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
ARTICLE HIGHLIGHTS
Research background

Glycated albumin (GA), the non-enzymatic glycation product of albumin in plasma, was first introduced as a glycemic marker in the beginning of the 21st century. GA is not affected by hemoglobin levels and reflects glycemic status over a shorter period (2-4 wk) as compared to HbA1c measurements. GA has been verified for various aspects in the management of diabetes mellitus (DM) in clinical chemistry.

Research motivation

This study is the first systematic review and meta-analysis on the diagnostic accuracy of GA for DM. GA may contribute as an intermediate glucose index in the current DM diagnostic system.

Research objectives

Our main purpose was to summarize and assess the diagnostic data to evaluate the suitability of GA in the diagnosis of DM.

Research methods

The Quality Assessment of Diagnostic Accuracy Studies-2 tool was applied for the assessment of quality. The bivariate model was used to pool sensitivity and specificity, and the hierarchical summary receiver operator characteristic curve (HSROC) model was utilized to estimate the summary receiver operating characteristics curve (SROC). The results account for the correlation between sensitivity and specificity across the studies, while the HSROC model also considered the variations between the functional relationship and thresholds in each study.

Research results

The average cut-off values of GA reported for gestational diabetes mellitus (GDM) diagnosis were much lower than those for non-GDM. Diagnosing DM with a circulating GA cut-off of 14.0% had a summary 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 (AUC) of 0.80 (95%CI: 0.76, 0.83) for SROC. The estimated SROC at different GA cut-off values for non-GDM exhibited that the average location parameter lambda was 2.354 (95%CI: 2.002, 2.707) and the scale parameter beta was -0.163 (95%CI: -0.614, 0.288).

Research conclusions

GA should be used as an additional test rather than an alternative to HbA1c or OGTT, considering its moderate accuracy in diagnosing non-GDM. Its use as the sole DM diagnostic test should be interpreted with caution to assure the correct classification of diabetic individuals.

Research perspectives

Further research on the diagnostic accuracy of GA for GDM and combinational measurements of GA with other assays has been suggested. Besides, it is pertinent for researchers to unify international standards and optimize GA detection methods.