Serum glycated albumin to haemoglobin A1C ratio can distinguish fulminant type 1 diabetes mellitus from type 2 diabetes mellitus

Abstract

Background: Fulminant type 1 diabetes mellitus (FT1DM), a subtype of type 1 diabetes mellitus, was first reported as a disease entity in 2000. Ketoacidosis at initial onset due to acute pancreatic cell destruction makes early diagnosis and treatment for FT1DM mandatory. In the early period of FT1DM, haemoglobin (Hb)A_1C levels are not markedly elevated. This study investigated serum glycated albumin (GA), which reflects acute short-term changes in plasma glucose, as a new clinical index for FT1DM at disease onset. Methods: Subjects comprised 35 patients with FT1DM who had undergone measurement of HbA_1C and serum GA at initial visit and 42 patients with type 2 diabetes mellitus (T2DM) with HbA_1C 1C was significantly lower in FT1DM than in T2DM, whereas serum GA was significantly higher. GA/HbA_1C ratio was thus significantly higher in FT1DM than in T2DM (3.9 ± 0.5 versus 2.8 ± 0.3; P < 0.0001). GA/HbA_1C ratio was >3.2 in 41 of 42 FT1DM patients (98%), compared with only one of 32 T2DM patients (3%). Conclusions: Serum GA is significantly higher in FT1DM than in T2DM, whereas HbA_1C is significantly lower. FT1DM can thus be distinguished from untreated T2DM by GA/HbA_1C ratio at initial visit before treatment for diabetes.