Glycated albumin is a useful marker for early screening of undiagnosed prediabetes and diabetes in patients presenting to a metropolitan emergency department.

Background: Glycated albumin (GA) is formed from the non-enzymatic reaction of glucose with lysine residues of the albumin molecule. Its concentration reflects glycaemia in the preceding 3 weeks and has been proposed as an alternative marker in conditions when HbA1c is not accurate.

Methods: Patients presenting to the emergency department of a small metropolitan hospital were screened for diabetes and prediabetes using HbA1c, glycated albumin and fructosamine.

Results: Our in-house derived reference interval in adults >18 years old was 163 to 280 mmol/mol (9.2-15.8 %). GA levels in chronic kidney disease and hypoalbuminaemia patients were not different from non-diabetic, apparently healthy group. GA and fructosamine were found to be equally good at identifying patients at risk of prediabetes and diabetes. A GA level of ≥274 mmol/mol (16 %) had a diagnostic sensitivity and specificity of 65 % and 77 % in identifying prediabetes risk (AUC = 0.709) and GA ≥ 308 mmol/mol (17 %) had a sensitivity of 76 % and specificity of 92 % in identifying those at risk of diabetes (AUC = 0.863). GA has a poor correlation with HbA1c (R = 0.410) and a GA of 458 mmol/mol (26 %) equated to an HbA1c of 48 mmol/mol (7 %).

Conclusion: Our study provides further evidence that GA can be used as an effective mid-term glycaemic marker in screening for prediabetes and diabetes in patients presenting to the emergency department.