Comparison of Glycated Albumin and Glycated Hemoglobin levels in the management of type 2 diabetic patients in the Tema Metropolis of Ghana.

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November, 2016
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Glycated Albumin (GA) has been proposed as an important index in assessing chronic glycaemic control in diabetic patients other than glycated hemoglobin (HbA1c), besides it reflects shorter periods of glycaemia. This study sought to validate the use of Glycated Albumin and Glycated Hemoglobin, as biomarkers of glycaemic control among Ghanaian diabetes patients. Venous blood samples were taken from 200 participants of whom 150 were type 2 diabetic patients and 50 healthy individuals without diabetes. The blood samples were analyzed for fasting glucose, lipid profile, renal function (BUN, CRT and eGFR), serum total protein and albumin on fully automated analyzer, Roche COBAS Integra 400 Plus System. The A1 fast fraction – cation exchange method was used to estimate the level of glycated hemoglobin whilst the sandwich enzyme-linked immunosorbent one-step process assay (ELISA) was used for the assay of the Human Glycosylated Albumin (GA) level in the samples. Blood glucose, Glycated hemoglobin, Glycated albumin, GA/HbA1c and serum albumin were significantly (P< 0.05) increased in the patients with diabetes compared to the non-diabetics. Renal assessment indicated significant differences (P< 0.05) in levels of serum urea, creatinine and sodium with increased levels in the diabetic patients. The estimated glomerular filtration rate (eGFR) was also significantly (P<0.0001) reduced in the diabetics (eGFR value) compared to the non-diabetes (eGFR value). The proportion of excellent control of blood glucose assessed using GA, 11.3%, was lower than that assessed by HbA1c (16.7%). Also, glycemic control assessed by GA showed a greater proportion of poor control (35.3%) than when assessed by HbA1c (28.7%). Across the various age groups, diabetic nephropathy (29.3%) was more prevalent in the diabetic patients aged between 70-79 years and retinopathy (43.3%) more prevalent in the patients aged 60-69 years. Correlation between the levels of HbA1c and Glycated albumin among patients with diabetes a showed a highly significant relationship (P<0.001). Poor glycaemic control determined by HbA1c and GA were highly associated with Obesity and reduced kidney function. Glycated albumin reflects glucose excursions more strongly than HbA1c; hence GA might be a more sensitive index for some diabetic complications than HbA1c.
A thesis submitted in fulfillment of the requirements for the degree of Master of Philosophy (Chemical Pathology) In the Department of Molecular Medicine, School of Medical Sciences College of Health,