ArticleJournal of diabetes investigation2026
Serum nonmercaptalbumin to total albumin ratio and bilirubin predict ADL decline in older adults with type 2 diabetes.
Article in Journal of diabetes investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
AIMS/
introductionTo determine whether the ratio of human nonmercaptalbumin to total albumin (HNA%) and serum bilirubin-two oxidative stress-related biomarkers-predicts incident disability in activities of daily living (ADL) among older adults with type 2 diabetes. MATERIALS AND
methodsIn this longitudinal cohort study, we followed 101 adults aged ≥70 years with type 2 diabetes who had no baseline ADL disability. The primary outcome was incident ADL disability requiring long-term care certification, a standardized national system in Japan indicating clinically significant physical impairment. Cox proportional hazards models, restricted cubic splines, and nonparametric bootstrap resampling (1,000 iterations) were used to assess associations.
resultsDuring the 7-year follow-up, 28 participants (27.7%) developed ADL disability. Those who became disabled had higher HNA% and older age, and lower serum bilirubin and albumin at baseline. Restricted cubic splines demonstrated linear increases in disability risk with higher HNA% and linear decreases with higher bilirubin. In the primary multivariable model including HNA%, bilirubin, and age, all remained independent predictors (HNA%: HR 1.063, 95% CI 1.005-1.124; bilirubin: HR 0.740, 95% CI 0.562-0.975; age: HR 1.115, 95% CI 1.032-1.206). This model improved discrimination compared with age alone, demonstrated the lowest Akaike's Information Criterion, and showed good calibration. Bootstrap analyses confirmed the robustness and stability of the model.
conclusionsHigher HNA%, lower serum bilirubin, and their combined assessment predicted future ADL decline in older adults with type 2 diabetes. These complementary redox biomarkers may contribute to improved risk stratification for functional deterioration.
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