Which can predict Pregnancy-induced Insulin Resistance and Gestational Diabetes Mellitus; Glycated Albumin or Glycated Hemoglobin?

Background: Aberrant gestational glucose homeostasis initiates a cascade of events that end in the development of gestational diabetes mellitus (GDM). Glycated albumin (GA) is a promising sensitive plasma marker for detecting early disturbed glucose homeostasis.Objectives: To evaluate the ability of trimester-course estimated plasma glycated hemoglobin (HbA1c) and GA levels to identify women vulnerable to developing GDM.Patients and methods: Blood samples were obtained from 272 newly pregnant women for the 75-g oral glucose tolerance test (OGTT), estimation of fasting blood glucose (FBG), and serum insulin to calculate the homeostasis model assessment of insulin resistance (HOMA-IR) score and estimation of HbA1c and GA levels at the 12th, 24th, and 36th gestational weeks (GW). Results: At 24-GW, 56 women developed GDM. FBG levels at 24-GW were positively correlated with a significant (P = 0.001) coefficient to the 12-GW body mass index (BMI), HbA1c (P < 0.001), and GA levels (P < 0.001). HOMA-IR score determined at 24-GW showed positive significant (P = 0.001) correlation with the 12-GW BMI, HbA1c (P < 0.001), and GA levels (P < 0.001). ROC curve analysis defined the estimated level of GA at the 12-GW as a significant (P < 0.001) identifier of normoglycemic liable to develop GDM and IR (P = 0.001).Conclusion: GA plasma levels start to increase earlier during pregnancy than HbA1c levels and so could be used as an early predictor for abnormal OGTT at 24 GW and can detect liability to have IR irrespective of the BG level.