, p<0.001, respectively). GA: HbA1c ratio was significantly higher in fulminant type 1 diabetic patients than in SPIDDM patients (3.5 ± 0.2 vs. 3.2 ± 0.5, p=0.015) and it was independently associated with MAGE within fulminant type 1 diabetes (F=21.2, p<0.001).
In conclusion, the present study demonstrated that GA: HbA1c ratio could be a better marker for glycemic variability than HbA1c in type 1 diabetes, especially in fulminant type 1 diabetes.
由于血清白蛋白糖基化比血红蛋白更快，糖化白蛋白（GA）与糖化血红蛋白A1c的比值（GA：HbA1c比值）有可能比HbA1c更敏感地反映血糖波动情况。本研究旨在根据1型糖尿病的亚型，即急性起病的1A型、暴发性和缓慢进展性1型糖尿病，评估GA：HbA1c比值作为1型糖尿病患者每日血糖波动指标的临床实用性。
连续招募了56例1型糖尿病门诊患者[16例暴发性、20例急性起病的1A型和20例缓慢进展性（SPIDDM）]。每位患者每天进行7次血糖自我监测。在1型糖尿病的亚型之间和亚型内部，研究了血糖的每日变化情况与GA、HbA1c、GA：HbA1c比值之间的关联。
在1型糖尿病患者中，GA和GA：HbA1c比值均与血糖波动平均幅度（MAGE）独立相关（分别为F = 27.53，p < 0.001和F = 13.02，p < 0.001）。暴发性1型糖尿病患者的GA：HbA1c比值显著高于SPIDDM患者（3.5 ± 0.2对3.2 ± 0.5，p = 0.015），并且在暴发性1型糖尿病中，它与MAGE独立相关（F = 21.2，p < 0.001）。
总之，本研究表明，在1型糖尿病中，尤其是在暴发性1型糖尿病中，GA：HbA1c比值可能是比HbA1c更好的血糖变异性指标。
