Glycated albumin and composite glycemic-lipid indices: complementary tools for type 2 diabetes diagnosis

Glycated albumin (GA) is a promising glycemic biomarker that offers advantages over glycated hemoglobin (HbA1c), especially under conditions that affect red blood cell turnover. In type 2 diabetes (T2DM), disturbances in glucose and lipid metabolism often coexist. This study aimed to evaluate the discriminatory performance of GA, HbA1c, and their composite indices incorporating high-density lipoprotein cholesterol (HDL-C) in a Serbian cohort of participants with established T2DM and controls. A total of 124 adults (including both T2DM patients and healthy controls) were analyzed for GA, HbA1c, glucose, and lipid profiles. Composite indices, namely, GA/HDL-C and HbA1c/HDL-C, were calculated. Logistic regression and receiver operating characteristic (ROC) analyses were used to assess discriminatory performance. GA and HbA1c levels were significantly higher in T2DM patients, while HDL-C levels were lower. Both GA/HDL-C and HbA1c/HDL-C showed strong associations with T2DM. HbA1c exhibited the highest area under the ROC curve (0.966), followed by HbA1c/HDL-C (0.883), GA/HDL-C (0.859), and GA (0.855). The GA/HDL-C index exhibited particularly high specificity (92.06%). GA levels in the control group were consistent with reference values reported in other populations. To our knowledge, this is the first study to report GA data in a Serbian cohort. The findings highlight GA as a useful complementary marker for distinguishing individuals with established T2DM from controls. Composite indices, particularly GA/HDL-C and HbA1c/HDL-C, may provide complementary information for integrated glycemic-lipid assessment.