Glycated albumin and HbA1C ratio simple and practical indicator of MAFLD risk in diabetes

A study published in Diabetology & Metabolic Syndrome, BMC, has concluded that in Type 2 Diabetes Mellitus patients, the glycated albumin/HbA1C ratio is negatively associated with metabolic dysfunction-associated fatty liver disease (MAFLD). This hallmarks that GA/HbA1C ratio is the reflection of the insulin resistance degree. The study added that this GA/HbA1C evaluates MAFLD risk in these subjects.

The fact that non-enzymatic glycosylation of proteins is elevated in diabetes mellitus (DM) patients is well established. Glycated albumin (GA) provides information on short-term glycemic control (2–3 weeks), while glycated haemoglobin (HbA1C) predicts more extended glycemic control status (2–3 months). HbA1C is the gold standard and is widely considered in a clinical setting.

The glycated albumin/glycated haemoglobin A1C (GA/HbA1C) ratio aid in the prediction of the future changes of HbA1C backed by the fact that GA changes precede those of HbA1C in T2DM patients.

GA/HbA1C ratio is a more reliable indicator regarding glycemic control and fluctuation within two weeks. This ratio is linked (positive association) to complications of diabetes like retinopathy, carotid atherosclerosis and diabetic kidney disease (prevalence and severity), cognitive impairment and metabolic dysfunctioning. It is also related to abdominal obesity, NAFLD, insulin resistance, and dyslipidemia.

NAFLD, a liver manifestation of metabolic dysfunction, is twofold more prevalent in T2DM patients.

The data available on the association between GA/HbA1C ratio and hepatic damage remains controversial. There need to be more studies in this context.

Studies demonstrate that an elevated GA/HbA1C ratio is significantly associated with the progression of liver fibrosis in chronic hepatitis patients. Other studies are showing a low ratio tied to increased hepatic inflammation.

There need to be more studies for T2DM elucidating the relationship between the GA/HbA1C ratio and MAFLD.

Against the above background, a study was conducted by a team of researchers led by Dr Jun-Wei Wang and Chun-Hua Jin from the Department of Endocrinology and Metabolism at Shanghai Sixth People's Hospital from Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, China to investigate, "What is the correlation between GA/HbA1C ratio and MAFLD?" The study also explored relevant factors in Chinese T2DM subjects.

The critical points of the study are:

• 7117 T2DM patients were included in the study, 3296 men and 3821 women.

• The diagnosis of MAFLD was made using Abdominal ultrasonography.

• Four groups were in the study based on the GA/HbA1C ratio quartiles. The cutoff was < 2.45, 2.45–2.72, 2.73–3.16, and > 3.16.

• There was a higher prevalence of MAFLD in women than men, with a P value of < 0.001.

• The prevalence of MAFLD decreased in line with ageing significantly and extended DD ( P < 0.001).

• The women had a lower GA/HbA1C ratio than men, with P < 0.001.

• The GA/HbA1C ratio increased (P < 0.001) with age.

• The ratio decreased with prolonged DD (P < 0.001 ).

• A significantly decreased trend in the prevalence of MAFLD across the GA/HbA1C ratio quartiles was recorded after adjusting for age, gender, and DD for the first, second, third and fourth quartiles, with values of 56.3%, 47.4%, 37.8%, and 35.6% respectively. The P value was < 0.001.

• The GA/HbA1C ratio and GA with MAFLD in the T2DM patients were lower (P < 0.001).

• No difference was reported in HbA1C levels in T2DM patients, with and without MAFLD, and the P value was 0.102.

• Both ALT and γ-GT levels had a P value of 0.002 which was significant.

• The decreased GA/HbA1C ratio was linked with increased MAFLD risk. (P < 0.001).

• An inverse association was determined by Fully adjusted Binary logistic regression for both GA/HbA1C ratios, having OR of 0.575 (P < 0.001) and quartiles having P value of < 0.001 for trend with MAFLD presence among T2DM patients.

• There was an increase in HOMA2-IR values in the T2DM subjects with MAFLD P < 0.001.

"GA/HbA1C ratio is a predictor for diabetic chronic complications", they discussed.

They said, " We performed the present investigation and had a large sample size elucidating the association of GA/HbA1C ratio and MAFLD in T2DM subjects"

They reported 44.3% of T2DM patients had MAFLD. This was in line with their previous studies.

We found that the elevated GA/HbA1C ratio is closely linked to reduced MAFLD risk despite controlling confounding factors (GA and HbA1C). The risk was reduced by 43% with each 1 SD rise of the GA/HbA1C ratio.

The MAFLD prevalence risk was decreased by more than half with a GA/HbA1C ratio greater than 3.16. The decrease was gradual (first to the fourth quartile).

They finally wrote, though, after GA and HbA1C adjusting, decreased GA/HbA1C ratio remained an independent risk factor for MAFLD in T2DM patients. Hence, the Reduced GA/HbA1C ratio led to more prone MAFLD in our study, due to negative correlation between hypertension, obesity and GA/HbA1C ratio.

Further reading:

Wang, JW., Jin, CH., Ke, JF. et al. GA/HbA1c ratio is a simple and practical indicator to evaluate the risk of metabolic dysfunction-associated fatty liver disease in type 2 diabetes: an observational study. Diabetol Metab Syndr 14, 167 (2022). https://doi.org/10.1186/s13098-022-00946-