Methodological gaps in the determination of hemoglobin and glycosylated albumin in the diagnosis and follow-up of diabetic nephropathy

Abstract

Background: Biomarkers are widely used to monitor complications of various chronic degenerative diseases such as Diabetes Mellitus (DM), being a field of profound dynamism in which there have been important methodological advances and use of new analytical techniques for their determination and interpretation. Renal complications related to DM represent a challenge in medical practice, due to the high mortality rate they generate. Glycosylated hemoglobin (HbA1c) has long been a biomarker of great importance; currently, glycosylated albumin (GA) is also used; however, there is divergence in its use. Purpose: A systematic review was carried out to evaluate the benefits of both paraclinical biomarkers, establishing inclusion criteria for this purpose. Methodology: The MeSH descriptors were established, and once the literature search was performed, the flow chart proposed by PRISMA was used to synthesize the main findings. Results: N=15 manuscripts were selected showing that GA is an emerging parameter that can deter-mine with greater sensitivity and specificity the progression to more advanced stages of renal disease and mortality in diabetic patients; although, it has disadvantages with respect to HbA1c, such as the ab-sence of a reference range and the lack of its continuous use in routine laboratories due to the inherent methodology. Conclusion: HbA1c continues to be the most widely used biomarker; however, the use of GA should be promoted as a new useful tool in the management of nephropathic diabetic patients.