Gohda Tomohito, Kamei Nozomu, Tanaka Marenao, Furuhashi Masato, Sato Tatsuya, Kubota Mitsunobu, Sanuki Michiyoshi, Mikami Risako, Mizutani Koji, Suzuki Yusuke, Murakoshi Maki
Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan.
Department of Endocrinology and Metabolism, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan.
Endocrinol Diabetes Metab. 2025 Jul;8(4):e70072. doi: 10.1002/edm2.70072.
The glycated albumin-to-glycated haemoglobin (GA/HbA1c) ratio is a potential marker of glycaemic variability; however, its association with adverse clinical outcomes in type 2 diabetes remains unclear. We aimed to determine whether the GA/HbA1c ratio is a better predictor of mortality and chronic kidney disease (CKD) progression than GA alone in type 2 diabetes.
This retrospective cohort analysis included 571 Japanese participants with type 2 diabetes who were stratified into tertiles based on their GA/HbA1c ratio. Cox proportional hazards models assessed associations between the GA/HbA1c ratio and mortality or CKD progression (≥ 30% decline in the estimated glomerular filtration rate [eGFR]), adjusting for age, sex, urinary albumin-to-creatinine ratio, eGFR, body mass index, haemoglobin and serum albumin.
In this cohort, the median age was 67 years, and 53.9% were male. During the median follow-up of 5.4 and 5.3 years for mortality and CKD progression, respectively, 40 (7.0%) participants died and 70 (12.3%) experienced CKD progression. For mortality, the GA/HbA1c ratio demonstrated a U-shaped association: although both the lowest (T1) and highest (T3) tertiles showed higher mortality risks than the middle tertile (T2), this association was significant for only T3 (hazard ratio, 1.46; 95% CI, 1.05-2.04). Neither GA nor HbA1c alone was significantly associated with mortality. For CKD progression, GA alone showed a U-shaped association, with both T1 and T3 exhibiting non-significantly higher risks than T2. Neither the GA/HbA1c ratio nor HbA1c alone was associated with CKD progression.
In individuals with type 2 diabetes, a higher GA/HbA1c ratio was associated with an increased risk of mortality but not with CKD progression. However, given the retrospective design and limited sample size, these findings should be interpreted with caution and confirmed in larger, prospective studies.
糖化白蛋白与糖化血红蛋白（GA/HbA1c）比值是血糖变异性的一个潜在标志物；然而，其与2型糖尿病不良临床结局的关联仍不明确。我们旨在确定在2型糖尿病中，GA/HbA1c比值是否比单独的GA更能预测死亡率和慢性肾脏病（CKD）进展。
这项回顾性队列分析纳入了571名日本2型糖尿病患者，他们根据GA/HbA1c比值被分层为三个三分位数组。Cox比例风险模型评估GA/HbA1c比值与死亡率或CKD进展（估计肾小球滤过率[eGFR]下降≥30%）之间的关联，并对年龄、性别、尿白蛋白与肌酐比值、eGFR、体重指数、血红蛋白和血清白蛋白进行了调整。
在这个队列中，中位年龄为67岁，男性占53.9%。在分别对死亡率和CKD进展进行的中位随访5.4年和5.3年期间，40名（7.0%）参与者死亡，70名（12.3%）经历了CKD进展。对于死亡率，GA/HbA1c比值呈现出U型关联：尽管最低（T1）和最高（T3）三分位数组的死亡风险均高于中间三分位数组（T2），但仅T3的这种关联具有统计学意义（风险比，1.46；95%CI，1.05 - 2.04）。单独的GA和HbA1c与死亡率均无显著关联。对于CKD进展，单独的GA呈现出U型关联，T1和T3的风险均略高于T2，但无统计学意义。GA/HbA1c比值和单独的HbA1c均与CKD进展无关。
在2型糖尿病患者中，较高的GA/HbA1c比值与死亡风险增加相关，但与CKD进展无关。然而，鉴于本研究的回顾性设计和有限的样本量，这些发现应谨慎解读，并在更大规模的前瞻性研究中得到证实。
