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Annals of Clinical Biochemistry

Year: 2010  |  Volume: 47  |  Issue: 4  |  Page No.: 313 - 317

Serum glycated albumin to haemoglobin A1C ratio can distinguish fulminant type 1 diabetes mellitus from type 2 diabetes mellitus

M Koga, J Murai, H Saito, S Kasayama, A Imagawa, T Hanafusa, T Kobayashi and the Members of the Japan Diabetes Society's Committee on Research on Type 1 Diabetes



Fulminant type 1 diabetes mellitus (FT1DM), a subtype of type 1 diabetes mellitus, was first reported as a disease entity in 2000. Ketoacidosis at initial onset due to acute pancreatic cell destruction makes early diagnosis and treatment for FT1DM mandatory. In the early period of FT1DM, haemoglobin (Hb)A1C levels are not markedly elevated. This study investigated serum glycated albumin (GA), which reflects acute short-term changes in plasma glucose, as a new clinical index for FT1DM at disease onset.


Subjects comprised 35 patients with FT1DM who had undergone measurement of HbA1C and serum GA at initial visit and 42 patients with type 2 diabetes mellitus (T2DM) with HbA1C <8.5% and no history of diabetes treatment as controls.


HbA1C was significantly lower in FT1DM than in T2DM, whereas serum GA was significantly higher. GA/HbA1C ratio was thus significantly higher in FT1DM than in T2DM (3.9 ± 0.5 versus 2.8 ± 0.3; P < 0.0001). GA/HbA1C ratio was >3.2 in 41 of 42 FT1DM patients (98%), compared with only one of 32 T2DM patients (3%).


Serum GA is significantly higher in FT1DM than in T2DM, whereas HbA1C is significantly lower. FT1DM can thus be distinguished from untreated T2DM by GA/HbA1C ratio at initial visit before treatment for diabetes.

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