Usefulness of hemoglobin a1c and glycated albumin measurements for insulinoma screening

An observational case-control study

Keiichi Torimoto, Yosuke Okada, Yoshiya Tanaka, Atsuko Matsuoka, Yushi Hirota, Wataru Ogawa, Yoshifumi Saisho, Isao Kurihara, Hiroshi Itoh, Shinya Inada, Masafumi Koga

Research output: Contribution to journalArticle

Abstract

Background: Insulinoma represents hypoglycemia as a predominant symptom; the autonomic symptoms may be resolved by chronically recurrent hypoglycemia resulting in the persistence of non-specific symptoms alone. Therefore, it has been estimated that there are many patients in whom the disease takes longer to diagnose and has remained undiagnosed. Although some parameters exist for the definitive diagnosis of the disease, there are currently no indices for early screening. Indices of glycemic control, hemoglobin A1c (HbA1c), and glycated albumin (GA) may be useful for the screening of patients with insulinoma having chronic hypoglycemia because the values become low in such a condition. Because there are no articles that have reported the point, we examine the effective cutoff values of HbA1c and GA for the diagnosis of insulinoma in the present study. Methods: In a multicenter cross-sectional study, 31 patients with insulinoma were included for comparison with 120 control subjects with normal glucose tolerance based on 75 g oral glucose tolerance tests whose characteristics were matched to the patients. The primary outcomes were optimal cutoff values of HbA1c and GA for the screening of insulinoma. Results: HbA1c was significantly lower in the insulinoma group at 4.7 ± 0.4% compared to the healthy control group at 5.7 ± 0.3% (p < 0.001), and GA was significantly lower in the insulinoma group at 11.6 ± 1.8% compared to the healthy control group at 14.5 ± 1.0% (p < 0.001). According to a receiver operating characteristic (ROC) analysis, optimal cutoff values of HbA1c and GA for the diagnosis of insulinoma were 5.0 and 12.4%, respectively. Area under the curve values of HbA1c and GA were 0.970 and 0.929, respectively, showing no significant difference (p = 0.399). Conclusions: In the present study, HbA1c and GA values in patients with insulinoma were significantly lower compared to the healthy controls, and effective cutoff values for screening were shown in the diagnosis of insulinoma for the first time. HbA1c and GA can be useful indices for insulinoma screening. Because malignant insulinoma have a similar diagnostic process to that of benign insulinoma, these could be useful for malignant insulinoma.

Original languageEnglish
Article number174
JournalBMC Cancer
Volume19
Issue number1
DOIs
Publication statusPublished - 2019 Feb 26

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Insulinoma
Case-Control Studies
Hemoglobins
Hypoglycemia
glycosylated serum albumin
Glycemic Index
Control Groups
Glucose Tolerance Test
ROC Curve
Area Under Curve

Keywords

  • Glycated albumin
  • HbA1c
  • Hypoglycemia
  • Insulinoma

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research

Cite this

Usefulness of hemoglobin a1c and glycated albumin measurements for insulinoma screening : An observational case-control study. / Torimoto, Keiichi; Okada, Yosuke; Tanaka, Yoshiya; Matsuoka, Atsuko; Hirota, Yushi; Ogawa, Wataru; Saisho, Yoshifumi; Kurihara, Isao; Itoh, Hiroshi; Inada, Shinya; Koga, Masafumi.

In: BMC Cancer, Vol. 19, No. 1, 174, 26.02.2019.

Research output: Contribution to journalArticle

Torimoto, Keiichi ; Okada, Yosuke ; Tanaka, Yoshiya ; Matsuoka, Atsuko ; Hirota, Yushi ; Ogawa, Wataru ; Saisho, Yoshifumi ; Kurihara, Isao ; Itoh, Hiroshi ; Inada, Shinya ; Koga, Masafumi. / Usefulness of hemoglobin a1c and glycated albumin measurements for insulinoma screening : An observational case-control study. In: BMC Cancer. 2019 ; Vol. 19, No. 1.
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T2 - An observational case-control study

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AU - Okada, Yosuke

AU - Tanaka, Yoshiya

AU - Matsuoka, Atsuko

AU - Hirota, Yushi

AU - Ogawa, Wataru

AU - Saisho, Yoshifumi

AU - Kurihara, Isao

AU - Itoh, Hiroshi

AU - Inada, Shinya

AU - Koga, Masafumi

PY - 2019/2/26

Y1 - 2019/2/26

N2 - Background: Insulinoma represents hypoglycemia as a predominant symptom; the autonomic symptoms may be resolved by chronically recurrent hypoglycemia resulting in the persistence of non-specific symptoms alone. Therefore, it has been estimated that there are many patients in whom the disease takes longer to diagnose and has remained undiagnosed. Although some parameters exist for the definitive diagnosis of the disease, there are currently no indices for early screening. Indices of glycemic control, hemoglobin A1c (HbA1c), and glycated albumin (GA) may be useful for the screening of patients with insulinoma having chronic hypoglycemia because the values become low in such a condition. Because there are no articles that have reported the point, we examine the effective cutoff values of HbA1c and GA for the diagnosis of insulinoma in the present study. Methods: In a multicenter cross-sectional study, 31 patients with insulinoma were included for comparison with 120 control subjects with normal glucose tolerance based on 75 g oral glucose tolerance tests whose characteristics were matched to the patients. The primary outcomes were optimal cutoff values of HbA1c and GA for the screening of insulinoma. Results: HbA1c was significantly lower in the insulinoma group at 4.7 ± 0.4% compared to the healthy control group at 5.7 ± 0.3% (p < 0.001), and GA was significantly lower in the insulinoma group at 11.6 ± 1.8% compared to the healthy control group at 14.5 ± 1.0% (p < 0.001). According to a receiver operating characteristic (ROC) analysis, optimal cutoff values of HbA1c and GA for the diagnosis of insulinoma were 5.0 and 12.4%, respectively. Area under the curve values of HbA1c and GA were 0.970 and 0.929, respectively, showing no significant difference (p = 0.399). Conclusions: In the present study, HbA1c and GA values in patients with insulinoma were significantly lower compared to the healthy controls, and effective cutoff values for screening were shown in the diagnosis of insulinoma for the first time. HbA1c and GA can be useful indices for insulinoma screening. Because malignant insulinoma have a similar diagnostic process to that of benign insulinoma, these could be useful for malignant insulinoma.

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KW - Glycated albumin

KW - HbA1c

KW - Hypoglycemia

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