, Volume 54, Issue 9, pp 2247-2253

Glycated albumin but not HbA1c reflects glycaemic control in patients with neonatal diabetes mellitus

Abstract

Aims/hypothesis

It is difficult to use HbA1c as an indicator of glycaemic control in patients with neonatal diabetes mellitus (NDM) because of high levels of fetal haemoglobin (HbF) remaining in the blood. In this study, glycated albumin (GA), which is not affected by HbF, and HbA1c were compared to evaluate whether they reflect glycaemic control in patients with NDM.

Methods

This study included five patients with NDM. Age at diagnosis was 38 ± 20 days. Insulin therapy was started in all patients, and levels of GA, HbA1c and HbF were measured monthly for 6 months. One-month average preprandial plasma glucose (aPPG) was calculated using self-monitoring of blood glucose.

Results

Plasma glucose and GA were elevated (29.7 ± 13.1 mmol/l [n = 5] and 33.3 ± 6.9% [n = 3], respectively) but HbA1c was within normal limits (5.4 ± 2.6% [35.5 ± 4.9 mmol/mol]; n = 4) at diagnosis. With diabetes treatment, aPPG (r = −0.565, p = 0.002), GA (r = −0.552, p = 0.003) and HbF (r = −0.855, p < 0.0001) decreased with age, whereas HbA1c increased (r = 0.449, p = 0.004). GA was strongly positively correlated with aPPG (r = 0.784, p < 0.0001), while HbA1c showed no correlation with aPPG (r = 0.221, p = 0.257) and was significantly inversely correlated with HbF (r = −0.539, p = 0.004).

Conclusions/interpretation

GA is a useful indicator of glycaemic control in patients with NDM, whereas HbA1c is influenced by age-related changes in HbF and does not accurately reflect glycaemic control.

Professor K. Fujieda, who supervised this research, died on 19 March 2010 before publication of this work.