Glycated albumin and the risk of micro- and macrovascular complications in subjects with Type 1 Diabetes

BACKGROUND We investigated the relationship between the glycemic indices glycated albumin (GA) and glycated hemoglobin (HbA1c) and the progression of diabetic vascular complications [diabetic nephropathy (DN) and carotid artery atherosclerosis (CAA)] in subjects with type 1 diabetes (T1D). METHODS A total of 154 participants with a median follow-up of 2.8 years were enrolled in this retrospective longitudinal study. We recruited T1D subjects who had regularly measured urine albumin-creatinine ratios and estimated glomerular filtration rates, as well as tested HbA1c and GA levels consecutively every 3 or 6 months. A subgroup of 54 subjects was measured repeated carotid intima-media thickness (IMT). RESULTS We classified subjects into the DN progression (Group I; n = 30) with either deteriorated stages of chronic kidney disease (n = 18) or albuminuria progression (n = 17), and the non-progression (Group II; n = 124). In multiple logistic regression analyses, baseline albuminuria (odds ratio [OR] = 2.64, 95 % confidence interval [CI] = 1.03-6.74), mean GA levels (OR = 2.03, 95 % CI = 1.27-3.26) were significantly associated with progression of DN. However, there was no association with mean HbA1c (OR = 0.98, 95 % CI = 0.62-1.54). In a subgroup analysis for follow-up measurements of carotid IMT, age was independently associated with the presence of plaque and the mean IMT. However glycemic indices were not significantly associated with CAA. CONCLUSIONS Mean GA levels were more closely associated with DN progression than mean HbA1c in subjects with T1D. However, they were not associated with the CAA.