Glycated Haemoglobin : It抯 Diagnostic and Prognostic Efficacy in Various Clinical Scenarios

Glycated Haemoglobin (HbA1c) gives a measure of long term Glycemic control. However, how the values of HbA1c affects the outcome in various comorbidities and its effect on the short term and long term outcome of these comorbidities remains a matter of Grey Zone. Cardiovascular Diseases, Chronic Kidney Disease, Anemia, Chronic Liver Disease etc, can alter the interpretation of HbA1C level, where it may not reflect the appropriate Glycemic control. Hence this review is done to look for the evidence and appropriateness of HbA1c as Diagnostic and Prognostic marker for Glycemic control in various clinical scenario.

Study of Glycated Haemoglobin and Lipid Profile in Patients with Diabetic Foot Ulcer

Introduction: Diabetic foot ulcer is a major disablingcomplication of Diabetes Mellitus and often precedes lowerextremity amputation. This study aims to evaluate the level ofHbA1c and lipid profile in patients with diabetic foot ulcer asT2DM patients areprone to diabetic dyslipidemia,which puts them at risk ofdeveloping macrovascular and microvascular diseases.Material and methods: The study was accomplished at atertiary care hospital in Jammu & Kashmir. One hundred tensubjects with T2DM were enrolled for the present study, thisincluded 55 subjects with DFU and 55 subjects without DFU.The HbA1c and lipid profile of the subjects were measuredwith standard methods.Results: In our study HbA1c level was found higher indiabetic patients with diabetic foot ulcer when compared withpatients without. Also lipid profile was found deranged indiabetic foot ulcer patients in comparison to control group. Itwas found that approximately 78% DFU have HbA1c levels˃7%. Unlike the DFU-patients, 79% of patients without DFUhave HbA1c level controlled.Conclusion: As diabetic foot ulcer is a major disablingcomplication of Diabetes Mellitus and often precedes lowerextremity amputation, we conclude that HbA1c level shouldbe maintained in normal range and regulating it is imperativefor avoiding T2DM complications.

A Pilot Study on Estimation of Serum Uric Acid Level among Euglycemic With Family History of Diabetes and no Family History of Diabetes

Background: Type II Diabetes mellitus has emerged as aglobal public health problem with more effect on developingworld. India is considered to become epicentre of DM in nearfuture. Serum uric acid is a by-product of purine metabolism.Most of the studies provide a positive relationship betweenhyperglycemia & hyperuricemia.Objectives: To co-relate the level of serum uric acid ineuglycemic persons having family history of DM and in personshaving no family history of DM and to assess the level ofHbA1c among these two groups.Materials and Methods: Present study was undertaken atMGM Medical College, Jamshedpur and Sadar Hospital,Jamshedpur with a sample size of 60 (30 in each group).Results: The present study didn’t find any significantdifference in serum uric acid between two groups although asignificant difference was observed in HbA1c in both groups.

Relationship Between Dyslipidaemia And Glycaemic Status In Patients With Type 2 Diabetes Mellitus

The risk of coronary heart disease (CHD) is dramatically increased in diabetic patients due to their atherogenic lipid profile. The severity of CHD in diabetic patients has been found to be directly associated with glycated haemoglobin (HbA1c). According to the Malaysian Clinical Practice Guidelines on diabetes mellitus (DM), HbA1c level less than 6.5% reduces the risk of microvascular and macrovascular complications. Hence, this study aimed to determine the relationship between dyslipidaemia and glycaemic status in patients with type 2 DM (T2DM) patients in Hospital Putrajaya, a tertiary endocrine centre in Malaysia. This was a cross sectional, retrospective study of 214 T2DM patients with dyslipidaemia who had visited the endocrine clinic between January 2009 and December 2012. Significant correlations were found between fasting blood glucose (FBG) and HbA1c with total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL), non-high density lipoprotein cholesterol (non-HDL), LDL/HDL ratio and TC/HDL ratio; greater correlation being with HbA1c than FBG. In patients with HbA1c ≥ 6.5%, TC, TG, non-HDL and TC/HDL ratio were significantly higher than in patients with HbA1c < 6.5%. Non-HDL, LDL/HDL ratio, TC/HDL ratio and HbA1c were significantly lower in patients on statin treatment than nontreated patients (p<0.05). This significant association between glycaemic status and dyslipidaemia emphasises the additional possible use of HbA1c as a biomarker for dyslipidaemia as well as a potential indirect predictor of cardiovascular disease (CVD) risk in T2DM patients.

Association between obesity and impaired glucose tolerance in new providence adolescents as demonstrated by the HbA1c test / Asociación entre la obesidad y los trastornos de tolerancia a la glucosa entre los adolescentes de nueva providencia según lo demostrado por la prueba de HbA1c

OBJECTIVE: To explore the association between obesity and the development of impaired glucose tolerance (IGT) in Bahamian adolescents. METHODS: Eight hundred and seventy-three adolescents were randomly selected from five high schools in New Providence. Each student's weight, height, and waist and hip circumferences were recorded to determine body mass index (BMI). Individuals with BMIs above the 84th and 95th percentiles were classified as overweight and obese, respectively. Venous blood samples were collected from each subject and haemoglobin Ai c (HbAi c) levels were measured using a direct immunoassay method. The criterion established by the International Expert Committee for the diagnosis of IGT (HbA i c concentration of 6.0-6.4%) was used. An analysis of covariance was performed to evaluate the relationship between obesity and IGT, and a logistic regression analysis predicted the risk of IGT based on BMI classification. RESULTS: Of the 861 adolescents who completed the study, 15.0% were classified as overweight, 15.2% as obese and 7.9% as severely obese. The overall cumulative prevalence of IGT based on HbAi c levels was 16 100 cases per 100 000 adolescents and was greater in males than in females. Higher percentages of overweight and obese students were identified as having IGT compared with their normal-weight counterparts. An analysis of covariance with post hoc analyses revealed that severely obese males and females, respectively were almost 26 (OR = 25.54, 95%CI 9.92, 65.77) or 23 (OR = 22.96, 95% CI 9.81, 53.73) times more likely to develop IGT than their normal-weight counterparts (p < 0.005). CONCLUSION: The data show a strong positive association between IGT and obesity among Bahamian adolescents.

OBJETIVO: Explorar la asociación entre la obesidad y el desarrollo de trastornos de tolerancia a la glucosa (IGT) en los adolescentes de Bahamas. MÉTODOS: Ochocientos setenta y tres adolescentes fueron seleccionados aleatoriamente de cinco escuelas secundarias en Nueva Providencia. Se registraron peso, altura, y las circunferencias de cintura y cadera de cada estudiante, para determinar el índice de masa corporal (IMC). Las personas con IMC por encima de los percentiles 84 y 95 fueron clasificados como con sobrepeso y obesos, respectivamente. Se obtuvieron muestras de sangre venosa de cada sujeto, y se midieron los niveles de hemoglobina A 1c (HbAc utilizando un método de inmunoensayo directo. Se utilizó el criterio establecido por el Comité Internacional de expertos para el diagnóstico de IGT (concentración de HbA 1c de 6.0-6.4%). Se realizó un análisis de covarianza para evaluar la relación entre la obesidad y IGT, y un análisis de regresión logística para predecir el riesgo de IGT sobre la base de la clasificación del IMC. RESULTADOS: De los 861 adolescentes que completaron el estudio, 15.0% fueron clasificados como con sobrepeso, 15.2% como obesos, y 7.9% como extremadamente obesos. La prevalencia acumulativa general de IGT basada en los niveles de HbA 1c fue 16 100 casos por 100 000 adolescentes, y fue mayor en los varones que en las mujeres. Mayores porcentajes de estudiantes con sobrepeso y obesidad fueron identificados con IGT en comparación con sus contrapartes de peso normal. Un análisis de covarianza con análisis post-hoc reveló que los varones y hembras extremadamente obesos, respectivamente, fueron casi 26 (OR = 25.54, 95%CI 9.92, 65.77) o 23 (OR = 22.96, 95% CI 9.81, 53.73) veces más propensas a desarrollar IGT que sus contrapartes de peso normal (p < 0.05). CONCLUSIÓN: Los datos muestran una fuerte asociación positiva entre IGT y obesidad entre los adolescentes de las Bahamas.

Glycated haemoglobin in diagnosis of diabetes mellitus and pre-diabetes among middle-aged and elderly population: Shanghai Changfeng study / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the optimal glycated haemoglobin (HbA1c) cut off points and evaluate the impact of HbA1c on diabetes and pre-diabetes in middle-aged and elderly population.</p><p><b>METHODS</b>Subjects were recruited from Shanghai Changfeng Study. A total of 1973 community-based participants (age ⋝45) without known diabetes underwent oral glucose tolerance test (OGTT) by using a 75-g oral glucose load and HbA1c was measured by using high performance liquid chromatography (HPLC). Subjects were classified as normal glucose tolerance (NGT), pre-diabetes(impaired glucose regulation, IGR) and new diagnosed diabetes (NDD) per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve (ROC).</p><p><b>RESULTS</b>Among 1973 subjects, 271 (13.7%) were diagnosed as NDD and 474 (24.0%) as IGR by using OGTT. HbA1c was 5.7%±0.7% in this population. Use of 6.5% as the HbA1C cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population (AUC 0.829, 95% CI 0.798-0.860, P<0.001) with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity (44.9%) and specificity (66.7%) with an AUC of 0.571 for HbA1c when 5.8% was used as the cutoff point. Participants detected with HbA1c⋝6.0% were associated with nearly the same metabolic characteristics, including body mass index (BMI), blood pressure, lipid profile and urine albumin-creatinine ratio (uACR) compared with diabetic subjects detected by OGTT.</p><p><b>CONCLUSION</b>The optimum HbA1c cutoff point for diabetes in our study population was lower than ADA criteria, and HbA1c may not be used to identify IGR.</p>

Glycated haemoglobin is a good predictor of neonatal hypoglycaemia in pregnancies complicated by diabetes

We investigated the usefulness of a single value of maternal HbA1c in late pregnancy as a predictor for neonatal hypoglycaemia and secondly, to fi nd the appropriate threshold value. A prospective analysis of the HbA1c concentration between 36 to 38 weeks of gestation in 150 pregnant mothers with either pre-existing or gestational diabetes was performed. At delivery, glucose levels in the cord blood were analysed. Neonatal hypoglycaemia was defi ned as a blood sugar level of < 2.6 mmol/l. Receiver operator characteristic curve was constructed to evaluate the value of HbA1c concentration in predicting hypoglycaemia. There were 16 foetuses who were hypoglycaemic at delivery. The area under the ROC curve for predicting neonatal hypoglycaemia was 0.997 with a 95% confi dence interval of 0.992 to 1, a very good prediction rate. The optimal threshold value for HbA1c in predicting hypoglycaemia in the foetus was 6.8% (51 mmol/mol). HbA1c level in late pregnancy is a good predictor for hypoglycaemia in the newborn.