Glycated Albumin for the Diagnosis of Diabetes in US Adults

BACKGROUND: There is growing interest in using glycated albumin for the diagnosis of diabetes, especially when standard tests (glucose and hemoglobin A(1c) [HbA(1c)]) are unavailable. However, it is unknown how well glycated albumin identifies diabetes in the general population. METHODS: We measured glycated albumin in stored serum samples from the 1999-2004 National Health and Nutrition Examination Survey. We evaluated the ability of glycated albumin to identify undiagnosed diabetes in US adults aged >= 20 (n = 4785), overall and at thresholds corresponding to clinical cut points for Hb A(1c) and fasting plasma glucose (FPG). We assessed 4 reference definitions for undiagnosed diabetes: increased FPG (>= 126 mg/dL) [>= 6.99 mmol/L), increased Hb A(1c) (>= 6.5%), either FPG or Hb A(1c) increased, or both FPG and Hb A(1c) increased. RESULTS: Among US adults, glycated albumin had excellent diagnostic accuracy across all 4 definitions of undiagnosed diabetes, with the area under the receiver operating characteristic curve (AUC) ranging from 0.824 to 0.951. Performance was generally consistent across patient demographic and clinical characteristics. Glycated albumin cut points of 16.5% and 17.8% were equivalent to an FPG of 126 mg/dL (6.99 mmol/L; 97th percentile) and Hb A(1c) of 6.5% (98th percentile) and had low to moderate sensitivity (0.273 to 0.707) but high specificity (0.980 to 0.992) for detecting undiagnosed diabetes. CONCLUSION: The excellent diagnostic performance of glycated albumin to identify diabetes defined by either FPG or Hb A(1c) suggests that glycated albumin may be useful for identifying adults with undiagnosed diabetes when standard tests are unavailable.

Automated summary

Glycated albumin has excellent diagnostic performance in identifying undiagnosed diabetes in the general population, suggesting its potential usefulness as an alternative test for diagnosing diabetes when standard tests are unavailable.