Importance of Hemoglobin A1c Levels for the Detection of Post-Surgical Infection Following Single-Level Lumbar Posterior Fusion in Patients with Diabetes / 대한신경손상학회지

OBJECTIVE: Several studies have reported that patients with diabetes mellitus (DM) are vulnerable to infection. However, the mechanism underlying this remains unclear. We hypothesized that preoperative blood glucose levels in patients with DM may be a risk factor for surgical site infection (SSI). We aimed to investigate the relationship between hemoglobin A1c (HbA1c) level and SSI incidence following single-level spinal fusion surgery. METHODS: Patients with DM who underwent single-level lumbar posterior fusion surgery were retrospectively reviewed. Ninety-two patients were included and classified into the SSI and SSI-free groups. Clinical data with demographic findings were obtained and compared. The HbA1c cut-off value was defined using receiver operating characteristic (ROC) and area under the curve (AUC) analyses, which showed a significantly increased SSI risk. Potential variables were verified using multiple logistic regression analysis. RESULTS: Among the enrolled patients, 24 had SSI and 68 did not within 1 year. The preoperative HbA1c level was higher in patients with SSI (6.8%) than in the non-infected patients (6.0%; p=0.008). ROC analysis showed that if the HbA1c level is higher than 6.9%, the risk of SSI significantly increases (p=0.003; AUC, 0.708; sensitivity, 62.5%; specificity, 70.6%). The preoperative HbA1c level was significantly correlated with SSI incidence, after adjusting for potential variables (p=0.008; odds ratio, 4.500; 95% confidence interval, 1.486–13.624). CONCLUSION: The HbA1c level, indicating glycemic control, in patients with DM may be a risk factor for SSI in single-level lumbar spine posterior fusion.

Performance Evaluation of the ARKRAY ADAMS A1c HA-8180

The hemoglobin A1c (Hb A1c) test is widely used to diagnose diabetes mellitus and monitor glycemic control in patients with diabetes. We evaluated the performance of the ARKRAY ADAMS A1c HA-8180 (ARKRAY KDK, Japan), an automated, HPLC-based Hb A1c analyzer. The ARKRAY ADAMS A1c HA-8180 was evaluated for its linearity and precision and compared to the HLC-723 G7 (Tosoh Corporation, Japan), according to the Clinical and Laboratory Standards Institute's guidelines. The coefficients of variation (CVs) for within-run precision at low and high levels were 0.6% and 0.3%, respectively, and the total CVs at low and high levels were 0.8% and 0.6%, respectively. The coefficient of determination (R2) was 0.9975, with linearity in the range of 3.0-18.5%. A comparison between the ARKRAY ADAMS A1c HA-8180 and HLC-723 G7 revealed a good correlation (r=0.9955) in the range of 4.8-14.6%. The runtime was 57 s per sample. The ARKRAY ADAMS A1c HA-8180 showed good analytical performance and high throughput. Therefore, it is suitable for routine use for clinical measurements of Hb A1c.

Factores no farmacológicos asociados al control de la diabetes mellitus tipo 2 / Nonpharmacological factors associated with diabetes mellitus type 2

Objetivo: determinar los factores asociados al control no farmacológico de los adultos con diabetes mellitus tipo 2 en la población americana. Metodología: se realizó una revisión sistemática en diferentes bases de datos con palabras clave acerca de los factores asociados al control de la diabetes mellitus tipo 2 bajo diferentes criterios de inclusión y exclusión, que posteriormente fueron revisados, para un total de 21 estudios analizados y categorizados; teniendo en cuenta para la discusión solo aquellas variables que permitieran establecer asociaciones estadísticamente significativas. Se tomó como variable de referencia para el control glicémico la hemoglobina A glicosilada. Resultados: los factores asociados con el control glicémico fueron la edad, sexo, raza, hemoglobina glicosilada base, idioma, duración de la enfermedad, dieta (ingesta de carbohidratos, lípidos y proteínas, así como costumbres de tabaquismo y alcoholismo), lípidos, peso, índice de masa corporal, perímetro abdominal, presión arterial sistólica, ejercicio (tipo aeróbico, de resistencia o combinado; consumo de oxígeno en ml/kg/min; umbral ventilatorio frente a hemoglobina glicosilada), programas de educación (número y tipo grupal o personal), conocimiento de la enfermedad, visita al nutricionista, autocuidado, seguridad social, empleo, estados de ánimo depresivos, nivel socioeconómico y educativo y funcionalidad familiar, los cuales fueron estadísticamente significativos (p< 0,05); sin embargo, los que fueron mayormente asociados en varios de los artículos fueron la hemoglobina glicosilada de base, los programas de educación al paciente diabético y la edad. Discusión: las anteriores variables establecidas a nivel estadístico como factores de riesgo permiten clasificarlas como modificables y no modificables,lo cual es fundamental para plantear y definir estrategias que permitan alcanzar el máximo control de la enfermedad, así como para amortiguar los efectos deletéreos de los procesos celulares de envejecimiento celular; evitando así las complicaciones microangiopáticas y neuromusculares típicas de esta endocrinopatía.

Objective: determine the factors associated with nonpharmacologic of adults with diabetes mellitus type 2 in the American population. Method: we conducted a systematic review in different databases with key words about the factors associated with diabetes mellitus type 2 under different inclusion and exclusion criteria, which were subsequently revised to a total of 21 studies analyzed and categorized, allowing for discussion only those variables that establish statistically significant associations. Was taken as the reference variable glycemic control glycosylated hemoglobin A. Results: factors associated with glycemic control were age, sex, race, glycosylated hemoglobin basis, language, duration of illness, diet (intake of carbohydrates, lipids and proteins as well as smoking and drinking habits), lipids, weight, body mass index, waist circumference, systolic blood pressure, exercise (aerobic, resistance or combined, oxygen consumption in ml/kg/min, ventilatory threshold versus glycosylated hemoglobin), education (number and type or group staff), knowledge of the disease, visit the nutritionist, self care, social security, employment, depressive moods, socioeconomic and educational level and family functioning, which were statistically significant (p<0.05), but which were mostly associated in several of the articles were glycosylated hemoglobin basic education programs for diabetic patients and age. Discussion: above variables statistically established risk factors allow classified as modifiable and non modifiable, which is essential to raise and define strategies to achieve maximum control of the disease and to mitigate the deleterious effects of the processes aging cell phone, thus avoiding complications and neuromuscular microangiopathic typical of this endocrinopathy.

Evaluation of HLC-723 G7 Hemoglobin A1c Autoanalyzer / 임상검사와정도관리

BACKGROUND: We evaluated the performance and analysis time of HLC-723 G7 (Tosoh corp. Tokyo, Japan) hemoglobin (Hb) A1c autoanalyzer. It utilizes cation exchange high performance liquid chromatography (HPLC) method and has a reduced analysis time compared with that of an earlier model HLC-723GHb V A1c 2.2(TM) (HLC-723GHb V, Tosoh corp. Tokyo, Japan). METHODS: We evaluated linearity, precision and comparison with HLC-723GHb V following NCCLS guidelines and counted the number of tests per hour to estimate analysis time. RESULTS: Linearity through the range from 5.8% to 13.9% was good (r2=0.9930, relative nonlinearity <2.5%). The within-run coefficients of variation (CVs) for groups of low, middle, and high level were 1.09%, 0.76%, and 0.68% and total CVs for each group were 1.60%, 0.91%, and 1.00%, respectively. Correlation equation between HLC-723 G7 and HLC-723GHb V was HLC-723 G7=1.0308 (HLC-723GHb V)-0.2896 %Hb A1c (r=0.9992, P<0.0001). Analysis time of HLC-723 G7 was 1.2 minutes per test compared with 2.1 minutes of HLC-723GHb V. CONCLUSIONS: HLC-723 G7 showed the acceptable performance and shortening analysis time therefore, it was suitable for reducing turn around time of Hb A1c assay.

Evaluation of VARIANTTM II Hemoglobin A1c Autoanalyzer / 대한임상병리학회지

BACKGROUND: We evaluated newly introduced VARIANTTM II(Bio-Rad Laboratories, CA, USA) hemoglobin(Hb) A1c autoanalyzer, including bar code reading, cap-piercing system and automatic hemolyzing. It utilizes ion-exchange high performance liquid chromatography(HPLC) method. METHODS: Linearity, precision, comparison with Hi-AUTOA1cTM HA-8121(Kyoto Daiichi, Kagaku Co. Ltd, Kyoto, Japan) and analysis time were evaluated. The reference range was determined by VARIANTTM II from 120 healthy subjects. RESULTS: Linearity through the range from 5.8% to 14.7% was good(r2=0.9909). The within-run coefficients of variation(CVs) for groups of low, middle and high level were 3.07%, 1.96% and 2.14% and between-day CVs for each group were 2.35%, 3.09% and 2.10%, respectively. Correlation equation between VARIANTTM II and Hi-AUTOA1cTM HA-8121 was VARIANTTM II = 1.0886(Hi-AUTOA1cTM HA-8121) + 0.4760% Hb A1c(r=0.9906). Two instruments were also compared by Altman and Bland's method and mean bias was 1.20. Analysis time of VARIANTTM II was 15.6 tests per hour compared with 14.8 tests of Hi-AUTOA1cTM HA-8121. The reference range in this study was 2.8-5.9% Hb A1c. CONCLUSIONS: VARIANTTM II showed the acceptable performance and advantage of calibration, and it was suitable for routine use in the clinical laboratory.

A Family Case of Hb Queens 34 (B15)Leu-->Arg / 대한혈액학회지

A 36-year-old pregnant woman with gestational diabetes mellitus and anemia was found to have an abnormal Hb (comprising 18.7%) in the automated midget low pressure cation- exchange chromatography (DiaSTATTM, Bio-Rad, USA) for Hb A1c assay. The abnormal Hb revealed an abnormal peak emerged slightly later than normal Hb A1 in DiaSTATTM chromatogram, subsequently confirmed by cellulose acetate membrane electrophoresis and isoelectric focusing. This hemoglobinopathy with high isoelectric point was noted and abnormal chain globin was prepared by chromatography. Family study was carried out and this chain variant was also found in four other family members, and all of them had no clinical abnormalities, except well controlled diabetes. As the results from peptide mapping, amino acid analysis and sequencing, abnormal Hb of the patient was finally identified as Hb Queens[ 34 (B15)Leu-->Arg] without clinical abnormalities.