Glycated albumin and glycated hemoglobin levels as a measure of control in diabetic patients attending out-patient clinic at Kenyatta National Hospital: a comparative study

Abstract

Diabetes Mellitus is a chronic metabolic disease that is characterized by persistent hyperglycemia. Progression of uncontrolled Diabetes Mellitus (DM) causes complications in several organs. Glycaemic control in individuals with DM is currently done by a combination of short term and long term biochemical tests. HbAIC represents time averaged plasma glucose level over 2-4 months while Glycated Albumin is a time averaged plasma glucose level over two to four weeks. The latter enables closer monitoring and evaluation of treatment regimen faster. Broad Objective To compare glycated albumin to glycated hemoglobin levels as a measure of glycemic control for Diabetic patients attending outpatient clinic at Kenyatta National Hospital. Specific Objectives 1. To determine random blood glucose in both type1 and type 2 diabetic patients. 2. To determine levels of glycated albumin and glycated hemoglobin (HbA1C) in the study population. 3. T o correlate the glycated albumin and glycated hemoglobin levels in the study population. Methodology Study design: Comparative cross-sectional descriptive study Study area: Diabetic clinic at Kenyatta National Hospital Study population: Diabetic patients both type 1 and 2 attending the diabetic clinic Sampling procedure: Diabetic patients were assessed for eligibility and recruited into the study. Recruitment was done consecutively till the desired number was achieved. Files for the eligible

patients were perused through to check for documented complications. A questionnaire was filled for the eligible patients and 4 ml of venous blood taken for analysis. Laboratory Analysis: After recruiting the study subjects, blood samples were collected (4 ml) from the consenting patients. Test for random blood sugar was done using a glucometer, Glycated Albumin and HbAIc were also determined and data collected and analyzed. Other characteristics like type of diabetes, body mass index and type of treatment the patients were using were also noted. The performance of the two tests was compared against each other. Data Management: The data obtained from the laboratory was entered into a computer database. Spreadsheets were generated and analyzed using windows SPSS version 17 Results The mean age was 52 yrs with a female preponderance of 60.4%. Majority of the patients had type 2 diabetes, 214 (82.3%), while only 46 (17.7%) had type 1. A large number of patients were on insulin, 100 (38.5%) followed by those on oral glucose lowering agents, mainly metformin. Random blood sugar analysis showed that, the population with good glycemic control constituted 156 (60%). Results from this study showed that majority of the patients had good glycemic control 170 (65.4%) based on the HbA1c assay, compared to 39.4% in GA. In this study there was no correlation between Random blood sugar with either HbA1c or Glycated Albumin. There was correlation between HbA1c and Glycated Albumin with R2 value of 0.64. Conclusions Based on the results from this study, majority of the patients showed good glycemic control based n HbA1c compared to Glycated albumin. Random blood sugar showed no correlation with Glycated albumin or glycated hemoglobin. There was correlation between HbA1c and Glycated Albumin with R2 value of 0.64.

Reccomendations The study found good correlation between HbA1c and Glycated Albumin which would support its utilization in monitoring glycemic control, however there is need for further studies to be done on characteristics of glycated albumin test and reference range validation in order to consider introducing it as a method of monitoring medium term glycemic control.