Clinical Significance of Glycated Albumin/HbA1c Ratio in Diabetic Patients with Liver Cirrhosis

Presentation Number: MON 621
Date of Presentation: April 3rd, 2017

Soo Min Hong*1, Kyung Ho Lim2, Sang Youl Rhee3, Suk Chon3, Jeong-taek Woo3, Seong woon Kim3 and Seungjoon Oh3
1Seoul Paik Hospital, In Je University School of Medicine, Seoul, Korea, Republic of (South), 2In Je University, School of Medicine, Busan, 3Kyung Hee University School of Medicine, Seoul, Korea, Republic of (South)

Abstract

HbA1c may not reflect correct glycemic state in diabetic patients with liver cirrhosis. The aim of this study is to evaluate the disparity between HbA1c and GA.

This was a cross-sectional study and 95 diabetic patients with liver cirrhosis were reviewed by records who visited the departments of endocrinology and gastroenterology in Kyung Hee University Hospital. We assessed random glucose level, HbA1c, GA and other baseline characteristic parameters.

The mean GA level was 25.42±9.23% in 95 diabetic patients with liver cirrhosis. By conversion equation, (2) (CH Jung et al. Plos one 2014; 9(4): e95729) the corresponding HbA1c level must be 9.42±2.48%. However, it was underestimated as 7.46±1.72% in this population (p < 0.0001).

In regard to anemia, the mean GA level in Hb < 10mg/dL group and Hb ≥ 10mg/dL group were similar ( 26.23±6.88% vs 25.32±9.49%, p = 0.44). However, the mean HbA1c level was significantly lower in Hb < 10mg/dL group than in Hb ≥ 10mg/dL group (6.34±1.47% vs 7.59±1.7%, p = 0.04). HbA1c seemed to be underestimated due to anemia. GA/HbA1c ratio was 3.23±0.78 in former group and was 4.07±0.84 in latter group (p < 0.0001).

 In regard to hypoalbuminemia, the mean HbA1c level in albumin < 3.5 mg/dL group and albumin ≥ 3.5 mg/dL group were similar (7.11±1.8% vs 7.55±1.7%, p = 0.21). The mean GA level was also similar in albumin < 3.5 mg/dL group and albumin ≥ 3.5 mg/dL group ( 29.26±10.76% vs 24.46±8.62%, p = 0.07). GA/HbA1c ratio was 3.3±0.81 in former group and was 4.22±0.89 in latter group (p = 0.004).

We also compared GA and HbA1c in three groups classified by Child-Pugh score. The mean GA levels were 23.57±7.94%, 28.64±8.98%, and 31.77±16.56% (p =0.045) in Child-Pugh class A, B, and C, respectively. The mean HbA1c levels were 7.49±1.67%, 7.46±1.76%, and 7.15±2.33% (p =0.742) in Child-Pugh class A, B, and C, respectively. GA/HbA1c ratios were 3.15±0.74%, 3.84±0.81%, and 4.28±0.98% (p < 0.0001) in Child-Pugh class A, B, and C, respectively.

The result of this study showed that HbA1c alone was not enough an indicator to evaluate glycemic state in diabetic patients with liver cirrhosis. GA showed no significant difference both in anemia group and in hypoalbuminemia group. Thus, we found GA to be a useful glycemic index in diabetic patients with liver cirrhosis, especially in those accompanied with anemia.

 

Nothing to Disclose: SMH, KHL, SYR, SC, JTW, SWK, SO