Evaluation of Glycated Albumin (GA) and GA/Hba1c Ratio for Diagnosis of Diabetes and Glycemic Control: A Comprehensive Review

Diabetes Mellitus (DM) is a group of metabolic diseases characterized by chronic high blood glucose concentrations (hyperglycemia). When it is left untreated or improperly managed, it can lead to acute complications including diabetic ketoacidosis and non-ketotic hyperosmolar coma. In addition, possible long-term complications include impotence, nerve damage, stroke, chronic kidney failure, cardiovascular disease, foot ulcers, and retinopathy. Historically, universal methods to measure glycemic control for the diagnosis of diabetes included fasting plasma glucose level (FPG), 2-h plasma glucose (2HP), and random plasma glucose. However, these measurements did not provide information about glycemic control over a long period of time. To address this problem, there has been a switch in the past decade to diagnosing diabetes and its severity through measurement of blood glycated proteins such as Hemoglobin A1c (HbA1c) and glycated albumin (GA). Diagnosis and evaluation of diabetes using glycated proteins has many advantages including high accuracy of glycemic control over a period of time. Currently, common laboratory methods used to measure glycated proteins are high-performance liquid chromatography (HPLC), immunoassay, and electrophoresis. HbA1c is one of the most important diagnostic factors for diabetes. However, some reports indicate that HbA1c is not a suitable marker to determine glycemic control in all diabetic patients. GA, which is not influenced by changes in the lifespan of erythrocytes, is thought to be a good alternative indicator of glycemic control in diabetic patients. Here, we review the literature that has investigated the suitability of HbA1c, GA and GA:HbA1c as indicators of long-term glycemic control and demonstrate the importance of selecting the appropriate glycated protein based on the patient’s health status in order to provide useful and modern point-of-care monitoring and treatment

In vitro determination of hemoglobin A1c for diabetes diagnosis and management: technology update

It is fascinating to consider the analytical improvements that have occurred since glycated hemoglobin was first used in routine clinical laboratories for diabetes monitoring around 1977; at that time methods displayed poor precision, there were no calibrators or material with assayed values for quality control purposes. This review outlines the major improvements in hemoglobin A1c (HbA1c) measurement that have occurred since its introduction, and reflects on the increased importance of this hemoglobin fraction in the monitoring of glycemic control. The use of HbA1c as a diagnostic tool is discussed in addition to its use in monitoring the patient with diabetes; the biochemistry of HbA1c formation is described, and how these changes to the hemoglobin molecule have been used to develop methods to measure this fraction. Standardization of HbA1c is described in detail; the development of the IFCC Reference Measurement Procedure for HbA1c has enabled global standardization to be achieved which has allowed global targets to be set for glycemic control and diagnosis. The importance of factors that may interfere in the measurement of HbA1c are highlighted

The combinational effect of cardiac and biochemical markers in diabetic patients with cardiovascular disease

Background: Clinicopathological correlations, as well as several angiographic studies, suggest that diabetic patients have more extensive atherosclerotic disease, affecting the coronary arteries in particular. We sought to examine the combinational effect of cardiac and biochemical markers in diabetic patients with cardiovascular disease.\ud Method: The study population constituted 50 healthy subjects, 50 cardiovascular subjects with diabetes and 50 cardiovascular subjects without diabetes. The population was subjected to biochemical and cardiac marker analysis and the results were verified.\ud Results and discussion: Studies suggest that glycated hemoglobin values in the abnormal range can identify persons at increased risk for coronary heart disease, stroke, and death before the diagnosis of diabetes, indicating that glycated hemoglobin is a useful marker of cardiovascular risk and death from any cause.\u

A Study on the association between plasma glucose, glycosylated hemoglobin and macro metals Calcium and Magnesium in Diabetes Mellitus

  Abstract       To find out the association between Fasting plasma glucose, glycosylated Hemoglobin to macro metals calcium and magnesium in a randomly selected 50 patients ( both diabetic and non diabetic) attending the MHC. Comparison of both men and women (men= 26, women=24) in the age group of 23 to 72 years were enrolled, Fasting plasma glucose, glycoHb, calcium and magnesium were measured using the fasting blood samples.  The parameters were then subjected to statistical analysis to find out the relation between any two analytes.  Results of paired t tests with a p of <0.01 was considered significant and p<0.001 were considered highly significant to conclude an association between the analytes studied. This study has proved beyond doubt that calcium and magnesium are indeed involved in diabetes mellitus both in its regulation and glucose metabolism. As the study was carried out during a short period of 1 Month, we were unable to indicate control subjects but purely worked out to find the association between FPG, Glycosylated hemoglobin, calcium and magnesium. The study recommends that along with glucose and Glycosylated hemoglobin, calcium and magnesium assays too should be carried out as additional parameters in the evolution of diabetes mellitus.Based on this study we strongly recommend that further research should be carried out to establish the role of calcium and magnesium especially red cell calcium and magnesium and diabetes mellitus

Validation and determination of a reference interval for Canine HbA1c using an immunoturbidimetric assay

Background: Hemoglobin A1c (HbA1c) provides a reliable measure of glycemic control over 2–3 months in human diabetes mellitus. In dogs, presence of HbA1c has been demonstrated, but there are no validated commercial assays. Objective: The purpose of the study was to validate a commercially available automated immunoturbidimetric assay for canine HbA1c and determine an RI in a hospital population. Methods: The specificity of the assay was assessed by inducing glycosylation in vitro using isolated canine hemoglobin, repeatability by measuring canine samples 5 times in succession, long term inter-assay imprecision by measuring supplied control materials, stability using samples stored at 4°C over 5 days and −20°C over 8 weeks, linearity by mixing samples of known HbA1c in differing proportions, and the effect of anticoagulants with paired samples. An RI was determined using EDTA-anticoagulated blood samples from 60 nondiabetic hospitalized animals of various ages and breeds. Hemoglobin A1c was also measured in 10 diabetic dogs. Results: The concentration of HbA1c increased proportionally with glucose concentration in vitro. For repeat measurements, the CV was 4.08% (range 1.16–6.10%). Samples were stable for 5 days at 4°C. The assay was linear within the assessed range. Heparin- and EDTA-anticoagulated blood provided comparable results. The RI for HbA1c was 9–18.5 mmol/mol. There was no apparent effect of age or breed on HbA1c. In diabetic dogs, HbA1c ranged from 14 to 48 mmol/mol. Conclusions: The assay provides a reliable method for canine HbA1c measurement with good analytic performance

The Effects Of Personalized Dietary Education On Glycosylated Hemoglobin Levels In Adult Diabetic Patients

Diabetes mellitus is a complex and multifactorial disease process with numerous debilitating outcomes if improperly managed. This chronic illness requires continuing medical care and education to prevent acute exacerbations and to reduce the risk of long-term complications. The primary manifestation, hyperglycemia, can be the result of various elements. One major cause of hyperglycemia is inappropriate dietary intake which results in detrimental short- and long­ term effects. A glycosylated hemoglobin measurement can be utilized as a marker in monitoring long-term glycémie control. This quasi-experimental study examined the effect of personalized dietary education on glycosylated hemoglobin levels in adult diabetic patients. The study was guided by the null hypothesis : There will be no difference in glycosylated hemoglobin levels in adult diabetic patients before and after a personalized dietary teaching intervention program. Pender\u27s Health Promotion Model provided the theoretical framework in interpreting dietary teaching\u27s effect on glycémie management. The sample 111 consisted of adult diabetic patients in rural Mississippi primary care facilities. Data were compiled using a demographic survey and the results of glycosylated hemoglobin testing obtained at baseline and two to three month post-intervention. Data were analyzed using descriptive statistics and the dependent t-test. Results indicated no significant reduction in the mean difference of the post-intervention glycosylated hemoglobin levels (p = 0.853). Additional findings were brought out by researcher analyzed demographic questionnaires. Recommendations for future research included replication of this study with a larger sample utilizing different geographical areas and different health care providers. Conduction of a similar study over a longer period of time utilizing multiple dietary educational interventions and several glycosylated hemoglobin measurements as determinants of long-term dietary compliance was further recommended

Glucose Monitoring During Pregnancy

Self-monitoring of blood glucose in women with mild gestational diabetes has recently been proven to be useful in reducing the rates of fetal overgrowth and gestational weight gain. However, uncertainty remains with respect to the optimal frequency and timing of self-monitoring. A continuous glucose monitoring system may have utility in pregnant women with insulin-treated diabetes, especially for those women with blood sugars that are difficult to control or who experience nocturnal hypoglycemia; however, continuous glucose monitoring systems need additional study as part of larger, randomized trials

A cross sectional study to determine the correlation of blood glucose and HbA1C in type 2 diabetes mellitus patients

Background: Measurement of glycosylated hemoglobin (HbA1c) is considered the gold standard for monitoring chronic glycemic level of diabetes patients. HbA1c is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. Levels of HbA1C represent the average blood glucose levels of diabetic patients over the previous 120 days. The objective of this study was to see the correlation between HbA1c levels and glucose levels. Methods: This cross-sectional study included 60 randomly selected subjects with known diabetes. Both fasting and post prandial blood glucose levels were measured by using venous blood samples. HbA1c levels were measured in venous blood by immunoturbidimetric method. Data were recorded on a proforma in MS-excel sheet. Pearson's coefficient of correlation was applied to find out any significant correlation between the HbA1c levels and the both fasting and postprandial blood glucose levels. Results: Results were obtained by statistical calculation and plotted with respect to scatter and bar diagram was done and a p<0.05 was considered significant (With 95% CI). Conclusions: A significant linear positive correlation exists between levels of HbA1C and fasting and post prandial blood glucose