Glycemic control in the clinical management of diabetic patients

Abstract

In clinical practice, glycemic control is generally assessed by measuring and interpreting glycated hemoglobin levels, however, this test should be run under standardized conditions. We focus here on the crucial steps to ensure IFCC standardized HbA 1c results, pointing out several residual weak points, mostly relating to the laboratory end-user (calibration, quality control materials, and EQAS). We also review the use of HbA 1c for diagnosing diabetes and the various indicators useful for assessing glucose variability because in some cases they seem to represent a patient ' s glucose profile more accurately than one-off HbA 1c assays. Finally, the potential utility of glycated albumin and the glycation gap, the costs involved and the laboratory management issues are briefly discussed.

Onset and progression of kidney disease in type 2 diabetes among multi-ethnic Asian population

“…This was calculated as intra-individual HbA1c Standard Deviation (SD) divided by HbA1c-Mean and expressed as a percentage (Mosca, Lapolla, Gillery, 2013). HbA1c-CV was chosen as a normalized measure of HbA1c variability in A C C E P T E D M A N U S C R I P T…”

A history of HbA1c through Clinical Chemistry and Laboratory Medicine

“…Along with this theoretical enigma, additional interesting fields have to be explored in laboratory medicine practice, in order to better define the input of new markers, such as glycated albumin [148] and AGEs [38] . Clinical Chemistry and Laboratory Medicine will naturally continue to be the right place [149,150] for summarizing the lessons from the past and for facing the challenges of the future.…”

New trends in the long and puzzling history of HbA1c

“…However, the semiological value of HbA 1c is questioned in various clinical situations because of analytical and/or pathophysiological interferences [3]. This is especially the case in the presence of Hb variants, as illustrated here in five papers.…”

“…HbA 1c assay has been recognized for decades as a major tool in the monitoring and follow-up of patients with diabetes mellitus. Recently, its use has been extended to diabetes diagnosis and to other pathological situations [2,3]. Thus, HbA 1c is now recognized as a major biomarker used in clinical practice.…”

“…This is especially the case in the presence of Hb variants, as illustrated here in five papers. This biological occurrence has constituted an important pitfall in clinical practice for many decades, first because the variant (and/or its glycated forms) may interfere with HbA 1c determination, and second because it may alter the normal metabolism of hemoglobin or red blood cells (RBCs) [3,11]. The major analytical issues related to HbA 1c measurement in the presence of a variant have been progressively addressed by the development of assay methods that allow the separation of the most common variants and in the majority of cases a reliable HbA 1c estimation, e.g., by ion-exchange HPLC, as illustrated in the evaluation study of a new system by Jaisson et al [12], or by capillary electrophoresis [13,14].…”