Low serum albumin and severe undernutrition in subjects with diabetes and weight loss

Abstract

Hypoalbuminemia predicts adverse outcomes in subjects with diabetes. We investigated how it relates to type, duration, control, and diabetic complications. Albumin levels were measured in subjects hospitalized for uncontrolled diabetes and unexpected weight loss in our diabetology ward from 2010 to 2019. All underwent a clinical interview and examination with a CT-scanner and were checked for chronic diabetic complications. By multivariate binary regression, we analyzed the determinants of low serum albumin (<38 g/L) or severe undernutrition (weight loss and albumin <30 g/L). The 334 subjects were in the majority men (60.5%), 59 ± 12 y old. They had recently lost –3.8 kg/3 mo (IQR: –5.0 to –1.5). The diabetes was mainly type 2: 78.7% (type 1: 15.3%, type 3, pancreatic: 6.0%), with means of 5 y duration (IQR: 0–13) and poorly controlled hemoglobin A1c (HbA1c) 10.5% ± 2.8%. The mean albuminemia was 37.6 ± 5.1 g/L (median: 38.5 g/L, IQR: 34.8–41.1). Low serum albumin was present in 151 subjects (45.2%), related to age, female sex, hepatic cirrhosis, C-reactive protein, HbA1c, and a high duration of diabetes. Severe undernutrition was present in 26 subjects (7.8%), also related to C-reactive protein, HbA1c, a high duration of diabetes, and pancreatic diabetes. The albumin levels were significantly lower (–2 g/L) both in subjects with diabetic retinopathy and neuropathy. After adjustment for age, sex, duration of diabetes, and HbA1c, a low serum albumin was related to neuropathy. In subjects with diabetes hospitalized for weight loss, a low serum albumin and severe undernutrition relate to poorly controlled and lengthy diabetes, especially pancreatic, and with diabetic neuropathy.