Glycated haemoglobin - is it its exclusive position in diabetology under threat?

Czech version

Authors: S. Lacigová; D. Čechurová; P. Brož; J. Gruberová; Z. Jankovec; M. Žourek; I. Haladová; M. Krčma; J. Víšek; Z. Rušavý
Authors‘ workplace: I. interní klinika Lékařské fakulty UK a FN Plzeň, přednosta doc. MUDr. Martin Matějovič, Ph. D.
Published in: Vnitř Lék 2008; 54(3): 251-256
Category: Review

Overview

Hyperglycaemia is the common characteristic for diabetes patients. Prolonged hyperglycaemia due to absolute or relative lack of insulin is the cause of microangiopathy. Glucose reacts with both blood vessel wall proteins and plasmatic proteins and erythrocyte haemoglobin. This characteristic of glucose is used to monitor the level of diabetes compensation. The level of glycated haemoglobin reflects glycaemia for the last 2 to 3 months. It began to be used in diabetology in the 1980's. This outline paper deals with some of the pitfalls with which glycated haemoglobin has been recently associated. The first part is dedicated to factors influencing haemoglobin glycation. The second, methodological part focuses on factors influencing its assessment and interpretation. The third part concentrates on the options for the substitution of glycated haemoglobin by other diabetes compensation markers.

Key words:
glycated haemoglobin – haemoglobinopathy – diabetes compensation

Sources

1. Standard České diabetologické společnosti a České biochemické společnosti ČLS JEP „Laboratorní diagnostika a sledování stavu diabetu mellitu“ (www.diab.cz), (www.sekk.cz).

2. Jeffcoate SL. Diabetes control and complications: the role of glycated hemoglobin, 25 years on Diabetic Medicine 2003; 21: 657-665.

3. Abraham EC, Hurd TA, Cope ND et al. Determination of glycosylated hemoglobins (HBA1c) with a new microcolumn procedure: suitability of the technique of assessing the clinical management of diabetes mellitus. Diabetes 1978; 27: 931-937.

4. Saudek CD, Derr RL, Kalyani RR. Assessing glycemia in diabetes using self-monitoring blood glucose and hemoglobin A1c. JAMA 2006; 295: 1688-1697.

5. Salardi S, Zucchini S, Santoni R et al. The glucose area under the profiles obtained with continuous glucose monitoring system relationship with HbA (Ic) in pediatric type 1 diabetic patients. Diabetes Care 2002; 25: 1840-1844.

6. McCarter RJ, Hempe JM, Chalew SA. Mean blood glucose and biological variation have greater influence on HbA1c levels than glucose instability: an analysis of data from the Diabetes Control and Complications Trial. Diabetes Care 2006; 29: 352-355.

7. Service FJ, O´Brien PC. Influence of glycemic variables on hemoglobin A1c. Endocr Pract 2007; 13: 350-354.

8. Rosediani M, Azidah AK, Mafauzy M. Correlation between fasting plasma glucose, post prandial glucose and glycated hemoglobin and fructosamin. Med J Malaysia 2006; 61: 67-71.

9. Ahmed N, Babaei-Jadidi R, Howell SK et al. Glycated and oxidized protein degradation products are indicators of fasting and postprandial hyperglycemia in diabetes. Diabetes Care 2005; 28: 2465-2471.

10. Kilpatrick ES, Rigby AS, Atkin SL. The effect of glucose variability on the risk of microvascular complication in type 1 diabetes. Diabetes Care 2006; 29: 1486-1490.

11. Osterman-Golkar SM, Vesper HW Assessment of the relationship between glucose and A1c using kinetic modeling. Journal of Diabetes and Its Complications 2006; 20: 285-294.

12. Schnedl WJ, Liebminger A, Roller RE et al. Hemoglobin variants and determination of glycated hemoglobin (HbA1c). Diabetes Metab Res Rev 2001; 17: 94-98.

13. Schnedl WJ, Lahousen T, Lang T et al. Determination of glycated hemoglobin in clinically silent hemoglobin variants. Diabetes Metab Res Rev 2004; 20: 460-465.

14. Schnedl WJ, Lahousen T, Krause R et al. Evaluation of conditions associated with glycated hemoglobin values below the reference range. Clin Lab 2007; 53: 179-181.

15. Weykamp CW, Penders TJ, Muskiet FA et al. Influence of hemoglobin variants and derivates on glycohemoglobin determinations, as investigated by 102 laboratories using 16 methods. Clin Chem 1993; 39: 1717-1723.

16. Yudkin JS, Forrest RD, Jackson CA et al. Unexplaned variability of glycated hemoglobin in non-diabetic subjects not related to glycaemia. Diabetologia 1990; 33: 208-215.

17. Yates AP, Laing I. Age-related increase in haemoglobin A1C and gasting plasma glucose is accompanied by a decrease in beta cell function without change in insulin sensitivity: evidence from cross-sectional study of hospital personnel. Diabet Med 2002; 19: 254-258.

18. Pieri C, Tesba R, Marra M et al. Age-dependent changes of serum oxygen radical scavanger capacity and haemoglobin glycosylation in non-insulin-dependent diabetic patients. Gerontology 2001; 47: 88-92.

19. Dubuc PU, Scott BC, Peterson CHM. Sex differences in glycated hemoglobin in diabetic and non-diabetic C57BL/6 mice. Diabetes Res Clin Pract 1993; 21: 95-101.

20. Borg R. Which factors affect the relationship between HbA1c and mean blood glucose? Presented 18. 9. 2007, Amsterdam, EASD (www.easd.org).

21. Tseng CHL, Brimacombe M, Xie M et al. Seasonal pattern in monthly hemoglobin A1c values. Am J Epidemiol 2005; 161: 565-574.

22. Ahmed N, Babaei-Jadidi R, Howell SK et al. Degradation products of proteins damaged by glycation, oxidation and nitration in clinical type 1 diabetes. Diabetologia 2005; 48: 1590-1603.

23. Testa R, Testa I, Manfrini S et al. Glycosylated hemoglobin and fructosamines: Does their determination really reflect the glycemic control in diabetic patients? Life Sci 1996; 59: 43-49.

24. Martín-Gallán P, Carrascosa A, Gussinyé M et al. Biomarkers of diabetes-associated oxidative stress and antioxidant status in young diabetic patients with or without subclinical complication. Free Radic Biol Med 2003; 12: 1563-1574.

25. Joy MS, Cefalu WT, Hogan SL et al. Long-term glycemic control measurements in diabetic patients receiving hemodialysis. Am J Kidney Dis 2002; 39: 297-307.

26. Balamurugan R, Bobby Z, Selvaraj N et al. Increased protein glycation in non-diabetic pediatric nephrotic syndrome: possible role of lipid peroxidation. Clin Chim Acta 2003; 337: 127-132.

27. Selvaraj N, Bobby Z, Koner BC et al. Reassessing the increased glycation of hemoglobin in nondiabetic chronic renal failure: hypothesis on the role of lipid peroxides. Clin Chim Acta 2005; 360: 108-113.

28. Sathiyapriya V, Bobby Z, Vinod Kumar S et al. Evidence for the role of lipid peroxides on glycation of hemoglobin and plasma proteins in non-diabetic asthma patients. Clin Chim Acta 2006; 366: 299-303.

29. Mohan Kumar KM, Bobby Z, Selvaraj N et al. Possible link between glycated hemoglobin and lipid peroxidation in hyperthyroidism Clin Chim Acta 2004; 342: 187-192.

30. Krone CA, Ely JT. Ascorbic acid, glycation, glycohemoglobin and aging. Med Hypotheses 2004; 62: 275-279.

31. Selvaraj N, Bobby Z, Sathiyapriya V. Effect of lipid peroxides and antioxidants on glycation of hemoglobin: an in vitro study on human erythrocytes. Clin Chim Acta 2006; 366: 190-195.

32. Schnedl WJ, Krause R, Halwasch-Baumann G et al. Evaluation of HbA1c determination methods in patients with hemoglobinopathies. Diabetes Care 2000; 23: 339-344.

33. Little RR. Glycated hemoglobin standardization-National Glycohemoglobin Standardization Program (NGSP) perspective. Clin Chem Lab Med 2003; 41: 1191-1198.

34. International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Scientific Division. Approved IFCC Reference Method for the Measurement of HBA1c in Human Blood. Clinical Chemistry and Laboratory Medicine 2002; 40: 78-89.

35. Dhatt GS, Agarwal MM, Bishawi B HbA1c: a comparison of NGSP with IFCC transformer values. Clin Chim Acta 2005, 358: 81-86.

36. Consensus statement on the Worldwide Standardization of the Hemoglobin A1c measurement. ADA, EASD, IFCC, IDF. Diabetes Care 2007; 30: 2399-2400.

37. McCarter RJ, Hempe JM, Gomez R et al. Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1 diabetes. Diabetes Care 2004; 27: 1259-1264.

38. Lachin JM, Genuth S, Nathan DM et al. The Hemoglobin Glycation Index is not an independent predictor of the risk of mikrovascular complications in the Diabetes Control and Complications Trial. Diabetes 2007; 56: 1913-1921.

39. Kuenen JC. How do the HbA1c values relate to mean blood glucose concentration? Results of the A1c Derived Average Glucose Study EASD. Presented 18. 9. 2007. Amsterdam, EASD (www.easd.org); (www.ADAG.com).

40. Ozmen S, Cil T, Atay AE et al. A simple way to estimate mean plasma glucose and to identify Type 2 diabetic subjects with poor glycaemic control when a standardized HbA1c assay is not available. Diabet Med 2006; 23: 1151-1154.

41. Nathan DM, Turgeon H, Regan S. Relationship between glycated hemoglobin levels and mean glucose levels over time. Diabetologia 2007; 50: 2239-2244.