Interlaboratory Variation of GHb Assays in Victoria, Australia

Gilbert, Richard E.; Goodall, Ian; Young, Victoria; Jerums, George

doi:10.2337/diacare.19.7.730

Cited by 14 publications

(9 citation statements)

References 8 publications

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“…No entanto, os valores de GHb/HbA 1c fornecidos por um laboratório podem não corresponder com os valores fornecidos por outro laboratório, mesmo usando o mesmo método e medindo a mesma fração. Não existe concordância entre os valores de referência e a comparação dos resultados é muito difícil (5,35,(47)(48)(49). A mesma amostra pode apresentar um valor de 7% em um laboratório e 9% em outro.…”

Section: Padronização E Harmonização Dos Resultadosunclassified

Glico-hemoglobina (HbA1c): aspectos clínicos e analíticos

Camargo

Gross

2004

Arq Bras Endocrinol Metab

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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.

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Section: Padronização E Harmonização Dos Resultadosunclassified

Glico-hemoglobina (HbA1c): aspectos clínicos e analíticos

Camargo

Gross

2004

Arq Bras Endocrinol Metab

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“…HbA1c analysis results are subject to variation as a result of the type of equipment used, with the analysis method accounting for differences of up to 23% in the result [36,37]. In the course of this study, changes in the equipment and methods used for HbA1c analysis were monitored via communication with the two pathology companies to assess the need for sensitivity analyses exploring the size of any such effect.…”

Section: Discussionmentioning

confidence: 99%

Diabetes in rural towns: effectiveness of continuing education and feedback for healthcare providers in altering diabetes outcomes at a population level: protocol for a cluster randomised controlled trial

et al. 2013

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BackgroundType 2 diabetes is one of the fastest growing chronic diseases internationally. The health complications associated with type 2 diabetes can be prevented, delayed, or improved via early diagnosis and effective management. This research aims to examine the impact of a primarily web-based educational intervention on the diabetes care provided by general practitioners (GPs) in rural areas, and subsequent patient outcomes. A population-level approach to outcome assessment is used, via whole-town de-identified pathology records.Methods/designThe study uses a cluster randomised controlled trial with rural communities as the unit of analysis. Towns from four Australian states were selected and matched on factors including rurality, population size, proportion of the population who were Indigenous Australians, and socio-economic status. Eleven pairs of towns from two states were suitable for the trial, and one town from each pair was randomised to the experimental group. GPs in the towns allocated to the experimental group are offered an intervention package comprising education on best practice diabetes care via an on-line active learning module, a moderated discussion forum, access to targeted and specialist advice through an on-line request form, and town-based performance feedback on diabetes monitoring and outcomes. The package is offered via repeated direct mail.DiscussionThe benefits of the outcomes of the trial are described along with the challenges and limitations associated with the methodology.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12611000553976

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“…The issues with the technical aspects of the assay were highlighted by studies in which samples for the measurement of HbA 1c were split between assays, yielding extreme variability in the results (35,36). Indeed, large epidemiological studies have suggested that HbA 1c testing is less sensitive than FPG measurement in terms of its diagnostic capabilities (37,38).…”

Section: Conclusion -Previous Reportsmentioning

confidence: 99%

HbA1c Measurement Improves the Detection of Type 2 Diabetes in High-Risk Individuals With Nondiagnostic Levels of Fasting Plasma Glucose

Perry¹,

et al. 2001

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OBJECTIVE -Whereas new diagnostic criteria based on a fasting plasma glucose (FPG) of Ͼ126 mg/dl (7.8 mmol/l) have improved the detection of diabetes, multiple reports indicate that many people with diabetes diagnosed by 2-h oral glucose tolerance test (OGTT) glucose measurements of Ն11.1 mmol/l (200 mg/dl) would remain undiagnosed based on this FPG criteria. Thus, improved methods to detect diabetes are particularly needed for high-risk individuals. We evaluated whether the combination of FPG and HbA 1c measurements enhanced detection of diabetes in those individuals at risk for diabetes with nondiagnostic or minimally elevated FPG. RESEARCH DESIGN AND METHODS -We analyzed FPG, OGTT, and HbA 1c data from 244 subjects screened for participation in the Early Diabetes Intervention Program (EDIP).RESULTS -Of 244 high-risk subjects studied by FPG measurements and OGTT, 24% of the individuals with FPG levels of 5.5-6.0 mmol/l (100 -109 mg/dl) had OGTT-diagnosed diabetes, and nearly 50% of the individuals with FPG levels of 6.1-6.9 mmol/l (110 -125 mg/dl) had OGTT-diagnosed diabetes. In the subjects with OGTT-diagnosed diabetes and FPG levels between 5.5 and 8.0 mmol/l, detection of an elevated HbA 1c (Ͼ6.1% or mean ϩ 2 SDs) led to a substantial improvement in diagnostic sensitivity over the FPG threshold of 7.0 mmol/l (61 vs. 45%, respectively, P ϭ 0.002). Concordant FPG levels Ն7.0 mmol/l (currently recommended for diagnosis) occurred in only 19% of our cohort with type 2 diabetes. CONCLUSIONS -Diagnostic criteria based on FPG criteria are relatively insensitive in the detection of early type 2 diabetes in at-risk subjects. HbA 1c measurement improves the sensitivity of screening in high-risk individuals. Diabetes Care 24:465-471, 2001

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Interlaboratory Variation of GHb Assays in Victoria, Australia

Cited by 14 publications

References 8 publications

Glico-hemoglobina (HbA1c): aspectos clínicos e analíticos

Glico-hemoglobina (HbA1c): aspectos clínicos e analíticos

Diabetes in rural towns: effectiveness of continuing education and feedback for healthcare providers in altering diabetes outcomes at a population level: protocol for a cluster randomised controlled trial

HbA1c Measurement Improves the Detection of Type 2 Diabetes in High-Risk Individuals With Nondiagnostic Levels of Fasting Plasma Glucose

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