Association of serum glycated albumin to haemoglobin A1C ratio with hepatic function tests in patients with chronic liver disease

This version was published on 1 September 2009

Ann Clin Biochem 2009;46:368-372
© 2009 Association for Clinical Biochemistry


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Original Articles

Yukihiro Bando1,
Hideo Kanehara1,
Daisyu Toya1,
Nobuyoshi Tanaka1,
Soji Kasayama2 and
Masafumi Koga3

1 Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Fukui;
2 Department of Medicine, Nissay Hospital, Osaka;
3 Department of Internal Medicine, Kinki Central Hospital, Hyogo, Japan

Corresponding author: Masafumi Koga, Department of Internal Medicine, Kinki Central Hospital, Kuruma-zuka 3-1, Itami, Hyogo 664-8533, Japan. Email: koga_m{at}

Background: In patients with chronic liver disease (CLD), glycated haemoglobin (HbA1C) levels have been shown to be apparently lower than realvalues, whereas serum glycated albumin (GA) levels are apparentlyhigher. The present study was aimed to examine whether bothglycaemic indices are influenced by hepatic function.

Methods: Subjects consisted of 82 patients with CLD. Various indicators for hepatic function as well as HbA1C and GA were also measured. Estimated HbA1C values were calculated from the mean plasmaglucose levels. Two hundred and two type 2 diabetic patientswithout CLD were studied as controls.

Results: Although GA was strongly correlated with HbA1C in patients with CLD as well as diabetic patients, GA levels in patients with CLD were relatively higher than those in diabetic patients. In patients with estimated HbA1C 5.8%, GA levels significantly increased but HbA1C levels decreased as a function of decreasing hepaplastin test (HPT). The ratio of GA/HbA1C (G/H ratio) increased as a function of decreasing HPT. In patients with estimated HbA1C >5.8%, in contrast, GA levels were independent of HPT levels. In the patients with CLD, GA and HbA1C were associatedwith mean plasma glucose levels and some indicators for hepaticfunction. The multivariate analysis revealed a significant associationof G/H ratio with HPT, cholinesterase and direct bilirubin.The G/H ratio was not associated with the mean plasma glucosebut with HPT and cholinesterase levels.

Conclusions: The G/H ratio correlates with hepatic function but not withplasma glucose levels. Therefore, CLD should be suspected fordiabetic patients with an elevated G/H ratio.

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