Introduction of glycated albumin in clinical practice

Glycated albumin (GA) is the result of non-enzymatic glycation of albumin that occurs into circulation. Glycation rate of albumin depends on glycemia and on the time of albumin stay into the bloodstream, so GA has been proposed as a biomarker of glycemic status. Consequently, several studies investigated the clinical usefulness of GA in diabetes, showing that it has good diagnostic accuracy and it could represent a useful screening test. Additionally, due to the shorter lifespan of albumin in comparison to the traditional biomarkers of glycemic control, like HbA1c, GA can be considered a biomarker of early response to hypoglycemic treatment. Moreover, GA has been proposed as a biomarker of glycemic control in patients with diabetic nephropathy, anemia, pregnancy, haemoglobin variants, transfusions, especially when HbA1c loses its accuracy. Notably, recent findings have associated GA also with the progression of diabetes over microangiopathy, such as retinopathy and nephropathy, and cardiovascular outcomes. GA circulating levels increase modestly with age in healthy subjects, and are influenced by conditions altering albumin turnover such as hypo- and hyperthyroidism, cirrhosis, nephrotic syndrome, obesity. The introduction of GA in clinical practice is facilitated by the establishment of GA reference intervals, recently described in several studies with comparable results, and the knowledge of the biological determinants of its circulating levels.