“Glycated albumin” a new paradigm in better monitoring Type 2 diabetes complications as a short-term glycemic index

Albumin is the most common protein found in serum, making up about 80% concentration of the circulating blood protein. It is replaced in the body approximately every 20-25 days. As with other proteins in the body, it is subject to non-enzymatic glycation by excess sugar. The glycation process is a condensation reaction between carbohydrate and free amino acid at the amino terminus of proteins or the epsilon amino groups of lysine residues of proteins. The reaction is initiated with attachment of the aldehyde function of acyclic glucose to a protein amino group via nucleophilic addition, forming an aldimine, also known as a Schiff base. This intermediate product subsequently undergoes an amadori rearrangement to form a 1-amino-1-deoxyfructose derivative in a stable ketoamine linkage, which in turn can cyclize to a ring structure [1]. Non-enzymatic glycation of albumin occurs at multiple sites, complex multi-step reactions ensue that cause formation of early and advanced glycation end-products (AGEs). AGEs lead to significant alterations in secondary structure and slight changes in tertiary structure of human serum albumin, resulting in the formation of thermodynamically more stable high molecular weight aggregates that may interfere with normal albumin function [2]. Protein glycation is both a marker for diabetes complications and an underlying cause of those complications. The purpose of diabetes monitoring is to help diabetics control the glycation. Diabetes is currently monitored by a combination of daily testing self-monitoring blood glucose (SMBG) and long-term testing haemoglobin A1c (HbA1c). A monthly diabetes monitoring test based on glycated albumin (GA) has the potential to provide better information for monitoring glycation. The progressive complications of unmanaged diabetes include heart disease, blindness, kidney failure, amputation of extremities due to circulation problems, and nerve disorders, as well as other chronic conditions. These complications are the cause of the immense personal, financial and societal costs of diabetes. Decades of research have established that prolonged exposure to excess glucose is the cause of diabetes complications and that long-term control of blood glucose levels is required to avoid or lessen the damage caused by excess glucose. The process of protein glycation “Glycated albumin” a new paradigm in better monitoring Type 2 diabetes complications as a short-term glycemic index