Complementary value of glycated albumin and continuous glucose monitoring for assessing microvascular complications in type 2 diabetes

AIMS: Glycated albumin (GA) has recently been recommended in the 2024 American Diabetes Association guidelines as an alternative glycemic marker, yet its complementary value alongside continuous glucose monitoring (CGM) metrics remains uncertain. METHODS: A total of 3251 individuals with type 2 diabetes were included. All participants underwent CGM, from which time in range (TIR) was calculated. Diabetic retinopathy (DR) was assessed by fundus examination, and diabetic kidney disease (DKD) was defined based on urinary albumin excretion and/or estimated glomerular filtration rate. Composite microvascular complications were defined as the presence of DR and/or DKD. RESULTS: Median GA and TIR were 20.5 % (16.8-25.9) and 75.0 % (60.0-87.0), respectively, and 45.8 % of participants had microvascular complications. After adjustment including TIR, the highest GA tertile wasindependently associated with higher odds of DR, DKD, and composite microvascular complications (odds ratios [ORs]: 1.31 [95 % CI 1.04-1.64], 1.58 [1.24-2.02], and 1.44 [1.17-1.79], respectively). These associations remained significant among participants achieving TIR > 70 % (ORs: 1.38 [1.04-1.83], 1.95 [1.43-2.65], and 1.57 [1.20-2.05], respectively). GA and TIR showed comparable C-statistics, while adding GA to TIR-based models improved net reclassification for microvascular complications by 13.2-16.3 %. CONCLUSIONS: In type 2 diabetes, GA is associated with microvascular complications independently of TIR and may provide complementary information when considered alongside TIR.