Glycated Albumin Value and Its Relation with The Improvement of Diabetic Ulcers: Pilot Study


Diabetic ulcer refers to a complication of chronic hyperglycaemia. When treating hyperglycaemia, it is necessary to well and immediately monitor the average level of glucose, i.e. glycated albumin (GA) value. This study investigated the correlation between GA values and the improvement of diabetic ulcers. A clinical, cross-sectional study. Thirty patients with Diabetic Foot Ulcer (DFU) were involved as the subjects of this study and they were selected by accidental sampling with the following criteria: (1) patients with Type 2 DM with DFU according to grade 2 and 3 PEDIS degrees; (2) aged 30-60 years; (3) diagnosis criteria for DM and DM type 2 in accordance to the American Diabetes Association 2012; (4) IMT value: 18.5-22.9. Data collection technique was by checking GA levels, while monitoring the improvement of diabetic ulcers was by using PEDIS degrees. Meanwhile, data analysis used Spearman’s rho. The results of this study showed that most of research subjects had the values of GA failure with PEDIS 2 degree, i.e. 8 (26.7%) and there was no normal GA value with the degree of PEDIS 1, 2 and 3. There was a significant correlation between GA values and PEDIS degree (p = 0.001, p < 0.05). The findings revealed a correlation of GA values and improvement in diabetes ulcers. GA control is needed for the improvement of diabetes ulcers under nursing care.

Keywords: Glycated Albumin; diabetic ulcers; DFU; chronic hyperglycaemia

[1] ADA. Classification and diagnosis of diabetes. Diabetes Care. 2015;38( January):S8– S16. doi: 10.2337/dc15-S005.

[2] Bakker K, Schaper NC. The development of global consensus guidelines on the management and prevention of the diabetic foot 2011. Diabetes. Metab. Res. Rev. 2012;28:116–118. doi: 10.1002/dmrr.2254.

[3] ADA. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36(SUPPL.1):67–74. doi: 10.2337/dc13-S067.

[4] Soewondo P. Current practice in the management of type 2 diabetes in Indonesia result from the international diabetes management practices study (IDMPS). J Indon Assoc. 2011;6:474–481.

[5] Takahashi S et al. Comparison of Glycated Albumin (GA) and Glycated Hemoglobin (HbA1c) in type 2 diabetic patients: Usefulness of GA for evaluation of short-term changes in glycemic control. Endocr. J. 2007;54(1):139–144. doi: 10.1507/endocrj.K06- 103.

[6] Koga M, Kasayama S. Clinical impact of glycated albumin as another glycemic control marker. Endocr. J. 2010;57(9):751–762. doi: 10.1507/endocrj.K10E-138.

[7] Shaw J, Hughes CM, Lagan KM, Bell PM, Stevenson MR. An evaluation of three wound measurement techniques in diabetic foot wounds. Diabetes Care. 2007;30(10):2641–2642. doi: 10.2337/dc07-0122.

[8] Lavery LA, Barnes SA, Keith MS, Seaman JW, Armstrong DG. Prediction of healing for postoperative diabetic foot wounds based on early wound area progression. Diabetes Care. 2008;31(1):26–29. doi: 10.2337/dc07-1300.

[9] Rogers LC, Bevilacqua NJ, Armstrong DG, Andros G. Digital planimetry results in more accurate wound measurements: A comparison to standard ruler measurements. J. Diabetes Sci. Technol. 2010;4(4):799–802. doi: 10.1177/193229681000400405.

[10] Gosain A, DiPietro LA. Aging and wound healing. World J. Surg. 2004;28(3):321–326. doi: 10.1007/s00268-003-7397-6.

[11] Keylock KT, Vieira VJ, Wallig MA, DiPietro LA, Schrementi M, Woods JA. Exercise accelerates cutaneous wound healing and decreases wound inflammation in aged mice. Am. J. Physiol. - Regul. Integr. Comp. Physiol. 2008;294(1):179–184. doi: 10.1152/ajpregu.00177.2007.

[12] Gilliver SC, Ashworth JJ, Ashcroft GS. The hormonal regulation of cutaneous wound healing. Clin. Dermatol. 2007;25(1):56–62. doi: 10.1016/J.CLINDERMATOL.2006.09.012.

[13] Hardman MJ, Ashcroft GS. Estrogen, not intrinsic aging, is the major regulator of delayed human wound healing in the elderly. Genome Biol. 2008;9(5). doi: 10.1186/gb-2008-9-5-r80.

[14] Javanbakht M, Abolhasani F, Mashayekhi A, Baradaran HR, Noudeh YJ. Health related quality of life in patients with type 2 diabetes mellitus in Iran: A national survey. PLoS One. 2012;7(8):1–9. doi: 10.1371/journal.pone.0044526.

[15] Widyasari N. Hubungan karakteristik responden dengan risiko diabetes melitus dan dislipidemia kelurahan tanah kalikedinding. J. Berk. Epidemiol. 2017. doi: 10.20473/jbe.v5i1.

[16] Khoo J, Dhamodaran S, Chen D-D, Yap S-Y, Chen RYT, Tian RHH. Exerciseinduced weight loss is more effective than dieting for improving adipokine profile, insulin resistance, and inflammation in obese men. Int. J. Sport Nutr. Exerc. Metab. 2015;25(6):566–575. doi: 10.1123/ijsnem.2015-0025.

[17] Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: Skin physiology and skin manifestations of obesity. J. Am. Acad. Dermatol. 2007;56(6):901–916. doi: 10.1016/j.jaad.2006.12.004.

[18] Krawinkel MB, Keding GB. Bitter gourd (Momordica Charantia): A dietary approach to hyperglycemia. Nutr. Rev. 2006;64(7):331–337. doi: 10.1301/nr.2006.jul.331-337.

[19] Huijberts MSP, Schaper NC, Schalkwijk CG. Advanced glycation end products and diabetic foot disease. Diabetes. Metab. Res. Rev. 2008;24(Suppl 1):S19-24. doi: 10.1002/dmrr.861.

[20] Liu ZJ, Velazquez OC. Hyperoxia, endothelial progenitor cell mobilization, and diabetic wound healing. Antioxidants Redox Signal. 2008;10(11):1869–1882. doi: 10.1089/ars.2008.2121.

[21] Martínez-Jiménez MA et al. Local use of insulin in wounds of diabetic patients: Higher temperature, fibrosis, and angiogenesis. Plast. Reconstr. Surg. 2013;132(6):1–6. doi: 10.1097/PRS.0b013e3182a806f0.

[22] Papapetropoulos A, García-Cardeña G, Madri JA, Sessa WC. Nitric oxide production contributes to the angiogenic properties of vascular endothelial growth factor in human endothelial cells. J. Clin. Invest. 1997;100(12):3131–3139. doi: 10.1172/JCI119868.

[23] Zhang X, Wu X, Wolf SE, Hawkins HK, Chinkes DL, Wolfe RR. Local insulin-zinc injection accelerates skin donor site wound healing. J. Surg. Res. 2007;142(1):90– 96. doi: 10.1016/J.JSS.2006.10.034.

[24] Lee C-H et al. Enhancement of diabetic wound repair using biodegradable nanofibrous metformin-eluting membranes: in vitro and in vivo. ACS Appl. Mater. Interfaces. 2014;6(6):3979–3986. doi: 10.1021/am405329g.

[25] Mirza RE, Fang MM, Ennis WJ, Kohl TJ. Blocking interleukin-1β induces a healingassociated wound macrophage phenotype and improves healing in type 2 diabetes. Diabetes. 2013;62(7):2579–2587. doi: 10.2337/db12-1450.

[26] Vincent AM, Russell JW, Low P, Feldman EL. Oxidative stress in the pathogenesis of diabetic neuropathy. Endocr. Rev. 2004;25(4):612–628. doi: 10.1210/er.2003-0019.

[27] Loots MAM, Lamme EN, Zeegelaar J, Mekkes JR, Bos JD, Middelkoop E. Differences in cellular infiltrate and extracellular matrix of chronic diabetic and venous ulcers versus acute wounds. J. Invest. Dermatol. 1998;111(5):850–857. doi: 10.1046/j.1523- 1747.1998.00381.x.

[28] Sibbald RG, Woo KY. The biology of chronic foot ulcers in persons with diabetes. Diabetes. Metab. Res. Rev. 2008;24(1):S25-30. doi: 10.1002/dmrr.847.

[29] Veves A et al. Endothelial dysfunction and the expression of endothelial nitric oxide synthetase in diabetic neuropathy, vascular disease, and foot ulceration. Diabetes. 1998;47(3):457–63. doi: 10.2337/diabetes.47.3.457.

[30] Park NY, Lim Y. Short term supplementation of dietary antioxidants selectively regulates the inflammatory responses during early cutaneous wound healing in diabetic mice. Nutr. Metab. 2011;8(1):80. doi: 10.1186/1743-7075-8-80.

[31] Fujimori E. Cross-linking and fluorescence changes of collagen by glycation and oxidation. Biochim. Biophys. Acta - Protein Struct. Mol. Enzymol. 1989;998(2):105– 110. doi: 10.1016/0167-4838(89)90260-4.

[32] Berlanga-acosta J, Schultz GS, López-mola E, Guillen-nieto G, García-siverio M, Herrera-martínez L. Glucose toxic effects on granulation tissue productive cells: The diabetics ’ impaired healing. 2013.

[33] Peppa M, Stavroulakis P, Raptis SA. Advanced glycoxidation products and impaired diabetic wound healing. Wound Repair Regen. 2009;17(4):461—472. doi: 10.1111/j.1524-475x.2009.00518.x.