scholarly journals Misleading HbA1c Measurement in Diabetic Patients with Hemoglobin Variants

2021 ◽  
Vol 9 (2) ◽  
pp. 43
Author(s):  
Manthana Mitchai ◽  
Nattakarn Suwansaksri ◽  
Suphakdee Seanseeha ◽  
Jindamanee Saenboonsiri ◽  
Putthichai Kraitree ◽  
...  
Keyword(s):  
Capillary Electrophoresis ◽  
Beta Thalassemia ◽  
Diabetic Patients ◽  
Strong Positive Correlation ◽  
High Prevalence ◽  
Patients With Diabetes ◽  
Abnormal Hemoglobin ◽  
Hemoglobin Variants ◽  
Hba1c Measurement ◽  
Hba1c Levels

Background and Objectives: Hemoglobin A1c (HbA1c) is widely used for the monitoring and management of diabetes mellitus. The aim of this study is to investigate the influence of hemoglobin (Hb) variants on the measurement of HbA1c. Materials and Methods: HbA1c levels of 845 blood samples obtained from diabetic patients with various hemoglobin types were measured using a turbidimetric inhibition immunoassay and capillary electrophoresis. Results: Of 845 patients with diabetes, 65.7% (555/845) have the normal hemoglobin type (A2A) and 34.3% (290/845) have various abnormal hemoglobin types, including heterozygous HbE 30.2% (255/845), homozygous HbE 1.9 % (16/845), Hb Constant Spring (CS) trait 1.4% (12/845), CSEA Bart’s 0.2% (2/845), and beta-thalassemia trait 0.6% (5/845). In most of the patients with diabetes, HbA1c levels determined by two different methods, inhibition immunoassay and capillary electrophoresis, gave strong positive correlation (R = 0.901, P < 0.001), except for those with homozygous HbE (N = 16) and CSEA Bart’s (N = 2). In all 18 patients with homozygous HbE and CSEA Bart’s, the HbA1c was undetectable by capillary electrophoresis, meaning that their estimated average glucose was undeterminable, although their HbA1c levels could be measured using an inhibition immunoassay. The discrepancy of HbA1c results obtained from two different methods is noted in patients without HbA. Conclusions: We have demonstrated the erroneous nature of HbA1c measurement in patients with hemoglobin variants, especially in those without HbA expression. Therefore, in the population with a high prevalence of hemoglobinopathies, hemoglobin typing should be considered as basic information prior to HbA1c measurement.

scholarly journals Heterozygote Hemoglobin G-Coushatta as the Cause of a Falsely Decreased Hemoglobin A1C in an Ion-Exchange HPLC Method

2017 ◽  
Vol 36 (3) ◽  
pp. 270-273
Author(s):  
Ayşegül Uğur Kurtoğlu ◽  
Esin Eren ◽  
Vedat Aslan ◽  
Özgür Erkal ◽  
Erdal Kurtoğlu ◽  
...  
Keyword(s):  
Glycated Hemoglobin ◽  
Hplc Method ◽  
Hemoglobin Variant ◽  
Dna Mutation ◽  
Patients With Diabetes ◽  
Short Program ◽  
Ion Exchange Hplc ◽  
Abnormal Hemoglobin ◽  
Hba1c Measurement ◽  
Hba1c Levels

SummaryGlycated hemoglobin (HbA1c) is used for the assessment of glycemic control in patients with diabetes. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA1c measurement. Here, we report two cases of Hemoglobin G-Coushatta (HBB:c.68A>C) variant that interferes in the measurement of HbA1c by a cation-exchange HPLC (CE-HPLC) method. HbA1c was measured by a CE-HPLC method in a Tosoh HLC-723 G7 instrument. The HbA1c levels were 2.9% and 4%. These results alerted us to a possible presence of hemoglobinopathy. In the hemoglobin variant analysis, HbA2 levels were detected as 78.3% and 40.7% by HPLC using the short program for the Biorad Variant II. HbA1c levels were measured by an immunoturbidimetric assay in a Siemens Dimension instrument. HbA1c levels were reported as 5.5% and 5.3%. DNA mutation analysis was performed to detect the abnormal hemoglobin variant. Presence of Hemoglobin G-Coushatta variant was detected in the patients. The Hb G-Coushatta variants have an impact on the determination of glycated hemoglobin levels using CEHPLC resulting in a false low value. Therefore, it is necessary to use another measurement method.

scholarly journals The Correlation between Clinical and Demographic Parameters and Sickness Absence in Diabetic Employees

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1309
Author(s):  
Oren Zack ◽  
Irena Golob ◽  
Gabriel Chodick ◽  
Idan Perluk ◽  
Rachel Raanan ◽  
...  
Keyword(s):  
Medical Records ◽  
Pearson Correlation ◽  
Severity Of Illness ◽  
Diabetic Patients ◽  
Telephone Interviews ◽  
Public Sector Employees ◽  
Patients With Diabetes ◽  
Absence From Work ◽  
Control Study ◽  
Hba1c Levels

Objectives: Diabetes mellitus is one of the most significant and prevalent chronic diseases. Individuals with diabetes can still encounter substantial difficulties in finding and keeping their job because of their condition. The purpose of this study was to examine the scope of diabetes-related absence from work and its relationship with variables such as type of employer, workload, the severity of illness, and type of treatment. Materials and Methods: We conducted a case-control study, including 220 diabetic patients and 230 controls. Information regarding absence from work was obtained by reviewing medical records, and general patient information was retrieved by conducting telephone interviews. Results: Patients with diabetes had, annually, more days of absence than non-diabetic patients (8.5 vs. 2.7, respectively p and lt; 0.001). Among diabetic patients, public-sector employees were absent more than private-sector employees (9.0 vs. 7.2 days, respectively, p and lt; 0.05). A positive correlation was found between workload (measured by stamina) and absence (Pearson correlation = 0.098, p = 0.04). Concerning the clinical variables, we found that employees suffering from diabetic complications exhibited higher absence rates (15.5 vs. 5.7 days, respectively, p and lt; 0.003). Parameters like HbA1c levels, patient age, disease duration, and type of treatment did not differ significantly amongst the groups with regards to absence rates. Conclusions: The main variables affecting absence from work were not medical but rather sociodemographic: education, workload, and type of employer. The results of this study reinforce the perception that well-controlled diabetic employees can be combined in most types of occupations without fear of increased absence from work.

Effect of Different Factors on Glycosylated Hemoglobin (HbA1c) Levels Among Diabetes Mellitus Patients

2021 ◽  
Vol 15 (12) ◽  
pp. 3513-3515
Author(s):  
Bader Alsuwayt
Keyword(s):  
Diabetes Mellitus ◽  
Glycated Hemoglobin ◽  
Glycosylated Hemoglobin ◽  
Diabetic Patients ◽  
Study Results ◽  
Patients With Diabetes ◽  
Insulin Use ◽  
Low Rate ◽  
Statin Use ◽  
Hba1c Levels

Aim: To describe the rate of the controlled level of glycosylated hemoglobin (HbA1c) among diabetes mellitus patients in Dammam city, Kingdom of Saudi Arabia (KSA). To assess the association between the status of HbA1c and the different patient-related factors namely: insulin use, metformin, dyslipidemia, and statin use. Methods: This cross-sectional study was performed at Security Forces Hospital, Dammam, KSA, between November 2020 and February 2021. A sample of two hundred known diabetic patients who were regularly followed up at the outpatient department (OPD) was selected randomly for the current study. Results: A very low rate (24%) of controlled HbA1C levels in patients with diabetes (type 1 DM and type 2 DM), The data showed that 85 % of all participants in our study are T2DM patients, while only 15% are T1DM patients, Our data showed that patients with dyslipidemia, hypothyroidism, or hypertension have a high level of uncontrolled HbA1C levels. Surprisingly, both dyslipidemia and statin use were predictors of uncontrolled HbA1C, Unexpectedly, non-metformin use has a protective effect toward controlling HbA1C, While insulin use is a strong predictor of uncontrolled HbA1C (OD 5.20). Conclusion: A low rate of controlled glycated hemoglobin (HbA1c) level among patients with diabetes (T1DM and T2DM) in our sample urges the need for immediate intervention to investigate and improve the current findings. Further investigations are needed to fully explain the high rate of uncontrolled HbA1c among insulin, metformin and statins users. Keywords: Glycated hemoglobin, HbA1c, Diabetes mellitus, Statins, Metformin.

scholarly journals Study of High Performance Liquid Chromatography and Turbidimetric Inhibition Immunoassay for HbA1c Analysis in Diabetic Patients with Variant Hemoglobin

2018 ◽  
Vol 8 (2) ◽  
pp. 114-117
Author(s):  
Gazi Sharmin Sultana ◽  
Nadia Zebin Khan ◽  
Zannat E Khuda ◽  
Tanvira Afroze Sultana ◽  
Tashmim Farhana Dipta ◽  
...  
Keyword(s):  
High Performance Liquid Chromatography ◽  
Liquid Chromatography ◽  
Glycemic Control ◽  
High Performance ◽  
Hplc Method ◽  
Diabetic Patients ◽  
Genetic Changes ◽  
Variant Hemoglobin ◽  
Hemoglobin Variants ◽  
Hba1c Levels

Background: HbA1c is considered as “gold standard” to evaluate glycemic control in patients with diabetes. Hemoglobin variants are mutant forms of hemoglobin that can occur by genetic changes in specific amino acid that can affect the accuracy of HbA1c measurements. High performance liquid chromatography (HPLC) is the standard method for HbA1c but inaccurate HbA1c values can occur when hemoglobin variants are present in diabetic patient. The aim of our study is to see Turbidimetric Inhibition Immunoassay (TINIA) method can report HbA1c values in diabetic patients with variant hemoglobin when the values are inaccurate on HPLC.Methods: 7590 diabetic patients were analyzed for HbA1c by HPLC method from BIRDEM General Hospital during December 2013 to January 2014. HbA1c levels were again measured by TINIA method in 50 cases out of 7590 who showed either undetectable / below normal HbA1c levels. Hb electrophoresis confirmed the variant hemoglobin in few casesResults: 50 cases out of 7590 (0.65%) had either undetectable / below normal HbA1c levels by HPLC method. Males-26 and females-24; and the ratio was 0.92:1. In 27 cases, HbA1c values were undetectable by HPLC method but in the reportable range by TINIA method. In the other 23 cases, HbA1c levels were below the reportable range (<4%) by HPLC method but were in the normal or higher range by TINIA method. On Bland Altman plot, TINIA method did not agree with HPLC method in variant cases.Conclusion: In South East Asia where Hb variant is high, Low or undetectable HbA1c level by HPLC may be a convenient clue for screening of hemoglobinopathies especially among diabetic population in Bangladesh. All laboratories should have alternative method of HbA1c testing like TINIA along with HPLC for correct determination of glycemic control in variant casesBirdem Med J 2018; 8(2): 114-117

scholarly journals The Association of Depression and the Cardiovascular Risk Factors of Blood Pressure, HbA1c, and Body Mass Index among Patients with Diabetes: Results from the Translating Research into Action for Diabetes Study

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Lindsay B. Kimbro ◽  
W. Neil Steers ◽  
Carol M. Mangione ◽  
O. Kenrik Duru ◽  
Susan L. Ettner
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Health ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
Patient Health ◽  
Hba1c Levels

Diabetic patients are nearly three times as likely to have depression as their nondiabetic counterparts. Patients with diabetes are already at risk for poor cardiovascular health. Using cross-sectional data from the translating research into action for diabetes (TRIAD) study, the authors tested the association of depression with cardiovascular risk factors in diabetic patients. Depression was measured using the patient health questionnaire (PHQ8). Patients who scored greater than 9 on the PHQ8 were classified as depressed and were compared with those who were not depressed(n=2,341). Depressed patients did not have significantly different blood pressure levels than those who were not depressed. However, those who were depressed had higher HbA1c levels than those who were not depressed(P<0.01)and higher BMIs than those who were not depressed(P<0.01). These results indicate that depressed diabetic patients are at greater risk of having poor control of cardiovascular risk factors and suggest that depression screening should be a standard practice among this patient group.

Risk Factors Associated with Diabetic Retinopathy and Thalassemia Prevalence Survey in Diabetes Mellitus Patients at Six Primary Care Units of Naresuan University Hospital: A Cross-sectional Study

2021 ◽  
Vol 104 (7) ◽  
pp. 1117-1123
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Diabetic Retinopathy ◽  
University Hospital ◽  
Beta Thalassemia ◽  
Cross Sectional ◽  
Thalassemia Minor ◽  
Abnormal Hemoglobin ◽  
Thalassemia Trait ◽  
Hba1c Measurement

Objective: To evaluate the risk factors and prevalence of diabetic retinopathy (DR) in both medical and socioeconomic aspects and find prevalence of thalassemia which associated hemoglobin A1c (HbA1c) measurement in diabetes mellitus (DM) patients at six primary care units (PCU) of Naresuan University Hospital (NUH). Materials and Methods: A cross-sectional survey of DM patients participated in annual proactive DR screening program at six PCU of NUH between December 2016 and March 2017 was conducted. Medical data were retrieved from medical records at PCU. Patients were also interviewed to gather socioeconomic information. Fundus examination was done by indirect ophthalmoscope. Three milliliters of blood was collected from each patient on the same day for Hb analysis. Results: Four hundred and eighty-eight DM patients participated in the present study. Mean age, duration of DM, fasting blood sugar (FBS) level, and HbA1c level were 61.2±9.8 years, 8 years (4 to 12), 124 mg/dL (108 to 151.5), and 7.1% (6.5 to 8.1), respectively. Prevalence of overall DR was 2.9% (14 patients) and proliferative DR was 0.2% (1 patient). Risk factors of DR were HbA1c at 7% or more [adjusted OR 4.7 (95% CI 1.4 to 13.5) and p=0.011] and emotional stress [adjusted OR 3.3 (95% CI 1.1 to 9.8) and p=0.033). Thalassemia screening found 116 patients had abnormal hemoglobin. Ninety-three patients were HbE trait, eight were HbE, ten were alpha-thalassemia trait, two were beta-thalassemia trait, one was HbH, one was alpha- and beta-thalassemia trait (α/β), and one was alpha-thalassemia trait and HbE trait (α/E), and all of them were thalassemia minor or intermedia. Only four patients from HbE trait group had DR. The mean HbA1c in all groups of patients with either normal or abnormal hemoglobin were not statistically significant different. Conclusion: The present study showed that HbA1c and emotional stress might have played an important role in association with DR development. Thalassemia minor and intermedia seemed not to associate with HbA1c measurement. Keywords: Diabetic retinopathy; Thalassemia; Primary care unit; Naresuan university; Risk factors

Split-Thickness Skin Grafts to the Foot and Ankle of Diabetic Patients

2017 ◽  
Vol 107 (5) ◽  
pp. 365-368 ◽  
Author(s):  
Kyle Sanniec ◽  
Tea Nguyen ◽  
Suzanne van Asten ◽  
Javier La Fontaine ◽  
Lawrence A. Lavery
Keyword(s):  
Skin Graft ◽  
Hba1c Level ◽  
Wound Closure ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Skin Grafts ◽  
Thickness Skin ◽  
Patients With Diabetes ◽  
Early Wound ◽  
Hba1c Levels

Background: There is an increased prevalence of foot ulceration in patients with diabetes, leading to hospitalization. Early wound closure is necessary to prevent further infections and, ultimately, lower-limb amputations. There is no current evidence stating that an elevated preoperative hemoglobin A1c (HbA1c) level is a contraindication to skin grafting. The purpose of this review was to determine whether elevated HbA1c levels are a contraindication to the application of skin grafts in diabetic patients. Methods: A retrospective review was performed of 53 consecutive patients who underwent split-thickness skin graft application to the lower extremity between January 1, 2012, and December 31, 2015. A uniform surgical technique was used across all of the patients. A comparison of HbA1c levels between failed and healed skin grafts was reviewed. Results: Of 43 surgical sites (41 patients) that met the inclusion criteria, 27 healed with greater than 90% graft take and 16 had a skin graft that failed. There was no statistically significant difference in HbA1c levels in the group that healed a skin graft compared with the group in which skin graft failed to adhere. Conclusions: Preliminary data suggest that an elevated HbA1c level is not a contraindication to application of a skin graft. The benefits of early wound closure outweigh the risks of skin graft application in patients with diabetes.

scholarly journals Capillary electrophoresis system for hemoglobin A1c determinations evaluated

1997 ◽  
Vol 43 (4) ◽  
pp. 644-648 ◽  
Author(s):  
Cees J A Doelman ◽  
Carla W M Siebelder ◽  
Wim A Nijhof ◽  
Cas W Weykamp ◽  
Jacques Janssens ◽  
...  
Keyword(s):  
Capillary Electrophoresis ◽  
Hemoglobin A1c ◽  
Clinical Laboratory ◽  
Analytical Tool ◽  
Analytical Technique ◽  
Hb A1c ◽  
Patients With Diabetes ◽  
Hb S ◽  
Electrophoresis System ◽  
Hemoglobin Variants

Abstract Hb A1c is the analyte of choice for monitoring metabolic control in patients with diabetes mellitus. Here we present a new analytical technique for measuring Hb A1c, capillary electrophoresis. The Hb A1c determination is not influenced by the labile Hb A1c fraction or by carbamylated or acetylated hemoglobin derivatives. Also, hemoglobin variants (Hb F, Hb S, and Hb C) do not interfere. This new application of capillary electrophoresis seems to be a valuable analytical tool for measuring Hb A1c in the clinical laboratory.

scholarly journals Differences between diabetic and non-diabetic patients with community-acquired pneumonia in primary care in Spain

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Loreto Arias Fernández ◽  
◽  
Jacobo Pardo Seco ◽  
Miriam Cebey-López ◽  
Ruth Gil Prieto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Descriptive Analysis ◽  
Community Acquired Pneumonia ◽  
First Episode ◽  
Diabetic Patients ◽  
High Prevalence ◽  
Patients With Diabetes ◽  
Rising Incidence ◽  
And Control

Abstract Background Diabetes is one of the underlying risk factors for developing community-acquired pneumonia (CAP). The high prevalence of diabetes among population and the rising incidence of this illness, converts it as an important disease to better control and manage, to prevent its secondary consequences as CAP. The objective of this research is to describe the characteristics of the patients with diabetes and the differences with the no diabetes who have had an episode of CAP in the context of the primary care field. Methods A retrospective, observational study in adult patients (> 18 years-old) who suffer from CAP and attended at primary care in Spain between 2009 and 2013 was developed using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP). We carried out a descriptive analysis of the first episodes of CAP, in patients with or without diabetes as comorbidity. Other morbidity (CVA, Anaemia, Arthritis, Asthma, Heart disease, Dementia, Depression, Dysphagia, Multiple sclerosis, Epilepsy, COPD, Liver disease, Arthrosis, Parkinson’s disease, Kidney disease, HIV) and life-style factors were also included in the study. Results A total of 51,185 patients were included in the study as they suffer from the first episode of CAP. Of these, 8012 had diabetes as comorbidity. There were differences between sex and age in patients with diabetes. Patients without diabetes were younger, and had less comorbidities including those related to lifestyles such as smoking, alcoholism, social and dental problems than patients with diabetes. Conclusions Patients who developed an episode of CAP with diabetes have more risk factors which could be reduced with an appropriate intervention, including vaccination to prevent successive CAP episodes and hospitalization. The burden of associated factors in these patients can produce an accumulation of risk. Health care professional should know this for treating and control these patients in order to avoid complications. Diabetes and those other risk factors associated could be reduced with an appropriate intervention, including vaccination to prevent the first and successive CAP episodes and the subsequent hospitalization in severe cases.

scholarly journals The National Glycohemoglobin Standardization Program: Over 20 Years of Improving Hemoglobin A1c Measurement

2019 ◽  
Vol 65 (7) ◽  
pp. 839-848 ◽  
Author(s):  
Randie R Little ◽  
Curt Rohlfing ◽  
David B Sacks
Keyword(s):  
Blood Glucose ◽  
Hemoglobin A1c ◽  
Blood Glucose Concentration ◽  
Clinical Value ◽  
Patients With Diabetes ◽  
Substantial Progress ◽  
Hemoglobin Variants ◽  
The Mean ◽  
Mean Blood Glucose ◽  
Hba1c Measurement

Abstract BACKGROUND Measurement of hemoglobin A1c (HbA1c) in the blood is integral to and essential for the treatment of patients with diabetes mellitus. HbA1c reflects the mean blood glucose concentration over the preceding 8 to 12 weeks. Although the clinical value of HbA1c was initially limited by large differences in results among various methods, the investment of considerable effort to implement standardization has brought about a marked improvement in analysis. CONTENT The focus of this review is on the substantial progress that has been achieved in enhancing the accuracy and, therefore, the clinical value of HbA1c assays. SUMMARY The interactions between the National Glycohemoglobin Standardization Program and manufacturers of HbA1c methods have been instrumental in standardizing HbA1c. Proficiency testing using whole blood has allowed accuracy-based assessment of methods in individual clinical laboratories that has made an important contribution to improving the HbA1c measurement in patient samples. These initiatives, supported by the efforts of the IFCC network, have led to a continuing enhancement of HbA1c methods. Many of the factors that previously influenced HbA1c results independently of blood glucose have been eliminated from most modern methods. These include carbamylation, labile intermediates, and common hemoglobin variants. Nevertheless, some factors (e.g., race and aging) may alter HbA1c interpretation, but whether these differences have clinical implications remains contentious. HbA1c has a fundamental role in the diagnosis and management of diabetes. Ongoing improvements in HbA1c measurement and quality will further enhance the clinical value of this analyte.

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