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Su Y, Xia C, Zhang H, Gan W, Zhang GQ, Yang Z, Li D. Emerging biosensor probes for glycated hemoglobin (HbA1c) detection. Mikrochim Acta 2024; 191:300. [PMID: 38709399 DOI: 10.1007/s00604-024-06380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
Glycated hemoglobin (HbA1c), originating from the non-enzymatic glycosylation of βVal1 residues in hemoglobin (Hb), is an essential biomarker indicating average blood glucose levels over a period of 2 to 3 months without external environmental disturbances, thereby serving as the gold standard in the management of diabetes instead of blood glucose testing. The emergence of HbA1c biosensors presents affordable, readily available options for glycemic monitoring, offering significant benefits to small-scale laboratories and clinics. Utilizing nanomaterials coupled with high-specificity probes as integral components for recognition, labeling, and signal transduction, these sensors demonstrate exceptional sensitivity and selectivity in HbA1c detection. This review mainly focuses on the emerging probes and strategies integral to HbA1c sensor development. We discussed the advantages and limitations of various probes in sensor construction as well as recent advances in diverse sensing strategies for HbA1c measurement and their potential clinical applications, highlighting the critical gaps in current technologies and future needs in this evolving field.
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Affiliation(s)
- Yang Su
- Key Laboratory of DrugTargeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Chengen Xia
- Key Laboratory of DrugTargeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - He Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Gan
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guo-Qi Zhang
- Department of Chemistry, School of Science, Xihua University, Chengdu, 610039, People's Republic of China
| | - Zi Yang
- Key Laboratory of DrugTargeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
| | - Dapeng Li
- Key Laboratory of DrugTargeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China.
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Manita D, Ogino S, Marivoet S, Ogura M. Detectability of and interference by major and minor hemoglobin variants using a new-generation ion-exchange HPLC system with two switchable analysis modes. Pract Lab Med 2024; 38:e00346. [PMID: 38099267 PMCID: PMC10716769 DOI: 10.1016/j.plabm.2023.e00346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
Objectives High-performance liquid chromatography (HPLC) is commonly used to measure hemoglobin A1c (HbA1c) levels and detect hemoglobin variants (Hb-Vars). HLC-723GR01 (GR01) is a new-generation automated ion-exchange HPLC system with two switchable analysis modes, namely short (30 s/test) and long modes (50 s/test). We evaluated the general performance of both analysis modes of GR01 for quantifying HbA1c and detecting Hb-Vars. Design and methods We evaluated the instrument's precision based on CLSI protocol EP-05-A3. A comparison of the two analysis modes of GR01 against the standard mode of HLC-723G11 was performed on 100 whole blood samples. The GR01 long mode was compared with affinity HPLC (AF-HPLC) for detecting common Hb-Vars (HbE, HbD, HbS, and HbC, >20 samples). To examine the detection capability for minor Hb-Vars, we analyzed 26 Hb-Vars using multiple analyzers, including both analysis modes of GR01. Results Both modes of GR01 had within-laboratory coefficients of variation of ≤1.0 % from four samples with HbA1c concentrations of 32-86 mmol/mol. Good correlation was observed between GR01 and HLC-723G11. The results for HbA1c detection in the presence of the major variants revealed a strong correlation between the long mode of GR01 and AF-HPLC (r = 0.986-0.998), and the difference biases ranged 0.1-1.9 mmol/mol. In the long mode, only one variant had a difference bias exceeding 14 % [10 % (%NGSP)]. Conclusion The two analysis modes of GR01 were fast and had high accuracy and reproducibility, indicating their utility for routine clinical use in measuring HbA1c samples with Hb-Vars.
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Affiliation(s)
| | | | | | - Masatsune Ogura
- Department of Clinical Laboratory Technology, Faculty of Medical Science, Juntendo University, Japan
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center, Japan
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Kim Tran S, Truong AB, Nguyen PH, Ngo TH, Vu TL, Dang Tran KD, Vo PM, Nguyen BT, Le Trong Huynh T, Nguyen KT, Tran HD. Preliminary Consequences of Blood Pressure Management and Blood Homocysteine Levels with Perindopril in Newly Diagnosed Hypertensive Patients in the Vietnamese Population. Int J Hypertens 2023; 2023:1933783. [PMID: 37886230 PMCID: PMC10599879 DOI: 10.1155/2023/1933783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/11/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
Background Perindopril is an ACE inhibitor that aids in both blood pressure regulation and homocysteine reduction. Objectives Our study aimed to evaluate the results of controlling blood pressure and blood homocysteine levels by perindopril in patients with primary hypertension. Materials and Methods A cross-sectional descriptive study with a longitudinal follow-up was conducted on 105 primary hypertensive patients treated with perindopril. Results The results of our study showed that after 6 weeks of treatment with perindopril, the proportion of patients with the target blood pressure (BP) level accounted for 70.5%, the rate of grade 1 hypertension decreased from 61.0% to 25.7%, grade 2 blood pressure decreased from 17.1% to 3.8%, and there was no case of grade 3 hypertension. At the same time, we also found that the rate of BP control in the group of patients who controlled Hcy below a threshold of 15 μmol/L was significantly higher than in the other group (p < 0.05). Concerning the efficacy of decreasing homocysteine in blood, we discovered that after 6 weeks of treatment with perindopril, the proportion of patients with elevated homocysteine reduced considerably from 74.3% to 40% (p < 0.05). In addition, the homocysteine concentration was 4.33 mol/L lower after treatment than before treatment (95% CI: 3.69-4.97) (p < 0.05). Conclusion Perindopril helps control blood pressure and reduces blood homocysteine levels in patients with primary hypertension.
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Affiliation(s)
- Son Kim Tran
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - An Bao Truong
- Department of Cardiology, An Giang Cardiovascular Hospital, Long Xuyen 880000, Vietnam
| | - Phi Hoang Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Toan Hoang Ngo
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Tuyen Long Vu
- Department of Foreign Language, Can Tho University, Can Tho 90000, Vietnam
| | - Khoa Dang Dang Tran
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Phuong Minh Vo
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Bao The Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Tuong Le Trong Huynh
- Department of Cardiology, Can Tho Central General Hospital, Can Tho 90000, Vietnam
| | - Kien Trung Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Hung Do Tran
- Faculty of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care 2023; 46:e151-e199. [PMID: 37471273 PMCID: PMC10516260 DOI: 10.2337/dci23-0036] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association for Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (HbA1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B. Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA
| | - George L. Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, IL
| | - David E. Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA
| | - Andrea R. Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E. Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL
| | - David M. Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA
| | - M. Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC
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5
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clin Chem 2023:hvad080. [PMID: 37473453 DOI: 10.1093/clinchem/hvad080] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association of Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (Hb A1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA, United States
| | - George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, ILUnited States
| | - David E Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA, United States
| | - Andrea R Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL, United States
| | - David M Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA, United States
| | - M Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
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Yadav N, Kumar Mandal A. Interference of hemoglobin variants in HbA 1c quantification. Clin Chim Acta 2023; 539:55-65. [PMID: 36476843 DOI: 10.1016/j.cca.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Fasting blood glucose and glycated hemoglobin (HbA1c) are routine biomarkers to screen and monitor diabetes mellitus. HbA1c results from glycation at the N-terminus of the β globin chain of tetrameric human hemoglobin. Fasting blood glucose level varies with the nature and amount of food intake, physical exercise, etc., and, accordingly, is a short-term measure of glucose control. In contrast, HbA1c provides an average measure of glucose control for the long-term (8-12 weeks). Unfortunately, genetic variants of hemoglobin may interfere with HbA1c quantification using ion exchange chromatography, capillary electrophoresis, immunoassay and boronate affinity chromatography. Mass spectrometry, however, measures total glycation of hemoglobin across both α and β globin chains and correlates well with the ion exchange based method. Additionally, mass spectrometry based quantification is not impacted by the presence of genetic variants of hemoglobin and thus might be a better analytical choice for diabetes mellitus.
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Affiliation(s)
- Neha Yadav
- Department of Biological Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, Nadia, West Bengal 741246, India
| | - Amit Kumar Mandal
- Department of Biological Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, Nadia, West Bengal 741246, India.
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Tran SK, Ngo TH, Nguyen PH, Truong AB, Truong GK, Tran KDD, Vo PM, Nguyen PT, Nguyen TT, Nguyen PNT, Nguyen KT, Tran HD. Hyperhomocysteinemia in Patients with Newly Diagnosed Primary Hypertension in Can Tho City, Vietnam. Healthcare (Basel) 2023; 11:healthcare11020234. [PMID: 36673602 PMCID: PMC9859246 DOI: 10.3390/healthcare11020234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Background: Elevated levels of blood total homocysteine is one of the cardiovascular risk factors in hypertensive patients. Objectives: Determine the prevalence of hyperhomocysteinemia and its associated factors in newly diagnosed primary hypertension patients. Materials and methods: A cross-sectional descriptive study on 105 patients with newly diagnosed primary hypertension at Can Tho University of Medicine and Pharmacy Hospital from May 2017 to May 2018. Total homocysteine levels and related factors were collected at the study time. Results: The mean plasma total homocysteine level was 16.24 ± 4.49 µmol/L. There were 78 patients with elevated plasma total homocysteine levels ≥15 µmol/L, accounting for 74.3% of all patients. Being elderly, gender, hypertension stage, and diabetes were factors associated with hyperhomocysteinemia (p < 0.05). Total homocysteine levels were positively correlated with SBP, DBP, and age with r(SBP) = 0.696, r(DBP) = 0.585, and r(age) = 0.286. Conclusion: Research on the subpopulation of Vietnamese people shows that hyperhomocysteinemia is common in patients with newly diagnosed primary hypertension, and high blood total homocysteine levels are often related to age, sex, hypertension stage, and diabetes.
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Affiliation(s)
- Son Kim Tran
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Toan Hoang Ngo
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Phi Hoang Nguyen
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - An Bao Truong
- Department of Cardiology, An Giang Cardiovascular Hospital, Long Xuyen 880000, Vietnam
| | - Giang Khanh Truong
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Khoa Dang Dang Tran
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Phuong Minh Vo
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Phi The Nguyen
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Thuan Tuan Nguyen
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Phu Ngoc Thien Nguyen
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Kien Trung Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Hung Do Tran
- Faculty of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
- Correspondence:
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A case of α-chain variant hemoglobin (Hb Chad) with falsely high HbA1c levels measured by immunoassay. Diabetol Int 2021; 13:330-335. [DOI: 10.1007/s13340-021-00529-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/06/2021] [Indexed: 02/05/2023]
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Rosli MR, Neoh CF, Wu DB, Hassan NW, Mahmud M, Rahimi A, Karuppannan M. Evaluation of home medication review for patients with type 2 diabetes mellitus by community pharmacists: a randomised controlled trial. Pharm Pract (Granada) 2021; 19:2397. [PMID: 34621450 PMCID: PMC8455124 DOI: 10.18549/pharmpract.2021.3.2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/05/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Successful diabetes treatment requires commitment and understanding of disease management by the patients. OBJECTIVE This trial aimed to evaluate the programme effectiveness of home medication review by community pharmacists (HMR-CP) in optimising diabetes care and reducing medication wastage. METHODS A randomised controlled trial was conducted on 166 patients with Type 2 Diabetes Mellitus (T2DM) who were randomly assigned to the intervention or control groups. The intervention group received HMR-CP at 0-month, 3-month, and 6-month. The primary outcome was haemoglobin A1c (HbA1c) while clinical outcomes, anthropometric data, and humanistic outcomes were the secondary outcomes. For the intervention group, drug-related problems (DRP) were classified according to the Pharmaceutical Care Network Europe Foundation (PCNE). Medication adherence was determined based on the Pill Counting Adherence Ratio (PCAR). The cost of medication wastage was calculated based on the total missed dose by the T2DM patients multiplied by the cost of medication. General linear model and generalised estimating equations were used to compare data across the different time-points within and between the groups, respectively. RESULTS No significant difference was observed in the demographic and anthropometric data at baseline between the two groups except for fasting blood glucose (FBG). There was a significant reduction in the HbA1c (-0.91%) and FBG (-1.62mmol/L) over the study period (p<0.05). A similar observation was noted in diastolic blood pressure (DBP) and total cholesterol (TC) but not in high-density lipoprotein (HDL), and anthropometric parameters. Both utility value and Michigan Diabetes Knowledge Test (MDKT) scores increased significantly over time. As for the intervention group, significant changes in PCAR (p<0.001) and the number of DRP (p<0.001) were noted. CONCLUSIONS HMR-CP significantly improved the glycaemic control, QoL, medication adherence, and knowledge of T2DM patients as well as reduced the number of DRP and cost of medication wastage. However, the impact of HMR-CP on certain clinical and anthropometric parameters remains inconclusive and further investigation is warranted.
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Affiliation(s)
- M Rozaini Rosli
- BPharm, MBA. PhD. Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia).
| | - Chin F Neoh
- PhD. Senior Lecturer. Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia).
| | - David B Wu
- PhD. Director. Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-Being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Sunway Town, Selangor (Malaysia).
| | - Nazariah W Hassan
- M.D. Family medicine specialist, Pasir Mas City Health Clinic. Kelantan (Malaysia).
| | - Mahani Mahmud
- M.D. Senior Medical Officer at Pasir Mas City Health Clinic, Hospital Street, Pasir Mas, Kelantan, Malaysia.
| | - Afifah Rahimi
- BPharm. Senior Pharmacist at Pasir Mas City Health Clinic, Hospital Street, Pasir Mas, Kelantan, Malaysia.
| | - Mahmathi Karuppannan
- PhD. Senior Lecturer, Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia).
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Robbins T, Sankaranarayanan S, Randeva H, Keung SNLC, Arvanitis TN. Association between glycosylated haemoglobin and outcomes for patients discharged from hospital with diabetes: A health informatics approach. Digit Health 2021; 7:20552076211007661. [PMID: 33948220 PMCID: PMC8054217 DOI: 10.1177/20552076211007661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 03/13/2021] [Indexed: 11/16/2022] Open
Abstract
Aims/Objectives Extensive research considers associations between inpatient glycaemic control and outcomes during hospital admission; this cautions against overly tight glycaemic targets. Little research considers glycaemic control following hospital discharge. This is despite a clear understanding that people with diabetes are at increased risk of negative outcomes, following discharge. We evaluate absolute and relative Hba1c values, and frequency of Hba1c monitoring, on readmission and mortality rates for people discharged from hospital with diabetes. Methods All discharges (n = 46,357) with diabetes from a major tertiary referral centre over 3 years were extracted, including biochemistry data. We conducted an evaluation of association between Hba1c, mortality and readmission, statistical significance and standardised Cohen's D effect size calculations. Results 399 patients had a Hba1c performed during their admission. 3,138 patients had a Hba1c within 1 year of discharge. Mean average Hba1c for readmissions was 57.82 vs 60.39 for not readmitted (p = 0.009, Cohen's D 0.28). Mean average number of days to Hba1c testing in readmitted was 97 vs 113 for those not readmitted (p = 0.00006, Cohen's D 0.39). Further evaluation of mortality outcomes, cohorts of T1DM and T2DM and association of relative change in Hba1c was performed. Conclusions Lower Hba1c values following discharge from hospital are significantly associated with increased risk of readmission, as is a shorter duration until testing. Similar patterns observed for mortality. Findings particularly prominent for T1DM. Further research needed to consider underlying causation and design of appropriate risk stratification models.
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Affiliation(s)
- Tim Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.,Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | | | - Harpal Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
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11
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May C-peptide index be a new marker to predict proteinuria in anemic patients with type 2 diabetes mellitus? Endocr Regul 2021; 54:1-5. [PMID: 32597149 DOI: 10.2478/enr-2020-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE C-peptide is a reliable marker of beta cell reserve and is associated with diabetic complications. Furthermore, HbA1c level is associated with micro- and macro-vascular complications in diabetic patients. HbA1c measurement of diabetic patients with anemia may be misleading because HbA1c is calculated in percent by taking reference to hemoglobin measurements. We hypothesized that there may be a relationship between C-peptide index (CPI) and proteinuria in anemic patients with type 2 diabetes mellitus (T2DM). Therefore, the aim of the present study was to investigate the association between C-peptide levels and CPI in anemic patients with T2DM and proteinuria. METHODS The patients over 18 years of age with T2DM whose C-peptide levels were analyzed in Endocrinology and Internal medicine clinics between 2014 and 2018 with normal kidney functions (GFR>60 ml/min) and who do not use any insulin secretagogue oral antidiabetic agent (i.e. sulfonylurea) were enrolled into the study. RESULTS Hemoglobin levels were present in 342 patients with T2DM. Among these 342 cases, 258 (75.4%) were non-anemic whereas 84 (24.6%) were anemic. The median DM duration of the anemic group was statistically significantly higher in T2DM (p=0.003). There was no statistically significant difference found in proteinuria prevalence between non-anemic and anemic patient groups (p=0.690 and p=0.748, respectively). Anemic T2DM cases were corrected according to the age, gender, and duration of DM. C-peptide and CPI levels were not statistically significant to predict proteinuria (p=0.449 and p=0.465, respectively). CONCLUSION The present study sheds light to the association between C-peptide, CPI, and anemic diabetic nephropathy in T2DM patients and indicates that further prospective studies are needed to clarify this issue.
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Lyons J, van der Linden EL, Meeks K, Beune E, Smeeth L, Bahendeka S, Spranger J, Klipstein-Grobusch K, Mockenhaupt FP, Danquah I, Agyemang C. Inverse Association between Iron Deficiency and Glycated Hemoglobin Levels in Ghanaian Adults-the RODAM Study. J Nutr 2020; 150:1899-1908. [PMID: 32433726 PMCID: PMC7330469 DOI: 10.1093/jn/nxaa109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/10/2020] [Accepted: 03/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Glycated hemoglobin (HbA1c) is often used to diagnose type 2 diabetes (T2D), but studies show that iron deficiency (ID) is associated with elevated HbA1c in the absence of hyperglycemia. It is unknown whether ID prevalence varies between sub-Saharan African populations living in different locations and whether ID influences HbA1c levels in these populations. OBJECTIVES We assessed the prevalence of ID among Ghanaian migrants in Europe and nonmigrant Ghanaians, and the influence of ID on HbA1c categories among Ghanaians without T2D. METHODS We used the database from the cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study. This contained data on 3377 Ghanaian men and women aged 25-70 y living in urban and rural Ghana and Ghanaian migrants living in Amsterdam, London, and Berlin. ID was defined as ferritin < 15 ng/mL or, if C-reactive protein was ≥5 mg/mL, as ferritin < 30 ng/mL according to the WHO. We used binary logistic regression to assess differences in ID between sites and its association with clinically defined HbA1c categories (<5.5%, ≥5.5% to <6.5%, ≥6.5%). Men and women were analyzed separately. RESULTS The prevalence of ID was higher in migrant [28.4%; adjusted OR (aOR): 3.08; 95% CI: 2.04, 4.65)] and urban (23.2%; aOR: 2.37; 95% CI: 1.56, 3.59) women than in rural women (11.9%). Among women, ID was associated with higher odds of HbA1c ≥ 5.5% to <6.5% in the absence of hyperglycemia (aOR: 1.43; 95% CI: 1.08, 1.87). This association was not found in men. CONCLUSIONS Further research is needed to identify factors underlying the high prevalence of ID among urban and migrant Ghanaian women, and the association of ID with HbA1c ≥ 5.5% to <6.5% in women. In addition, our study reinforces the need to consider iron concentrations if interpreting HbA1c among African populations.
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Affiliation(s)
- Julia Lyons
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Eva L van der Linden
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Karlijn Meeks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, NIH, Bethesda, MD, USA
| | - Erik Beune
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité University Hospital Berlin, Berlin, Germany
- Center for Cardiovascular Research, Charité University Hospital Berlin, Berlin, Germany
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité University Hospital Berlin, Berlin, Germany
| | - Ina Danquah
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Hospital Berlin, corporate member of Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Chen KJ, Wu YT, Lee CK. Cellulose binding domain fusion enhanced soluble expression of fructosyl peptide oxidase and its simultaneous purification and immobilization. Int J Biol Macromol 2019; 133:980-986. [DOI: 10.1016/j.ijbiomac.2019.04.171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 11/25/2022]
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Cikomola JC, Kishabongo AS, Speeckaert MM, Delanghe JR. Diabetes mellitus and laboratory medicine in sub-Saharan Africa: challenges and perspectives. Acta Clin Belg 2019; 74:137-142. [PMID: 30029579 DOI: 10.1080/17843286.2018.1498179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Diabetes mellitus is an increasing public health problem in sub-Saharan Africa with a substantial socioeconomic burden. Although laboratory medicine has been recognized as one of the six key public health functions, there are still gaps in strengthening of laboratory services in developing countries. In the last decades, a lot of progress has been made in the diagnostic field of infectious diseases, whereas the diagnosis of noncommunicable diseases is still insufficient and uneven. This article analyses the challenges encountered in diagnosing and monitoring of diabetes mellitus in sub-Saharan Africa and explores new alternative diagnostic tools.
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Affiliation(s)
- Justin C. Cikomola
- Department of Internal Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | - Antoine S. Kishabongo
- Department of Laboratory Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo
| | | | - Joris R. Delanghe
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
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15
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A case of variant hemoglobin (Hb Agenogi) with type 2 diabetes mellitus showed high HbA1c levels measured by immunoassay due to enhanced antigenicity. Diabetol Int 2019; 10:138-142. [DOI: 10.1007/s13340-018-0383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
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Abstract
We report the unusual case of a patient found to have a low glycosylated haemoglobin (HbA1c) despite having recently been diagnosed with diabetes mellitus type 2. The patient, who was not anaemic, with no symptoms or family history of haematological conditions, was subsequently found to have an elevated reticulocyte count, inferring increased red cell turnover as the culprit for the discordant HbA1c result. A diagnosis of hereditary spherocytosis was made based on characteristic peripheral blood film appearances and confirmed by eosin-5-maleimide binding test. Exposure of an undiagnosed haemolytic anaemia by virtue of a low HbA1c is uncommon. However, conditions that distort HbA1c measurements are not infrequent. This case should serve to remind clinicians of the limitations of HbA1c in specified situations, and to remain vigilant when interpreting results.
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Affiliation(s)
- Emily Finan
- Department of Haematology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Joe Joseph
- Department of Haematology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
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17
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Chen KJ, Wang CH, Liao CW, Lee CK. Recombinant fructosyl peptide oxidase preparation and its immobilization on polydopamine coating for colorimetric determination of HbA1c. Int J Biol Macromol 2018; 120:325-331. [DOI: 10.1016/j.ijbiomac.2018.08.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/02/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
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18
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Newman CN, Litwin CM, Bowlby DA, Lewis KA, Paulo RC. Hemoglobin Providence (β82 Lys > Asn, Asp) and lower-than-expected HbA1c in a nonadherent teenager with type 1 diabetes: a case report and literature review. Clin Case Rep 2017; 5:2000-2002. [PMID: 29225844 PMCID: PMC5715421 DOI: 10.1002/ccr3.1244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/16/2017] [Accepted: 09/18/2017] [Indexed: 11/11/2022] Open
Abstract
Endocrinologists should have a high index of suspicion for a Hb variant when the HbA1c is not consistent with other indices of glycemic control.
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Affiliation(s)
- Charles N Newman
- Department of Pathology and Laboratory Medicine Medical University of South Carolina Charleston South Carolina 29425
| | - Christine M Litwin
- Department of Pathology and Laboratory Medicine Medical University of South Carolina Charleston South Carolina 29425
| | - Deborah A Bowlby
- Division of Pediatric Endocrinology Medical University of South Carolina Charleston South Carolina 29425
| | - Katherine A Lewis
- Division of Pediatric Endocrinology Medical University of South Carolina Charleston South Carolina 29425
| | - Remberto C Paulo
- Division of Pediatric Endocrinology Medical University of South Carolina Charleston South Carolina 29425
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Zhou HM, Liu F, Yang AG, Guo YQ, Zhou YR, Gu YQ, Yan BY, Li QH. Efficacy, safety and influencing factors of intra-calf muscular injection of bone marrow mononuclear cells in the treatment of type 2 diabetes mellitus-induced lower extremity vascular disease. Exp Ther Med 2017; 14:5177-5185. [PMID: 29201234 DOI: 10.3892/etm.2017.5193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 03/17/2017] [Indexed: 11/06/2022] Open
Abstract
The efficacy, safety and impact of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) associated with the intra-calf muscular injection of bone marrow mononuclear cells (BMMCs) in the treatment of type 2 diabetes mellitus (T2DM)-induced lower extremity vascular disease (LEVD) were evaluated. Patients with T2DM-LEVD were randomly divided into a control group and BMMCs group to assess the efficacy and safety of the treatment; serum VEGF and bFGF levels were detected. The BMMCs group was divided into superior genicular artery (SGA) and inferior genicular artery (IGA) subgroups as well as low-dose and high-dose subgroups for the comparison of efficacy indices. The BMMCs group exhibited significantly improved indices (P<0.05) compared with the control group and no fatalities or cancer occurred. There were no significant changes in serum VEGF and bFGF levels (P>0.05). The claudication distance in the IGA subgroup was significantly greater that in the SGA subgroup (P<0.05); the low-dose subgroup and the high-dose subgroup did not demonstrate any significant differences in each index (P>0.05). BMMC treatment for T2DM-LEVD was found to be safe and effective and had no significant impact on serum VEGF and bFGF levels in the short term; However, the degree of LEVD may affect its efficacy.
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Affiliation(s)
- Hui-Min Zhou
- Department of Endocrinology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, P.R. China
| | - Fan Liu
- Department of Endocrinology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, P.R. China
| | - Ai-Ge Yang
- Department of Endocrinology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, P.R. China
| | - Yu-Qing Guo
- Department of Endocrinology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, P.R. China
| | - Ya-Ru Zhou
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Yong-Quan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Bao-Yong Yan
- Cell Therapy Laboratory, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, P.R. China
| | - Quan-Hai Li
- Cell Therapy Laboratory, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, P.R. China
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Current Status of HbA1c Biosensors. SENSORS 2017; 17:s17081798. [PMID: 28777351 PMCID: PMC5579747 DOI: 10.3390/s17081798] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 01/08/2023]
Abstract
Glycated hemoglobin (HbA1c) is formed via non-enzymatic glycosylation reactions at the α–amino group of βVal1 residues in the tetrameric Hb, and it can reflect the ambient glycemic level over the past two to three months. A variety of HbA1c detection methods, including chromatography, immunoassay, enzymatic measurement, electrochemical sensor and capillary electrophoresis have been developed and used in research laboratories and in clinics as well. In this review, we summarize the current status of HbA1c biosensors based on the recognition of the sugar moiety on the protein and also their applications in the whole blood sample measurements.
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The Importance and Utility of Hemoglobin A1c Levels in the Assessment of Donor Pancreas Allografts. Transplantation 2016; 101:2508-2519. [PMID: 27984519 DOI: 10.1097/tp.0000000000001612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hemoglobin A1C (HbA1c) levels are often obtained in potential pancreas graft donors to assess the overall long-term functional glycemic control or the possibility of unrecognized diabetes. Although routinely measured, the impact of donor HbA1c levels on pancreas graft outcomes has not been reported. Here, we researched the relationship between donor HbA1c levels and postoperative pancreas graft survival. METHODS Data from 266 pancreas transplant patients including 182 simultaneous kidney-pancreas and 84 pancreas alone transplants were reviewed for the study. The patients were separated into groups according to their HbA1c levels (5 groups: HbA1c < 5.0, 5.0-5.4, 5.5-5.9, ≥6.0 % and not available, or 2 groups: HbA1c <5.7, ≥5.7%). Overall, death-censored and technically successful pancreas graft survival and rejection rates of each group were compared. In the case of technically successful graft survival, graft losses due to technical problems in the first 60 days were excluded. RESULTS All groups were similar with regard to donor variables including age, sex, ABO blood type, ethnicity, donor type and recipient variables including recipient age, sex, induction agents and maintenance treatment. Mean follow-up time was 4.2 ± 1.97 years. The overall graft survivals and death censored graft survivals among groups were not statistically different from one other (P > 0.05). Additionally, excluding early technical losses in 18 patients did not reveal any differences in graft survivals. Patient survival and biopsy-proven acute rejections were statistically similar among HbA1c strata. CONCLUSIONS This univariate retrospective analysis of a single center/organ procurement organization use of HbA1c shows that donor HbA1c levels between 3.5 and 6.2 in otherwise transplantable pancreata are not associated with different short-term outcomes.
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Otabe S, Nakayama H, Ohki T, Soejima E, Tajiri Y, Yamada K. Haemoglobin variants may cause significant differences in haemoglobin A1c as measured by high-performance liquid chromatography and enzymatic methods in diabetic patients: a cross-sectional study. Ann Clin Biochem 2016; 54:432-437. [PMID: 27496792 DOI: 10.1177/0004563216664366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background We aimed to determine whether the discrepancy between haemoglobin A1c values determined by high-performance liquid chromatography and enzymatic haemoglobin A1c measurements in diabetic patients was clinically relevant. Methods We randomly recruited 1421 outpatients undergoing diabetic treatment and follow-up who underwent at least three haemoglobin A1c measurements between April 2014 and March 2015 at our clinic. In 6369 samples, haemoglobin A1c was simultaneously measured by HA-8160 and MetaboLead (enzymatic assay), and the values were compared. Results haemoglobin A1c measurements by high-performance liquid chromatography and enzymatic assay were strongly correlated (correlation coefficient: 0.9828, linear approximation curve y = 0.9986x - 0.2507). Mean haemoglobin A1c (6.8 ± 1.0%) measured by high-performance liquid chromatography was significantly higher than that measured by enzymatic assay (6.5 ± 1.0%, P < 0.0001). During the sample processing, four (0.3%) subjects presented consistently lower haemoglobin A1c values (<0.7%) by high-performance liquid chromatography than those from enzymatic assay. Of these, three had Hb Toranomon [β112 (G14) Cys→Trp]. The fourth had Hb Ube-2 [α68 (E17) Asn→Asp]. One other subject presented consistently higher haemoglobin A1c values (>1%) by high-performance liquid chromatography than those from enzymatic assay and was diagnosed with a -77 (T > C) mutation in the δ-globin gene. These unrelated asymptomatic subjects had normal erythrocyte profiles, without anaemia. Conclusions We showed that haemoglobin A1c values measured by high-performance liquid chromatography were significantly higher than those measured by enzymatic assay in diabetic subjects. However, when an oversized deviation (>0.7%) between glycaemic control status and haemoglobin A1c is apparent, clinicians should check the methods used to measure haemoglobin A1c and consider the possible presence of a haemoglobin variant.
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Affiliation(s)
- Shuichi Otabe
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.,2 Otabe Clinic, Fukuoka, Japan
| | - Hitomi Nakayama
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tsuyoshi Ohki
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Eri Soejima
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yuji Tajiri
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kentaro Yamada
- 1 Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
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Chandrashekar V. Hb A1c Separation by High Performance Liquid Chromatography in Hemoglobinopathies. SCIENTIFICA 2016; 2016:2698362. [PMID: 26989559 PMCID: PMC4771897 DOI: 10.1155/2016/2698362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/16/2016] [Accepted: 01/24/2016] [Indexed: 06/05/2023]
Abstract
Hb A1c measurement is subject to interference by hemoglobin traits and this is dependent on the method used for determination. In this paper we studied the difference between Hb A1c measured by HPLC in hemoglobin traits and normal chromatograms. We also studied the correlation of Hb A1c with age. Hemoglobin analysis was carried out by high performance liquid chromatography. Spearman's rank correlation was used to study correlation between A1c levels and age. Mann-Whitney U test was used to study the difference in Hb A1c between patients with normal hemoglobin and hemoglobin traits. A total of 431 patients were studied. There was positive correlation with age in patients with normal chromatograms only. No correlation was seen in Hb E trait or beta thalassemia trait. No significant difference in Hb A1c of patients with normal chromatograms and patients with hemoglobin traits was seen. There is no interference by abnormal hemoglobin in the detection of A1c by high performance liquid chromatography. This method cannot be used for detection of A1c in compound heterozygous and homozygous disorders.
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Affiliation(s)
- Vani Chandrashekar
- Department of Hematology, Apollo Hospitals, No. 21, Off Greams Road, Greams Lane, Chennai 600006, India
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25
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Chen J, Diesburg-Stanwood A, Bodor G, Rasouli N. Led Astray by Hemoglobin A1c: A Case of Misdiagnosis of Diabetes by Falsely Elevated Hemoglobin A1c. J Investig Med High Impact Case Rep 2016; 4:2324709616628549. [PMID: 26848480 PMCID: PMC4735504 DOI: 10.1177/2324709616628549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hemoglobin A1c (A1c) is used frequently to diagnose and treat diabetes mellitus. Therefore, it is important be aware of factors that may interfere with the accuracy of A1c measurements. This is a case of a rare hemoglobin variant that falsely elevated a nondiabetic patient’s A1c level and led to a misdiagnosis of diabetes. A 67-year-old male presented to endocrine clinic for further management after he was diagnosed with diabetes based on an elevated A1c of 10.7%, which is approximately equivalent to an average blood glucose of 260 mg/dL. Multiple repeat A1c levels remained >10%, but his home fasting and random glucose monitoring ranged from 92 to 130 mg/dL. Hemoglobin electrophoresis and subsequent genetic analysis diagnosed the patient with hemoglobin Wayne, a rare hemoglobin variant. This variant falsely elevates A1c levels when A1c is measured using cation-exchange high-performance liquid chromatography. When the boronate affinity method was applied instead, the patient’s A1c level was actually 4.7%. Though hemoglobin Wayne is clinically silent, this patient was erroneously diagnosed with diabetes and started on an antiglycemic medication. Due to this misdiagnosis, the patient was at risk of escalation in his “diabetes management” and hypoglycemia. Therefore, it is important that providers are aware of factors that may result in hemoglobin A1c inaccuracy including hemoglobin variants.
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Affiliation(s)
- Jean Chen
- University of Colorado School of Medicine, Aurora, CO, USA; VA Eastern Colorado Health Care Systems, Denver, CO, USA
| | | | - Geza Bodor
- VA Eastern Colorado Health Care Systems, Denver, CO, USA
| | - Neda Rasouli
- University of Colorado School of Medicine, Aurora, CO, USA; VA Eastern Colorado Health Care Systems, Denver, CO, USA
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Effects of hemoglobin S variants on the measurement of glycosylated hemoglobin A1c by four analytical methods. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-014-0257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Benítez IC, Lameiro PC, Ropero P, De la Osa JJL, Fernández FG, Ortiz AM. Hemoglobin Valme HBB:c.124T>G: a new hemoglobin variant with diminished oxygen affinity causes interference in hemoglobin A1c measurement in an automated ion-exchange HPLC method. Clin Chem Lab Med 2015; 53:e211-3. [PMID: 25781690 DOI: 10.1515/cclm-2014-1028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/19/2015] [Indexed: 11/15/2022]
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Iizuka K, Mizuno M, Niwa H, Takeda J. A Rare Case of Variant Hemoglobin (Hb Yahata) Suspected Based on Inconsistent Plasma Glucose and HbA1c Levels. Intern Med 2015; 54:1771-5. [PMID: 26179534 DOI: 10.2169/internalmedicine.54.4017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 52-year-old man presented for an evaluation of worsening glycemic control secondary to glucocorticoid administration. The glycated hemoglobin (HbA1c) level was 8%, and oral glucose tolerance testing revealed impaired tolerance, whereas the plasma glucose and glycoalbumin levels were normal. The results of high-performance liquid chromatography (HPLC) for HbA1c, isoelectrofocusing of the hemolysate and precise HPLC measurements of the HbA1c level supported the presence of an Hb variant, and DNA sequencing of the β-globin gene revealed Hb Yahata [β112 TGT (Cys)→TAT (Tyr)] (heterozygote). In this case, the discrepancy between the plasma glucose and HbA1c levels raised suspicion of this rare Hb variant.
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Affiliation(s)
- Katsumi Iizuka
- Department of Diabetes and Endocrinology, Graduate School of Medicine, Gifu University, Japan
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Bouzid K, Ahmed HB, Kalai E, Blibeche S, Couque N, Khiari K, Bahlous A, Abdelmoula J. Prevalence of hemoglobin variants in a diabetic population at high risk of hemoglobinopathies and optimization of HbA1c monitoring by incorporating HPLC in the laboratory workup. Libyan J Med 2014; 9:25768. [PMID: 25361891 PMCID: PMC4216394 DOI: 10.3402/ljm.v9.25768] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/29/2014] [Accepted: 10/06/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In Tunisia, diabetes mellitus and hemoglobinopathies are major public health problems. Glycated hemoglobin (HbA1c) is recommended for long-term monitoring of diabetes mellitus, but the presence of hemoglobin variants may interfere with HbA1c measurement. The aim was to determine the prevalence of hemoglobin variants in Tunisian diabetics and optimize the monitoring of diabetics using HbA1c. METHODS The study enrolled 9,792 Tunisian diabetic patients. HbA1c was measured by cation-exchange high-pressure liquid chromatography (HPLC). All the chromatograms were analyzed for the presence of Hb variants. RESULTS We identified 228 cases (2.33%) of Hb variants with D-10 HPLC (Bio-Rad): 191 with HbA/S trait, 27 with HbA/C trait, and 10 hemoglobin variants with the mention 'Variant-Window' on the chromatograms and subsequently identified as HbA/S on Variant I HPLC (Bio-Rad). Thus, the prevalence of HbS was 2.05%. We did not find any homozygous variant. All HbA1c results were reported to the treating physician. CONCLUSIONS To evaluate glycated hemoglobin in populations with a high prevalence of hemoglobinopathies, we should use the HPLC method, which is easy, economical, and reliable. Based on an algorithm, hemoglobin variants visualized on HPLC should be reported to the physician to improve the management of patients.
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Affiliation(s)
- Kahena Bouzid
- Laboratory of Clinical Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine University El Manar-Tunis, El Manar, Tunisia; Laboratory of Engineering of Proteins and Bioactive Molecules: LR 11EES24:LIP-MB, Tunis, Tunisia;
| | - Habib B Ahmed
- Department of Cardiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Eya Kalai
- Laboratory of Clinical Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Salma Blibeche
- Laboratory of Clinical Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Nathalie Couque
- Department of Molecular Genetics and Biochemistry, Robert Debré Hospital, Paris, France
| | - Karima Khiari
- Department of Endocrinology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Afef Bahlous
- Laboratory of Clinical Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Jaouida Abdelmoula
- Laboratory of Clinical Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
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Radin MS. Pitfalls in hemoglobin A1c measurement: when results may be misleading. J Gen Intern Med 2014; 29:388-94. [PMID: 24002631 PMCID: PMC3912281 DOI: 10.1007/s11606-013-2595-x] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 05/17/2013] [Accepted: 08/13/2013] [Indexed: 12/13/2022]
Abstract
Since the beginning of clinical use in the 1970s, hemoglobin A1c (A1c) has become the standard tool for monitoring glycemic control in patients with diabetes. The role of the A1c test was broadened in 2010, when the American Diabetes Association added A1c as a diagnostic criterion for diabetes. Because of hemoglobin A1c's integral role in diagnosis and treatment, it is important to recognize clinical scenarios and interfering factors that yield false results. The purpose of this review is to describe the A1c measurement, outline clinical scenarios or factors that may yield false results, and describe alternative laboratory biomarkers.
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Affiliation(s)
- Michael S Radin
- Division of Endocrinology, Diabetes, and Metabolism, Winthrop-University Hospital, Mineola, NY, USA,
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Higa M, Yoshifuji A, Doi A, Yoshida E, Yamashita K, Ichijo T, Ouchi H, Miyazaki A, Hirose T. A diabetic patient with hemoglobin variant Hb Mito diagnosed from a change in HbA1c measurement method. Diabetol Int 2013. [DOI: 10.1007/s13340-013-0120-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Kishabongo AS, Katchunga P, Van Aken EH, Speeckaert MM, Lagniau S, Husein D, Taes YE, Delanghe JR. Glycated nail proteins: a new approach for detecting diabetes in developing countries. Trop Med Int Health 2013; 19:58-64. [DOI: 10.1111/tmi.12218] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Antoine Sadiki Kishabongo
- Department of Laboratory Medicine; Catholic University of Bukavu; Bukavu Democratic Republic of the Congo
| | - Philippe Katchunga
- Department of Internal Medicine; Catholic University of Bukavu; Bukavu Democratic Republic of the Congo
| | | | | | - Sabrina Lagniau
- Department of Clinical Chemistry; Ghent University Hospital; Gent Belgium
| | - Dashty Husein
- Department of Endocrinology; Ghent University Hospital; Gent Belgium
| | - Youri E. Taes
- Department of Endocrinology; Ghent University Hospital; Gent Belgium
| | - Joris R. Delanghe
- Department of Clinical Chemistry; Ghent University Hospital; Gent Belgium
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González-Borrachero ML, Ropero-Gradilla P, Vergara-Chozas JM, González-Fernández FA. Hemoglobin Jerez [α2 β2 95 (FG2) Lys→Gln]: Performance of HbA1c measurement with five analytical methods. Clin Chim Acta 2013; 425:160-2. [DOI: 10.1016/j.cca.2013.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/19/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
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Lorenzo-Medina M, de la Iglesia S, Ruiz-García L, Quintana-Hidalgo L, Martín-Alfaro R, Herrada J. Pitfalls of glycated hemoglobin in the glycemic assessment of diabetes patients with hemoglobin louisville: role of serum fructosamine. J Diabetes Sci Technol 2013; 7:804-5. [PMID: 23759417 PMCID: PMC3869152 DOI: 10.1177/193229681300700329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mercedes Lorenzo-Medina
- Department of Clinical Chemistry, , Hospital General de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain;
| | - Silvia de la Iglesia
- Department of Hematology, Hospital General de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Lidia Ruiz-García
- Department of Clinical Chemistry, , Hospital General de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain;
| | - Lucia Quintana-Hidalgo
- Department of Clinical Chemistry, , Hospital General de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain;
| | - Ruth Martín-Alfaro
- Department of Clinical Chemistry, , Hospital General de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain;
| | - Juan Herrada
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas
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Chackathayil J, Patel JV, Gill PS, Potluri R, Natalwala A, Uppal H, Lavu D, Heun R, Hughes EA, Lip GYH. Cardiovascular Risk Profiles amongst Women in a Multiethnic Population in Inner City Britain: A Potential Impact of Anaemia. Int J Endocrinol 2013; 2013:303859. [PMID: 23509453 PMCID: PMC3590708 DOI: 10.1155/2013/303859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/20/2012] [Accepted: 01/07/2013] [Indexed: 11/17/2022] Open
Abstract
The risk of diabetes is markedly reduced in men with iron deficiency anaemia (IDA). The nature of this relationship in women is not clear, nor is there information about the influence of ethnicity, given the increased susceptibility of diabetes amongst South Asians and Afro-Caribbeans. We reviewed 3563 patients with a diagnosis of anaemia from 2000 to 2007. The age-adjusted prevalence of vitamin B12 deficiency and IDA was calculated, together with cardiovascular comorbidities amongst Caucasians, South Asians, and Afro-Caribbeans. The prevalence of vitamin B12 deficiency (women only) or IDA was markedly higher in South Asians compared to Caucasians and Afro-Caribbeans. Among women with IDA, diabetes was more prevalent among South Asians (45%, 95% CI 39.0-51.0) compared to Caucasians (3.0%, 2.1-4.0); P < 0.001. Among South Asian women with vitamin B12 deficiency, the prevalence of diabetes was reduced 8.5% (5.2-12.0). South Asian women with vitamin B12 deficiency had a higher prevalence of myocardial infarction (MI) and ischemic heart disease (IHD), but this relationship was reversed in IDA. IDA is associated with a greater prevalence of diabetes in South Asian women, but it is not coordinated by a greater risk of macrovascular complications. Given the cardiovascular impact of diabetes in South Asians, this association merits further study in relation to its pathophysiological implication.
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Affiliation(s)
- Julia Chackathayil
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH and Sandwell Medical Research Unit, Sandwell General Hospital, West Bromwich, West Midlands B71 4HJ, UK
| | - Jeetesh V. Patel
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH and Sandwell Medical Research Unit, Sandwell General Hospital, West Bromwich, West Midlands B71 4HJ, UK
- *Jeetesh V. Patel:
| | - Paramjit S. Gill
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Rahul Potluri
- Department of Cardiovascular Medicine, University of Manchester, Manchester M13 9NT, UK
| | - Ammar Natalwala
- Division of Medical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Hardeep Uppal
- Division of Medical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Deepthi Lavu
- Department of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Reinhard Heun
- Department of Psychiatry, Derby City General Hospital, Uttoxeter Road, Derby DE22 3NE, UK
| | - Elizabeth A. Hughes
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH and Sandwell Medical Research Unit, Sandwell General Hospital, West Bromwich, West Midlands B71 4HJ, UK
| | - Gregory Y. H. Lip
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH and Sandwell Medical Research Unit, Sandwell General Hospital, West Bromwich, West Midlands B71 4HJ, UK
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Nigam PK, Sharma S, Sareen R, Paul V, Lal A. Lack of precision in HbA(1c) values on variant II in cases of hemoglobin Q India. Indian J Clin Biochem 2012; 21:72-5. [PMID: 23105618 DOI: 10.1007/bf02912916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study was carried out to check the precision of HbA(1c) values on Bio-Rad Variant II in cases of a rare hemoglobin variant Q India. The study was carried out over a three month period on samples collected for HbA(1c) estimation. Seven out of eleven patients showed variable results of HbA(1c) with a very high and unacceptable intraday mean coefficient of variation (CV) of 9.93%. We conclude, that the results of HbA(1c) on Variant II can not be reported without adversely affecting HbA(1c) as a marker of long-term glycemic control in patients who have hemoglobin Q India. The HbA(1c) value of these patients needs to be assessed by a different instrument/method or the glycemic control be monitored by an alternate test like serum Fructosamine.
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Affiliation(s)
- P K Nigam
- Dr Lal PathLabs Pvt Ltd, 'ESKAY HOUSE', 54, Hanuman Road, 110001 New Delhi, India
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Miyazaki A, Kohzuma T, Kasayama S, Koga M. Classification of variant forms of haemoglobin according to the ratio of glycated haemoglobin to glycated albumin. Ann Clin Biochem 2012; 49:441-4. [DOI: 10.1258/acb.2012.011192] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Asymptomatic variant haemoglobin is increasingly being found in the measurement of glycated haemoglobin (HbA1c) for the management of diabetes mellitus. We compared the HbA1c concentrations measured by high-performance liquid chromatography (HPLC) and immunoassay and glycated albumin (GA) concentrations and calculated the respective ratios in order to classify the variant haemoglobin. Methods Twenty different haemoglobin variants from 43 subjects were identified by mass spectrometry and DNA analysis. Since GA accurately reflects glycaemic control in patients with variant haemoglobin, we calculated respective ratios of HbA1c and GA. Haemoglobin variants causing a low ratio of HbA1c measured by HPLC (HPLC-HbA1c) to GA with a normal ratio of HbA1c measured by immunoassay (IA-HbA1c) to GA were classified as C1. A further classification of α and β was used with abnormalities of the α chain or β chain in the haemoglobin gene. Other haemoglobin variants were classified as non-C1. Eight diabetic patients with stable glycaemic control were used as controls. Results Twenty forms of variant haemoglobins were classified as C1 α (2 variants; I-Interlaken and Hb J-Meerut), C1 β (15 variants) and non-C1 (3 variants; Hb Himeji, Hb Woolwich, Hb Peterborough). Positive correlations between GA and HPLC-HbA1c or IA-HbA1c were seen in the C1 β patients with diabetes mellitus. The regression line between GA and HPLC-HbA1c, but not that between GA and IA-HbA1c, showed a downward shift in comparison with the data obtained from the diabetic controls. Conclusions Variant haemoglobin could be classified by calculating the ratios of HPLC-HbA1c, IA-HbA1c and GA.
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Affiliation(s)
- Ayako Miyazaki
- Department of Central Laboratory, Osaka Medical College, Takatsuki 569-8686
| | - Takuji Kohzuma
- Diagnostics Department, Asahi Kasei Pharma Corporation, Tokyo 101-8101
| | - Soji Kasayama
- Department of Medicine, Nissay Hospital, Osaka 550-0012
| | - Masafumi Koga
- Department of Internal Medicine, Kinki Central Hospital, 3-1, Kuruma-zuka, Itami, Hyogo 664-8533, Japan
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Falsely decreased HbA1c in a type 2 diabetic patient treated with dapsone. J Formos Med Assoc 2012; 111:109-12. [PMID: 22370290 DOI: 10.1016/j.jfma.2012.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/03/2009] [Accepted: 07/24/2009] [Indexed: 02/02/2023] Open
Abstract
Glycated hemoglobin A1c (HbA1c) is an important indicator of glycemic control. The current recommendation for glycemic control based on HbA1c values has been widely accepted. However, HbA1c values depend on the lifespan of erythrocytes and the assay methods used. Here, we report the case of a patient with type 2 diabetes with unusual falling of HbA1c due to interference from dapsone treatment for leukocytoclastic vasculitis. He was a 52-year-old man, who was diagnosed with type 2 diabetes mellitus 5 years previously and who had been treated in our hospital in the past 3 years. Glycemia was controlled by sulfonylurea and metformin. During the 3-years follow-up period, HbA1c dropped significantly during the addition of dapsone treatment, although plasma glucose levels remained stable. HbA1c levels were raised after discontinuation of dapsone. With rechallenge of dapsone usage, HbA1c decreased again. We conclude that dapsone may be the cause of artificially low HbA1c. Other measurements to monitor glycemic control should be considered when dapsone is used for the treatment of concurrent disorders, such as autoimmune disease and pneumocystis jiroveci pneumonia.
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Katsiki N, Papanas N, Mikhailidis DP, Fonseca VA. Glycated hemoglobin A₁c (HbA₁c) and diabetes: a new era? Curr Med Res Opin 2011; 27 Suppl 3:7-11. [PMID: 21916533 DOI: 10.1185/03007995.2011.618179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract In January 2011 the American Diabetes Association (ADA) published the latest guidelines for the diagnosis and treatment of diabetes mellitus (DM)(1,2). Despite some controversies, glycated hemoglobin A(1c) (HbA(1c)), an established marker of long-term glycemia traditionally used to assess the quality of DM management, remained an independent criterion for the diagnosis of DM, and indeed now appears to be well established in the USA. This has far-reaching implications for clinical practice worldwide.
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40
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Cases with Hb Toranomon show abnormal HbA1c levels measured by upgraded high-performance liquid chromatography models. Diabetol Int 2011. [DOI: 10.1007/s13340-011-0045-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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41
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Nishihara E, Koga M, Kadowaki S, Murakami M, Harano K, Ito M, Kubota S, Amino N, Miyauchi A. Method-dependent HbA1c values in a family with hemoglobin Himeji. Clin Chim Acta 2011; 412:1689-92. [DOI: 10.1016/j.cca.2011.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/23/2011] [Accepted: 05/23/2011] [Indexed: 11/17/2022]
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, Lernmark A, Metzger BE, Nathan DM. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care 2011; 34:e61-99. [PMID: 21617108 PMCID: PMC3114322 DOI: 10.2337/dc11-9998] [Citation(s) in RCA: 320] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 02/28/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (HbA(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA.
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, Lernmark A, Metzger BE, Nathan DM. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem 2011; 57:e1-e47. [PMID: 21617152 DOI: 10.1373/clinchem.2010.161596] [Citation(s) in RCA: 308] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence Based Laboratory Medicine Committee of the AACC jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (Hb A(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of Hb A(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892-1508, USA.
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Danzig JA, Moser JT, Belfield P, Alter CA. Glucose-6-phosphate dehydrogenase deficiency diagnosed in an adolescent with type 1 diabetes mellitus and hemoglobin A1c discordant with blood glucose measurements. J Pediatr 2011; 158:849-51. [PMID: 21232753 DOI: 10.1016/j.jpeds.2010.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/21/2010] [Accepted: 12/06/2010] [Indexed: 11/25/2022]
Abstract
Disorders of hemolysis reduce the exposure time of hemoglobin to glucose, resulting in a falsely low hemoglobin A1c level. This case report describes the unexpected diagnosis of glucose-6-phosphate dehydrogenase deficiency made during evaluation of discordant HbA1c and blood glucose measurements.
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Affiliation(s)
- Jennifer A Danzig
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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45
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GOSSELIN RC, CARLIN AC, DWYRE DM. Comparison of the BioRad Variant and Primus Ultra2 high-pressure liquid chromatography (HPLC) instruments for the detection of variant hemoglobins. Int J Lab Hematol 2010; 33:159-67. [DOI: 10.1111/j.1751-553x.2010.01260.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bhat VS, Dewan KK, Krishnaswamy PR. Diagnostic Dilemma of HbA1c Detection in Presence of a Hemoglobinopathy: A Case Report. Indian J Clin Biochem 2010; 26:91-5. [PMID: 22211024 DOI: 10.1007/s12291-010-0076-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 06/07/2010] [Indexed: 11/24/2022]
Abstract
We report a case of a diabetic, heterozygote with near normal hematology, marginally low level of hemoglobin A(2)(HbA(2)) having an increased level of hemoglobin F(HbF) that was pancellularly distributed among the red cells. BioRad DiaSTAT measurements gave a high glycated hemoglobin A1c(HbA1c) of 31.5% and the BioRad Variant analyzer recorded an HbA1c value which was very low, in discordance with the detected blood glucose levels. Flow cytometry and polymerization chain reaction (PCR) based studies were carried out which revealed the case to be that of the common hereditary persistence of fetal hemoglobin (HPFH)-3, an Asian Indian mutation. Fructosamine estimation and HbA1c by Boronate affinity chromatography were able to resolve the discordant value detected and was able to confirm the diabetes status. The case would have been a diagnostic dilemma, if reported without correlation.
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Kim S, Ferri S, Tsugawa W, Mori K, Sode K. Motif-based search for a novel fructosyl peptide oxidase from genome databases. Biotechnol Bioeng 2010; 106:358-66. [PMID: 20198658 DOI: 10.1002/bit.22710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The measurement of glycated hemoglobin A1c (HbA1c) has important implications for diagnosis of diabetes and assessment of treatment effectiveness. We proposed specific sequence motifs to identify enzymes that oxidize glycated compounds from genome database searches. The gene encoding a putative fructosyl amino acid oxidase was found in the Phaeosphaeria nodorum SN15 genome and successfully expressed in Escherichia coli. The recombinant protein (XP_001798711) was confirmed to be a novel fructosyl peptide oxidase (FPOX) with high specificity for alpha-glycated compounds, such as HbA1c model compounds fructosyl-(alpha)N-valine (f-(alpha)Val) and fructosyl-(alpha)N-valyl-histidine (f-(alpha)Val-His). Unlike previously reported FPOXs, the P. nodorum FPOX has a K(m) value for f-(alpha)Val-His (0.185 mM) that is considerably lower than that for f-(alpha)Val (0.458 mM). Based on amino acid sequence alignment, three dimensional structural modeling, and site-directed mutagenesis, Gly60 was found to be a determining residue for the activity towards f-(alpha)Val-His. A flexible surface loop region was also found to likely play an important role in accepting f-(alpha)Val-His.
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Affiliation(s)
- Seungsu Kim
- Department of Biotechnology, Tokyo University of Agriculture and Technology, Koganei-shi, Japan
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Abstract
The impact of hemoglobinopathies on healthcare in the United States, particularly sickle cell disease (SCD), has been significant. Enactment of the Sickle Cell Anemia Control Act in 1972 significantly increased the federal interest in the SCDs and other hemoglobinopathies. Only since May 1, 2006, have all states required and provided universal newborn screening for SCD despite a national recommendation to this effect in 1987. In this article, we review the history of screening for SCD and other hemoglobinopathies, along with federal and state activities that have contributed to improved health outcomes for patients with SCD, as well as current newborn screening practices. We also chronicle the federal activities that have helped to shape and to refine laboratory screening and diagnostic proficiency. Finally, we review molecular testing strategies that have evolved and outline their possible future impacts on disease detection and outcome improvement.
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Affiliation(s)
- Jane M Benson
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Jung CL, Kwon KJ, Hong KS, Sung YA, Lee ST, Ki CS, Lee MA, Chung WS. Hemoglobin Yamagata: Hemoglobin Variant Detected by HbA1c Test. Ann Lab Med 2009; 29:536-40. [DOI: 10.3343/kjlm.2009.29.6.536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Chae Lim Jung
- Department of Laboratory Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyoung Joo Kwon
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Ki Sook Hong
- Department of Laboratory Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Yeon Ah Sung
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seung-Tae Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Ae Lee
- Department of Laboratory Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Wha Soon Chung
- Department of Laboratory Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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Thevarajah M, Nadzimah M, Chew Y. Interference of hemoglobinA1c (HbA1c) detection using ion-exchange high performance liquid chromatography (HPLC) method by clinically silent hemoglobin variant in University Malaya Medical Centre (UMMC)—A case report. Clin Biochem 2009; 42:430-4. [DOI: 10.1016/j.clinbiochem.2008.10.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 10/08/2008] [Accepted: 10/09/2008] [Indexed: 10/21/2022]
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