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Glycated Albumin As a Sensitive Indicator of Glycemic Control Compared with Hba1c Among Type 2 Diabetes Mellitus Patients in the Gaza Strip

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Glycated Albumin As a Sensitive Indicator of Glycemic Control Compared with Hba1c Among Type 2 Diabetes Mellitus Patients in the Gaza Strip اندامعـت اﻹسﻻميـت- غزة The Islamic University – Gaza عمـادة انذراسـاث انعهيا Deanery of Higher Education كهيـت انعهـىو Faculty of Science ماخسـتير انعهـىو انحياتيـت Master of Biological Science تحـانيم طبيـت Medical Technology ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Glycated Albumin as A sensitive Indicator of Glycemic Control Compared with HbA1c among Type 2 Diabetes Mellitus Patients in the Gaza Strip Prepared by Majed A. Jebreil Supervisor Dr. Atef Masad Assistant Professor of Biomedicine A Thesis Submitted in Partial Fulfilment of the requirements for the degree of Master of Science in Biological Sciences-Medical Technology هـ1433-2012و Declaration I hereby declare that this submission is my own work and that, to the best of my knowledge and belief, it contains no material previously published or written by another person nor material which to a substantial extent has been accepted for the award of any other degree of the university or other institute, except where due acknowledgement has been made in the text. Signature Date Majed A. Jebreil June, 2012 All Rights Reserved © 2012. No part of this work can be copied, translated or stored in Any kind of a retrieval system, without prior permission of the author I Dedication To my Parents who have always been supporting me, especially My Father Eng. Abdurrahman Jebreil for his great efforts and support. To my brother Eng.Tawfik Jebreil, and sisters Abeer, Lena & Dina. Dedication is almost expressed to the Palestinian people who are suffering and struggling with the persistence to have a free Palestine. Majed A. Jebreil II Acknowledgments First of all, I would like to express my deepest gratitude and appreciation to my supervisor Dr. Atef Masad for his continuous support, encouragement and kind supervision that leads to the emergence of this work in its current form. Special thanks to the Islamic University of Gaza and the Faculty of Science and all the staff members of Medical Technology Master Program for giving me the opportunity and knowledge to achieve this research. Thanks are also to all staff in Public Aid Hospital, Al El Shifa and Naser Hospitals for their kind Help. Also, special thanks to Mr. Yousef el Arqan for giving me permission to do part of my research in his lab. Finally, I would like to thank my friends and relatives for their support and encouragement. III Glycated Albumin as A sensitive Indicator of Glycemic Control Compared with HbA1c among Type 2 Diabetes Mellitus Patients in the Gaza Strip Abstract Background: Diabetes mellitus is a clinical syndrome characterized by hyperglycaemia that deteriorates with disease duration. Protein glycation has important implications for protein activity, unfolding, and degradation, oxidative stress, as well as for cell functioning. Early diabetic management can reduce underlying complications, such as diabetic retinopathy, kidney failure, cardiovascular disease and blindness. Diabetic patients should control their blood glucose continuously, the most widely used screening tests include the fasting blood sugar (FBS) test, and Glycated haemoglobin (HbA1c) which is considered as the golden standard of glycemic control according to WHO 2011. There has been accumulating evidence demonstrating the usefulness of Glycated Albumin (GA), rather than HbA1c in some diseases and pathological conditions such as blood disorders and hemodialysis diabetic patients. Serum albumin has a shorter lifespan than that of erythrocytes; therefore it can reflect the short-term glycemic control status than HbA1c. Objectives: The aim of this study is to determine the significance of Glycated albumin (GA) in comparison with Glycated hemoglobin (HbA1c) among T2DM patients in Gaza strip. Materials and methods: This study is a Case-control study; A total of 90 cases of type 2 diabetic patients were evaluated and classified into two groups, Group A: 60 of type 2 diabetes mellitus (T2DM) patients without HD, Group B: 30 T2DM Hemodialysis patients (HD-T2DM), and Equal number of control subjects were run in parallel with each group. GA was measured using ELISA technique, and HbA1c was measured using quantitative colorimetric methods, Glucose, Fructosamine, Urea, Creatinine, Microalbuminuria, Total protein, Albumin, Total cholesterol, Triglycerides, IV and HDL-C were measured using colorimetric and kinetic chemistry kits, LDL-C was calculated using the empirical relationship of Friedewald. Results: Our study confirmed that point measurements of GA and HbA1c are mostly uncorrelated among T2DM and T2DM hemodialysis patients, and that values for Glycated albumin accurately represented the glycation status of T2DM patients with and without renal failure better than HbA1c. Our results showed that mean of BMI was significantly increased in diabetic patients in both groups compared with control (31.5±5.6, 29.9±5.9, P-value < 0.05) respectively compared with (20.5±4.8, P-value < 0.05) of control. FBS, GA and GP means were significantly increased in T2DM and HD-T2DM patients compared with controls, where FBS mean value was (190.7±58.0, 191.1±78.5,and 94.4±14.6, P-value < 0.05) respectively, and GA mean value was (803.1±254.6, 874.2±203.9, and 181.9±50.6, P-value < 0.05) respectively, while GP mean value was (395.0±113.6, 364.0±63.4 and 143.7±36.3, P-value < 0.05) respectively. However, HbA1c mean values were significantly decreased in diabetic hemodialysis patients compared with T2DM patients and control, the mean value was (6.1±0.6, 7.4±0.5 and 5.3±0.6, P-value < 0.05) in HD-T2DM, T2DM and control respectively. Our results showed that 63% of T2DM and 100% of T2DM-HD of cases showed high level of GA and GP compared with normal level of HbA1cmeasurement among HD- T2DM. Conclusion: GA is more sensitive indicator of glycemic control compared with HbA1c among Type 2 Diabetes Mellitus and haemodialysis patients.GA was found to be a better marker than HbA1c for evaluating short term glycemic status among T2DM patients, and achieved great success in the evaluation of diabetic hemodialysis patients, while HbA1c failed to evaluate them. Keywords: Glycated Albumin, HbA1c, Diabetes mellitus type 2, Diabetic Haemodialysis, Glycaemic control, Palestine, IUG. V اﻷنبىمين انمحمم بانسكر كمؤشر فعال نمتابعت مرضى انسكري من اننىع انثانً فً قطاع غزة مقارنت مع انهيمىغهىبين انمحمم بانسكر مهخص انذراست (Abstract (Arabic مقذمـــت : يشض انغكش٘ ْٕ يرﻻصيح عشٚشٚح ذرًٛض تضٚادج انغكش فٙ انذو انز٘ ٚرذْٕس يع يذج انًشض. ٚجة عهٗ يشظٗ انغكش٘ أٌ ٚرحكًٕا تًغرٕٖ انغكش فٙ انذو تشكم دائى , ٚٔفعم أٌ ٚقٕيٕا تفحص يخضٌٔ انغكش نذٚٓى يٍ خﻻل انًٕٛٓغهٕتٍٛ انًحًم تانغكش أٔ اﻷنثٕيٍٛ انًحًم تانغكش. اﻷنثٕيٍٛ انًحًم تانغكش اعرخذو كًؤشش نًشاقثح َغثح انغكش فٙ انذو ,ُْٔاك أدنح يرشاكًح أشثرد أًْٛرّ عهٗ حغاب انًٕٛٓغهٕتٍٛ انًحًم تانغكش خاصحً فٙ تعط اﻷيشاض ٔانحاﻻخ انًشظٛح انخاصح يصم أيشاض انذو, ٔيشظٗ غغٛم انكهٗ انًصاتٌٕ تًشض انغكش٘ . اﻷنثٕيٍٛ انًحًم تانغكش عًشِ أقصش تكصٛش يٍ كشاخ انذو انحًشاء, نزا فئَّ ٚعكظ يشاقثح يشض انغكش٘ نفرشج صيُٛح قصٛشج , نزا فئَّ قذ ٚكٌٕ يؤششا ً أكصش فائذج يٍ انًٕٛٓغهٕتٍٛ انًحًم تانغكش فٙ ذقٛٛى يشٚط انغكش٘ نفرشج صيُٛح قصٛشج . انهــذف من انرســانـت : ذى ذصًٛى ْزِ انشعانح نرحذٚذ أًْٛح اﻷنثٕيٍٛ انًحًم تانغكش يٍ خﻻل يقاسَرّ يع انًٕٛٓغهٕتٍٛ انًحًم تانغكش تٍٛ يشظٗ انغكش٘ انُٕع انصاَٙ فٙ قطاع غضج. انمــىاد وانطـــرق : فٙ ْزِ انذساعح , كاٌ يجًٕع انًشظٗ 00 يشٚط عكش٘ )ركٕس ٔإَاز (, يصُفٍٛ إنٗ يجًٕعرٍٛ: انًجًٕعح اﻷٔنٗ عثاسج عٍ 00 يشٚط عكش٘ يٍ انُٕع انصاَٙ غٛش يصاتٍٛ تانفشم انكهٕ٘ , ٔانًجًٕعح انصاَٛح عثاسج عٍ 00 يٍ يشظٗ غغٛم انكهٗ انًصاتٍٛ تًشض انغكش٘ انُٕع انصاَٙ أٚعا , تاﻹظافح إنٗ 00يرطٕع غٛش يصاتٍٛ تًشض انغكش٘ أٔ أ٘ أيشاض أخشٖ كًجًٕعح ظاتطح . VI ذى اعرخذاو ذقُٛح اﻹنٛضا نفحص اﻷنثٕيٍٛ انًحًم تانغكش , ٔقٛاط انًٕٛٓغهٕتٍٛ انًحًم تانغكش تٕاعطح يٕاد كًٛٛائٛح نَٕٛح كًٛح , أيا انفشكرٕص أيٍٛ ٔتاقٙ انفحٕصاخ فرى قٛاعٓا تاعرخذاو يٕاد كًٛٛائٛح نَٕٛح ٔإَضًٛٚح. اننتــائــــــح : أظٓشخ انذساعح عذو ٔجٕد اسذثاغ تٍٛ انًٕٛٓجهٕتٍٛ انًحًم تانغكش عُذ كم يٍ يشظٗ انغكش انُٕع انصاَٙ )انًصاتٌٕ تًشض انفشم انكهٕ٘ ٔتذٌٔ انفشم انكهٕ٘. حٛس كاَد قٛى اﻷنثٕيٍٛ انًحًم تانغكش أكصش دقح يٍ انًٕٛٓجهٕتٍٛ انًحًم تانغكش فٙ ذقٛٛى يشظٗ انغكش انُٕع شاَٙ ٔأٚعا انًصاحة تٕجٕد فشم كهٕ٘ , كًا أشاسخ انذساعح نٕجٕد عﻻقح راخ دﻻنح إحصائٛح نقٛى يعايم كرهح انجغى عُذ يشظٗ انغكش فٙ كﻻ انحانرٍٛ يقاسَح يع انعُٛح انعاتطح حٛس كاَد قٛى انٕعػ انحغاتٙ فٙ كﻻ انحانرٍٛ(5.9±29.9 ,5.6±31.5) عهٗ انرشذٛة يقاسَح يع (4.8±20.5( نهعُٛح انعاتطح ٔكاَد قًٛح اخرثاس انذﻻنح اﻻحصائٛح أقم يٍ 0.05 . أظٓشخ انذساعح ٔجٕد صٚادج راخ دﻻنح إحصائٛح فٙ قٛى عكش انذو انصائى , اﻷنثٕيٍٛ انًحًم تانغكش ٔ انثشٔذٍٛ انًحًم تانغكش عُذ يشظٗ انغكش انُٕع انصاَٙ فٙ كهرا انحانرٍٛ يقاسَح تانعُٛح انعاتطح حٛس كاَد قٛى انٕعػ انحغاتٙ نفحص عكش انذو انصائى ) ,191.1±78.5 ,190.7±58.0 14.6±94.4( عهٗ انرٕانٙ, ٔفحص اﻷنثٕيٍٛ انًحًم تانغكش ) ,874.2±203.9 ,803.1±254.6 and 181.9±50.6( عهٗ انرٕانٙ, تًُٛا كاٌ انثشٔذٍٛ انًحًم تانغكش ,395.0±113.6) (and 143.7±36.3 63.4±364.0عهٗ انرٕانٙ , ٔحٛس كاَد جًٛع قٛى اخرثاس انذﻻنح اﻹحصائٛح أقم ي0.05ٍ, تًُٛا أشاسخ انذساعح نٕجٕد اَخفاض يهحٕظ ٔرٔ دﻻنح إحصائٛح فٙ قٛى انًٕٛٓجهٕتٍٛ انًحًم تانغكش عُذ يشظٗ انفشم انكهٕ٘ يقاسَح تًشظٗ انغكش انُٕع انصاَٙ ٔ انعُٛح انعاتطح حٛس كاٌ انٕعػ انحغاتٙ فٙ كم يٍ يشظٗ انغكش انًصاتٌٕ تانفشم انكهٕ٘ ٔتذٌٔ فشم كهٕ٘ , ٔانعُٛح انعاتطح )and 5.3±0.6 0.5±7.4 ,0.6±6.1( عهٗ انرشذٛة ٔكاَد قًٛح اخرثاس انذﻻنح اﻻحصائٛح أقم يٍ 0.05 . VII ٔقذ أظٓشخ انذساعح تأٌ حٕانٙ 00 % يٍ يشظٗ انغكش انُٕع انصاَٙ ٔجًٛع حاﻻخ انفشم انكهٕ٘ نذٚٓى اسذفاع يهحٕظ فٙ يغرٕٖ اﻷنثٕيٍٛ انًحًم تانغكش ٔيغرٕٖ انثشٔذٍٛ انًحًم تانغكش يقاسَح تانًعذل انطثٛعٙ انطثٛعٛح نهًٕٛٓجهٕتٍٛ انًحًم تانغكش عُذ يشظٗ انغكش انًصاتٌٕ تانفشم انكهٕ٘. اﻻســتـنــتاج : ٔجذ أٌ اﻷنثٕيٍٛ انًحًم تانغكش كاٌ أفعم يٍ انًٕٛٓغهٕتٍٛ انًحًم تانغكش كًؤشش نرقٛٛى يشظٗ انغكش٘ انُٕع انصاَٙ فٙ فرشج صيُٛح قصٛشج ، ٔحقق َجاحا كثٛشا فٙ ذقٛٛى يشظٗ غغٛم انكهٗ انًصاتٌٕ تانغكش٘ , فٙ حٍٛ فشم انًٕٛٓغهٕتٍٛ انغكش٘ فٙ ذقًٛٛٓى.
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