Glico-hemoglobina (HbA1c): aspectos clínicos e analíticos

Abstract

RESUMOA glico-hemoglobina (GHb) é um parâmetro importante no controle glicêmico de pacientes com DM. Vários estudos clínicos mostraram claramente que a melhora no controle glicêmico está fortemente associada com a diminuição no desenvolvimento e/ou progressão das complicações em diabetes melito tipos 1 e 2. A medida exata e precisa da GHb é uma questão importante para os laboratórios clínicos. Vários fatores afetam os resultados e podem levar a resultados errôneos. Nesta revisão, discutimos os problemas da padronização da determinação da GHb para monitorar a terapia diabética e também os principais fatores interferentes. Os métodos para GHb podem ser diferentemente afetados pelas interferências. O efeito da interferência pode ser clinicamente mais relevante com o pior controle glicêmico. O laboratório deve estar atento para estes fatores para evitar confusão na interpretação clínica dos resultados, e os clínicos devem contatar o laboratório sempre que houver discrepância entre a impressão clínica e o resultado laboratorial. Glycohemoglobin (GHb) has a key role in the assessment of glycemic control in diabetic patients. Several studies have clearly shown that improved glycemic control is strongly associated with decreased development and/or progression of diabetic complications in both type 1 and 2 diabetes mellitus. Therefore, accurate determination of GHb concentration is an important issue for clinical laboratories. Several factors may affect and lead to erroneous results. We discuss the problems of standardization of GHb measurements for monitoring glycemic control and also consider the potential interfering factors on GHb measurements. Moreover, GHb assays may be affected by interference in different ways. The effect of interference may be more clinically relevant with poor metabolic control. Laboratory staff must be aware of all pitfalls to avoid adding more confusion to the clinical interpretation of HbA 1c values and physicians should contact laboratories if discrepancies between clinical impressions and laboratory data are observed.

New Validated Method for Quantification of Glycated Hemoglobin by LC-QToF-MS: Is HRMS Able to Quantify Clinical Samples?

“…The data obtained by this work are in agreement with other studies in the literature − and can be used to support the hypotheses addressed and the promising applicability of the validated method in both the diagnosis and control of diabetes and in the monitoring of available methods. This challenge analyte quantification was chosen to demonstrate the full capability of HRMS to differentiate high molecular weight molecules, in complex matrices with minimal sample preparation.…”

Combined Use of Job Stress Models and the Incidence of Glycemic Alterations (Prediabetes and Diabetes): Results from ELSA-Brasil Study

“…Although the use of HbA1c may be underestimated for the occurrence of the outcome of interest (prediabetes and diabetes), it is a reliable measure of chronic blood glucose that presents technical advantages in analysis and predicts the progression of diabetes and cardiovascular events in a more consistent way [52]. In addition, a sensibility test, carried out for two prediabetes and diabetes outcome measurement criteria (isolated HbA1c or HbA1c and tolerance to glucose test), confirms that, for the diagnosis of diabetes and prediabetes, HbA1c emphasizes stress at work (data not presented).…”

The influence of quality of life in treatment adherence of diabetic patients: a systematic review

“…The A1c is an important parameter for glycemic control in patients with DM. The A1c is strongly related to the onset and progression of chronic complications of DM (34) . Assuming that diabetic patients with lower levels of A1c have better QOL, it can be inferred that individuals in the sample of these studies are more adherent to treatment of the disease.…”