[Assessment of the use of hemoglobin AIc in diabetes mellitus screening]. / Evaluation de l'utilisation de l'hémoglobine AIc dans le dépistage du diabète sucré.

A population of 495 volunteer subjects who applied to the screening diabetes Centre of Hôtel-Dieu hospital in Paris has been studied and divided into two samples. In the first 300 subjects sample the sensitivity and the specificity of different fasting blood glucose threshold values, of different glycosylated hemoglobin threshold levels and of various combinations of the above mentioned parameter have been evaluated as a test for diabetes diagnosis defined by a 2-hr OGTT value greater than or equal to 200 mg/dl. The predictive values for both positive and negative diagnosis were also evaluated. The combination of a fasting blood glucose greater than or equal to 120 mg/dl with a glycosylated hemoglobin greater than 5.8% was found to be the best association with a good relative specificity (97.9%), a fair sensitivity (64.7%) and a fair predictive value for a positive diagnosis (64.7%). A second sample includes 195 subjects. These were classified according to either the above criterion or either the 2-hr OGTT value greater than or equal to 200 mg/dl. A great majority of subjects (95.4%) was classified in concordance by the two methods. The characteristics of the subjects that were identically classified as diabetic subjects (n = 5) were compared to those of differently classified subjects (n = 9). Longitudinal surveys are needed in order to assess the validity of HbA1c measurement as a tool for diabetes screening by reference to unquestionable criteria of the disease.

[Determination of glycosylated hemoglobin HbA1c by liquid phase chromatography]. / Dosage de l'hémoglobine glycosylée HbA1c par chromatographie en phase liquide.

Glycated hemoglobin A1c assay is performed using HPLC on cation exchange TSK SP 5 PW column. Separation is obtained in 11 minutes using graduated elution with sodium chloride and Bis-Tris buffer. HBA1c is resolved from the other hemoglobins (A1a, A1b, Ao, F, S, C). Reproducibility of method is quite good (cv less than 3%) and correlated with classic low pressure chromatographic analysis using cation exchange resin.

[Theophylline overdoses on admission to a resuscitation unit]. / Les surdosages en théophylline à l'admission en réanimation.

The aim of this study is to assess in a prospective fashion the causes and the frequency of overdosage with Theophylline on admission to intensive care units, in patients on long term treatment with oral Theophylline and/or had previously received an intravenous injection (IV) of Aminophylline. In 72 patients [52 chronic airflow obstruction (or BPCO), 21 asthmatics] admitted for acute respiratory insufficiency (IRA) the blood level of Theophylline on admission to intensive care (T0) was determined systematically, and was in the toxic range (greater than 29 mg/l) in 17% of cases (12/72). In patients with T0 greater than 20 mg/l, repeat measurements of Theophylline clearance were carried out: 12 hours after admission by studying the fall in plasma levels (Cl1), then after 8 days (+/- 5) while perfusing IV Aminophylline at a constant flow (Cl2) and finally after changing over to slow release oral Theophylline 18 days (+/- 10) after admission (Cl3). Cl1 was less than 35 ml/kg/h in 9 patients (group I) and greater than 55 ml/kg/h in 3 patients (group II). All the patients in group I were on oral Theophylline in a dose which was not excessive (mean 10.6 +/- 3.3 mg/kg/24 h) and only one patient received an injection of IV Aminophylline. In group I, the clearance of Theophylline was very low initially (Cl1 = 18.6 +/- 9.6 ml/kg/h) and finally rose (Cl2 = 34.7 +/- 14 ml/kg/h p less than 0.02; and Cl3 = 46.9 +/- 24 ml/kg/h p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of glycosylated hemoglobin and fasting plasma glucose with two-hour post-load plasma glucose in the detection of diabetes mellitus.

In the course of a screening for diabetes mellitus in the Hôtel-Dieu Hospital in Paris, from September 15, 1981 to April 1, 1984, an oral glucose tolerance test and a measurement of glycosylated hemoglobin were performed on 333 outpatients. With two-hour plasma glucose as a reference, the sensitivities of glycosylated hemoglobin, fasting plasma glucose, and a combination of glycosylated hemoglobin and fasting plasma glucose equal, respectively, 60.0%, 52.0%, and 40.0%; the specificities 90.9%, 98.7%, and 99.4%; the predictive value for a positive diagnosis 34.9%, 76.5%, and 83.3%. If one takes into account the implications of diabetes mellitus, especially its economic and psychosociologic consequences, it seems better for diagnosis--from a public health point of view--to use tests with a high degree of specificity and a high predictive value for a positive diagnosis, such as the combination of fasting plasma glucose and glycosylated hemoglobin, than tests with a good sensitivity but poor specificity. In the long term, validation of glycosylated hemoglobin as a diagnostic test for asymptomatic diabetes mellitus will be obtained only by reference to unquestionable criteria of the disease, determined by longitudinal survey.