A Cross-Sectional Study on the Accuracy of Glycated Albumin in Diagnosing Pregnancies Complicated with Gestational Diabetes Mellitus
Celestine Osita John
Department of Obstetrics and Gynecology, University of Port Harcourt, Nigeria.
Atochi Prince Woruka *
Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: The diagnosis of gestational diabetes mellitus is made using the oral glucose tolerance test. Conducting this test requires patient preparation. Meanwhile, glycated albumin does not require the patient to be prepared. Glycated albumin is affected by ethnicity and black Americans have higher glycated albumin levels than Caucasians. This study determined the use of glycated albumin in diagnosing gestational diabetes mellitus among pregnant women.
Materials and Method: The study was a prospective cross-sectional study of 200 pregnant women between 24 to 28 weeks of gestation at the University of Port Harcourt Teaching Hospital. The diagnosis of Gestational diabetes mellitus (GDM) was based on the World Health Organization 2013 diagnostic criteria. The diagnostic cut-off of glycated albumin was determined using the receiver operator characteristic (ROC) curve. The comparison of means was done using the Student’s T-test.
Results: The area under the receiver operator characteristic curve for glycated albumin was 0.8 and the optimal cut-off value of glycated albumin in the diagnosis of gestational diabetes mellitus was 19%. Glycated albumin was significantly elevated in women with gestational diabetes mellitus compared to women without gestational diabetes mellitus at P<0.001.
Conclusion: Glycated albumin has an area under the ROC curve of 0.85 with an optimal cut-off value of 19.0%. Glycated albumin is significantly elevated in women with GDM than in women without GDM with a sensitivity of 83.3% and a specificity of 86.8%. Therefore, glycated albumin can be used to diagnose GDM.
Keywords: Glycated albumin, oral glucose tolerance test, gestational diabetes mellitus, pregnancy complications
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Chong HP, Alazzani H, Boelaert K. Endocrine disorders in pregnancy. Obstet Gynecol Reprod Med. 2019;29:301-305. DOI:10.1016/j.ogrm.2019.08.005. https://doi.org/10.1016/j.ogrm.2019.08.005
Ogu RN, John CO, Maduka O, Chinenye S. Screening for Gestational Diabetes Mellitus: Findings from a Resource Limited Setting of Nigeria. Br J Med Med Res. 2017;20:1-8 Available:https://doi.org/10.9734/BJMMR/2017/31966
John DH, Awoyesuku PA, MacPepple DA, Kwosah NJ. Prevalence of Gestational Diabetes Mellitus and Maternal and Fetal Outcomes at the Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria. JAMMR. 2019;31:1-16 Available:https://doi.org/10.9734/jammr/2019/v31i930319
Eades CE, Cameron DM, Evans JMM. Prevalence of Gestational Diabetes Mellitus in Europe: A Meta-analysis. Diabetes Res Clin Pract. 2017;129:173-181 Available:https://doi.org/10.1016/j.diabres.2017.03.030
Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Child B. 2018;18:1-20. Available:https://doi.org/10.1186/s12884-018-2131-4
Muche AA, Olayemi OO, Gete YK. Prevalence and Determinants of Gestational Diabetes Mellitus in Africa Based on the Updated International Diagnostic Criteria: A Systematic Review and Meta-analysis. Arch Public Health. 2019;77:1-20. Available:https://doi.org/10.1186/s13690-019-0362-0
John DH, Awoyesuku PA, MacPepple DA, Kwosah NJ. Prevalence of Gestational Diabetes Mellitus and Maternal and Fetal Outcomes at the Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria. JAMMR. 2019;31: 1-16. Available:https://doi.org/10.9734/jammr/2019/v31i930319
Billionnet C, Mitanchez D, Weill A, Nizard J, Alla F, Hartemann A. et al. Gestational Diabetes and Adverse Perinatal Outcomes from 716,152 Births in France in 2012. Diabetologia. 2017; 60:636–644. Available:https://doi.org/10.1007/s00125-017-4206-6
Battarbee AN, Venkatesh KK, Aliaga S, Boggess KA. The Association of Pregestational and Gestational Diabetes with Severe Neonatal Morbidity and Mortality. J Perinatol. 2020;40:232-239. Available:https://doi.org/10.1038/s41372-019-0516-5
Sathiamma PK, Lalithambica KA. Prospective Study on Maternal and Perinatal Outcome of Gestational Diabetes Mellitus. Int J Reprod Contracept Obstet Gynecol. 2017;6:2933-2938.
Available:https://doi.org/10.18203/2320-1770.ijrcog20172910
Farahvar S, Walfisch A, Sheiner E. Gestational Diabetes Risk Factors and Long-term Consequences for Both Mother and Offspring: A Literature Review. Expert Rev Endocrinol Metab. 2019;14: 63-74.
Available:https://doi.org/10.1080/17446651.2018.1476135
Bianco ME, Josefson JL. Hyperglycemia During Pregnancy and Long-Term Offspring Outcomes. Curr Diab Rep. 2019;19:143. Available:https://doi.org/10.1007/s11892-019-1267-6
McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational Diabetes Mellitus. Nat Rev Dis Primers. 2019;5:47. Available:https://doi.org/10.1038/s41572-019-0098-8
Hymavathi K, Tadisetti S, Polisetty K, Gottipatti MD. Gestational Diabetes Mellitus-Universal Versus Selective Screening. Int J Reprod Contracept Obstet Gynecol. 2016;5:2155-2160.
Available:https://doi.org/10.18203/2320-1770.ijrcog20162083
World Health Organization. Diagnostic Criteria and Classification of Hyperglycemia First Detected in Pregnancy; 2013 Available:http://apps.who.int/iris/bitstream/10665/85975/1/WHO_NMH_MND_13.2_eng.pdf.
National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. nice.org.uk/guidance/ng3; 2020.
Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC. et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A Pragmatic Guide for Diagnosis, Management, and Care. Int J Gynecol Obstet. 2015;131: S173–S211.
Available:https://doi.org/10.1016/S0020-7292(15)30007-2
Jagannathan R, Neves JS, Dorcely B, Chung ST, Tamura K, Rhee M. The Oral Glucose Tolerance Test: 100 Years Later. Diabetes Metab Syndr Obes. 2020;13:3787-3805 Available:https://doi.org/10.2147/DMSO.S246062
Bogdanet D, O’Shea P, Lyons C, Shafat A, Dunne F. The Oral Glucose Tolerance Test—Is It Time for a Change?—A Literature Review with an Emphasis on Pregnancy. J Clin Med. 2020; 9:3451. Available:https://doi.org/10.3390/jcm9113451
Nanda R, Patel S, Sahoo S, Mohapatra E. Review of Pre-Analytical Errors in Oral Glucose Tolerance Testing in a Tertiary Care Hospital. J Nepal Health Res Counc. 2018;16:6-10 Available:https://doi.org/10.3126/jnhrc.v16i1.19353
Agarwal MM, Punnose J, Dhatt GS. Gestational Diabetes: Problems Associated with the Oral Glucose Tolerance Test. Diabetes Res Clin Pract. 2004;63:73- Available:https://doi.org/10.1016/j.diabres.2003.08.005
Freitas PAC, Ehlert LR, Camargo JL. Glycated albumin: a potential biomarker in diabetes. Arch Endocrinol Metab. 2017;61:296–304. Available:https://doi.org/10.1590/2359-3997000000272
Piuri G, Basello K, Rossi G, Soldavini CM, Duiella S, Privitera G. et al. Methylglyoxal, Glycated Albumin, PAF, and TNF- Possible Inflammatory and Metabolic Biomarkers for Management of Gestational Diabetes. Nutrients. 2020;12:479. Available:https://doi.org/10.3390/nu12020479
Zendjabil M. Glycated albumin. Clinica Chimica Acta. 2019;502:240-244 Available:https://doi.org/10.1016/j.cca.2019.11.007
Neelofar N, Ahmad J. An overview of in vitro and in vivo glycation of albumin: a potential disease marker in diabetes mellitus. Glycoconj J. 2017;34:575-584. Available:https://doi.org/10.1007/s10719-017-9789-0
Dozio E, Di Gaetano N, Findeisen P. Corsi RMM. Glycated Albumin: From Biochemistry and Laboratory Medicine to Clinical Practice. Endocrine. 2017;55:682-690 Available:https://doi.org/10.1007/s12020-016-1091-6
George JA, Erasmus RT. Haemoglobin A1c or Glycated Albumin for Diagnosis and Monitoring Diabetes: An African Perspective. Ind J Clin Biochem. 2018;33: 255–261 Available:https://doi.org/10.1007/s12291-018-0755-9
Selvin E, Steffes MW, Ballantyne CM, Hoogeveen RC, Coresh J, Brancati FL. Racial Differences in Glycemic Markers: A Cross-sectional Analysis of Community-Based Data. Ann Intern Med. 2011;154: 303–309. Available:https://doi.org/10.7326/0003-4819-154-5-201103010-00004
Xiong JY, Wang JM, Zhao XL, Yang C, Jiang XS, Chen YM, et al. Glycated albumin as a biomarker for diagnosis of diabetes mellitus: A systematic review and meta-analysis. World J clin Cases. 2021;9:9520-9534. Available:https://dx.doi.org/10.12998/wjcc.v9.i31.9520
Liu X, Wu Na, Al-mureish A. A Review on Research Progress in the Application of Glycosylated Hemoglobin and Glycated Albumin in the Screening and Monitoring of Gestational Diabetes. Int J Gen Med. 2021;14:1155-1165. Available:https://doi.org/10.2147/IJGM.S296316
Li H, Wang F, Tao M, Huang Y, Jia W. Association between glycemic control and birthweight with glycated albumin in Chinese women with gestational diabetes mellitus. J Diabetes Investig. 2016;7:48–55. Available:https://doi.org/10.1111/jdi.12383
Zhu J, Chen Y, Li C, Tao M, Teng Y. The diagnostic value of glycated albumin in gestational diabetes mellitus. J Endocrinol Invest. 2018;41:121–128. Available:https://doi.org/10.1007/s40618-016-0605-7
Leeflang MMG, Allerberger F. How to: evaluate a diagnostic test. Clin Microbiol Infect. 2019; 25(1):54-59. Available:https://doi.org/10.1016/j.cmi.2018.06.011
Chikere CMU, Wilson K, Graziadio S. Vale L, Allen AJ. Diagnostic test evaluation methodology: A systematic review of methods employed to evaluate diagnostic tests in the absence of gold standard – An update. PLoS One. 2019;14:e0223832. Available:https://doi.org/10.1371/journal.pone.0223832
Obuchowski NA, Bullen JA. Receiver operating characteristic (ROC) curves: review of methods with applications in diagnostic medicine. Phys Med Biol. 2018;63(7):07TR01 Available:https://doi.org/10.1088/1361-6560/aab4b1
Dong Y, Zhai Y, Wang J, Chen Y, Xie X, Zhang C et al. Glycated albumin in pregnancy: reference intervals establishment and its predictive value in adverse pregnancy outcomes. BMC Preg Childbirth. 2020;20(12):1-9. Available:https://doi.org/10.1186/s12884-019-2704-x