Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9520-9534
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9520
Glycated albumin as a biomarker for diagnosis of diabetes mellitus: A systematic review and meta-analysis
Jia-Yao Xiong, Jun-Mei Wang, Xiao-Lan Zhao, Chao Yang, Xian-Shu Jiang, Yan-Mei Chen, Chang-Qin Chen, Zhi-Yong Li
Jia-Yao Xiong, Jun-Mei Wang, Xiao-Lan Zhao, Chao Yang, Xian-Shu Jiang, Yan-Mei Chen, Chang-Qin Chen, Zhi-Yong Li, Department of Endocrinology, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
Author contributions: Xiong JY contributed to data acquisition, analysis, and interpretation of data, and drafted the article; Wang JM contributed to data acquisition and analysis, and drafted the article; Zhao XL and Yang C contributed to data analysis and interpretation, and revised the article; Jiang XS and Chen YM contributed to data interpretation, and revised the article; Chen CQ contributed to data analysis and interpretation, and made critical revisions to the manuscript; Li ZY contributed to conception and design of the study and critical revision of the manuscript; all author approved the final version.
Conflict-of-interest statement: The authors deny any conflict of interest related to this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Yong Li, MD, Chief Physician, Professor, Department of Endocrinology, Yongchuan Hospital of Chongqing Medical University, No. 439 Xuanhua Road, Yongchuan District, Chongqing 402160, China. 616455870@qq.com
Received: February 24, 2021
Peer-review started: February 24, 2021
First decision: April 20, 2021
Revised: May 4, 2021
Accepted: September 10, 2021
Article in press: September 10, 2021
Published online: November 6, 2021
Processing time: 247 Days and 9.1 Hours
Abstract
BACKGROUND

Glycated albumin (GA), the non-enzymatic glycation product of albumin in plasma, became a glycemic marker in the beginning of the 21st century. The assay is not affected by hemoglobin levels and reflects the glycemic status over a shorter period as compared to HbA1c measurements. Thus, GA may contributes as an intermediate glucose index in the current diabetes mellitus (DM) diagnostic system.

AIM

To search and summarize the available data on glycated albumin measurements required for the diagnosis of diabetes mellitus.

METHODS

Databases, including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL), among others, were systematically searched. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was applied for the assessment of quality, and the bivariate model was used to pool the sensitivity and specificity. The hierarchical summary receiver operator characteristic curves (HSROC) model was utilized to estimate the summary receiver operating characteristics curve (SROC). Sensitivity analysis was performed to investigate the association of the study design and patient characteristics with the test accuracy and meta-regression to find the source of heterogeneity.

RESULTS

Three studies regarding gestational diabetes mellitus (GDM) and a meta-analysis of 16 non-GDM studies, comprising a total sample size of 12876, were included in the work. Results reveal that the average cut-off values of GA reported for the diagnosis of GDM diagnosis was much lower than those for non-GDM. For non-GDM cases, diagnosing DM with a circulating GA cut-off of 14.0% had a sensitivity of 0.766 (95%CI: 0.539, 0.901), specificity of 0.687 (95%CI: 0.364, 0.894), and area under the curve of 0.80 (95%CI: 0.76, 0.83) for the SROC. The estimated SROC at different GA cut-off values for non-GDM exhibited that the average location parameter lambda of 16 non-GDM studies was 2.354 (95%CI: 2.002, 2.707), and the scale parameter beta was -0.163 (95%CI: -0.614, 0.288). These non-GDM studies with various thresholds had substantial heterogeneity, which may be attributed to the type of DM, age, and body mass index as possible sources.

CONCLUSION

Glycated albumin in non-DM exhibits a moderate diagnostic accuracy. Further research on the diagnostic accuracy of GA for GDM and combinational measurements of GA and other assays is suggested.

Keywords: Glycated albumin; Diabetes mellitus; Diagnosis; Sensitivity and Specificity; Systematic review; Meta-analysis

Core Tip: This is the first systematic review and meta-analysis investigating the utility of glycated albumin (GA) for the diagnosis of diabetes mellitus (DM). Three studies regarding gestational diabetes mellitus (GDM) were included in the systematic review, and another 16 studies on non-GDM were included in the meta-analysis. This study found that the average cut-off values of GA reported for GDM diagnosis were much lower than those for non-GDM. The GA cut-off value of 14.0% exhibited a moderate diagnostic accuracy in non-GDM. GA, as the sole DM diagnostic test, should be interpreted with caution to assure the correct classification of diabetic individuals.