Diabetology International

, Volume 8, Issue 2, pp 199–204 | Cite as

High glycated albumin (GA) levels and the GA/HbA1c ratio in patients with insulin autoimmune syndrome

  • Masafumi KogaEmail author
  • Shinya Inada
  • Jun Taniguchi
  • Yuki Nakatani
  • Hiroshi Yoshino
  • Gen Yoshino
  • Yukiyoshi Okauchi
  • Ikuo Mineo
Original Article


Insulin autoimmune syndrome (IAS) involves not only fasting hypoglycemia, but also postprandial hyperglycemia. In the present study, we hypothesized that glycated albumin (GA) levels and the GA/HbA1c ratio, which reflect fluctuations in plasma glucose levels, are elevated in IAS patients. Four IAS patients were enrolled in the present study. Thirty-two non-diabetic subjects matched for gender, age, and BMI were used as the control group. The fasting plasma glucose levels in the IAS patients were significantly lower than in the control group. However, the oral glucose tolerance test (OGTT) revealed impaired glucose tolerance or diabetes mellitus in all the IAS patients, and thus the OGTT 2-h plasma glucose levels were significantly higher than in the control group. The GA levels and the GA/HbA1c ratio in the IAS patients were significantly higher than in the control group, despite no significant difference in the HbA1c levels between the two groups. In one case in which IAS spontaneously went into remission, there was a significant correlation between anti-insulin antibodies and GA, but not HbA1c. Improvement in glucose fluctuations was observed by continuous glucose monitoring in another patient along with improvement in the clinical symptoms. Furthermore, anti-insulin antibodies, GA, and the GA/HbA1c ratio decreased, but HbA1c did not change significantly in three IAS patients along with the improvement in clinical symptoms. These results suggest that GA and the GA/HbA1c ratio are useful indicators for determining the level of disease activity in IAS patients.


Glycated albumin HbA1c Hypoglycemia Insulin autoimmune syndrome Insulin antibodies Postprandial hyperglycemia 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Human rights and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients prior to their participation in this study.


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Copyright information

© The Japan Diabetes Society 2016

Authors and Affiliations

  • Masafumi Koga
    • 1
    Email author
  • Shinya Inada
    • 2
  • Jun Taniguchi
    • 3
  • Yuki Nakatani
    • 4
  • Hiroshi Yoshino
    • 5
  • Gen Yoshino
    • 6
  • Yukiyoshi Okauchi
    • 7
  • Ikuo Mineo
    • 7
  1. 1.Department of Internal MedicineHakuhokai Central HospitalAmagasakiJapan
  2. 2.Department of Internal MedicineKawanishi City HospitalHyogoJapan
  3. 3.Department of DiabetesTokeidai Memorial HospitalSapporoJapan
  4. 4.Department of Diabetes & EndocrinologyDokkyo Medical University Nikko Medical CenterTochigiJapan
  5. 5.Division of Diabetes, Metabolism, and Endocrinology, Department of Internal MedicineToho University School of MedicineTokyoJapan
  6. 6.Center for Diabetes, Shin-Suma General HospitalKobeJapan
  7. 7.Diabetes Center, Toyonaka Municipal HospitalOsakaJapan

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