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Glycohemoglobin and Risk of Microalbuminuria

Purpose: To evaluate a patient with diabetes mellitus for the risk of developing microalbuminuria.

Description

A patient with diabetes mellitus is at risk for diabetic nephropathy, which may present with microalbuminuria. Krolewski et al identified the risk for microalbuminuria in a patient with diabetes mellitus based on level of glycosylated hemoglobin and duration of disease. This can help educate the diabetic on the importance of good glucose control.


The risk of microalbuminuria in patients with insulin-dependent diabetes mellitus increases with:

(1) duration of diabetes (but with a falling off in those with diabetes for 25-32 years)

(2) glycosylated hemoglobin A1 values over 10.1%, which corresponds to a hemoglobin A1c level of 8.1%

 

 

Odds Ratio for Microalbuminuria at Various Percentages of Glycosylated Hemoglobin A1 (GHA1)

Years with IDDM (Postpubertal)

GHA1

5.9-8.8%

GHA1

8.9-9.8%

GHA1

9.9-10.7%

GHA1

10.8-11.9%

GHA1

12.0-21.3%

1-6

1.0

1.6

2.6

2.2

5.8

7-12

2.4

2.3

2.4

6.8

13.2

13-18

2.3

4.7

3.9

7.5

28.8

19-24

11.3

15.0

14.3

12.1

23.6

25-32

7.1

7.9

13.0

19.0

12.5

after Table 2, page 1253

 

where:

• IDDM = insulin-dependent diabetes mellitus

• GHA1 = glycosylated hemoglobin A1

 

According to the methods section for the analytical methods used:

 

percent glycohemoglobin A1c =

= ((percent GHA1) - 0.14) / 1.23

 

If this rearranged:

 

percent total glycosylated A1 =

= (1.23 * (percent hemoglobin A1c)) + 0.14

 

 

Odds Ratio for Microalbuminuria at Various Percentages of Hemoglobin A1c

Years with IDDM (Postpubertal)

HgbA1c 4.7 - 7.0%

HgbA1c 7.1-7.8%

HgbA1c 7.9-8.6%

HgbA1c 8.7%-9.5%

HgbA1c 9.6-17.2%

1-6

1

2

3

2

6

7-12

2

2

2

7

13

13-18

2

5

4

8

29

19-24

11

15

14

12

24

25-32

7

8

13

19

13

after Table 2, page 1253 with original data for glycosylated hemoglobin A1

 

In Figure 3 the Odds Ratio can be predicted from the hemoglobin A1c by the following equations:

 

HgbA1c in Percent

Odds Ratio for  Microalbuminuria in Insulin Dependent Diabetes Mellitus

7 to 10.25

(0.1770 * (HgbA1c in percent)) - 0.2597

10.25 to 15

(0.248 * ((HgbA1c)^2)) - 4.589 * (HgbA1c) + 22.68

 


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Specialty

Objective

ICD-10