Glycated hemoglobin - Wikipedia, the f…
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Glycated hemoglobin (glycosylated hemoglobin, hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also HbA1c) is a form of hemoglobin used primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose. Normal levels of glucose produce a normal amount of glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of glycated hemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous months prior to the measurement. The 2010 American Diabetes Association Standards of Medical Care in Diabetes added the A1c ≥ 6.5% as another criterion for the diagnosis of diabetes, but this is controversial and has not been universally adopted. In diabetes mellitus, higher amounts of glycated hemoglobin, indicating poorer control of blood glucose levels, have been associated with cardiovascular disease, nephropathy, and retinopathy. Monitoring the HbA1c in type-1 diabetic patients may improve treatment.
1 History 2 Underlying principle 3 Measuring A1C 3.1 Switch to IFCC units 4 Interpretation of results 5 Indications and use 6 Modification by exercise training 7 Standardization & traceability 8 See also 9 References 10 External links
Hemoglobin A1c was first separated from other forms of hemoglobin by Huisman and Meyering in 1958 using a chromatographic column. It was first characterized as a glycoprotein by Bookchin and Gallop in 1968. Its increase in diabetes was first described in 1969 by Samuel Rahbar et. al. The reactions leading to its formation were characterized by Bunn and his co-workers in 1975. The use of hemoglobin A1c for monitoring the degree of control of glucose metabolism in diabetic patients was proposed in 1976 by Anthony Cerami, Ronald Koenig and coworkers.
 The 2010 American Diabetes Association Standards of Medical Care in Diabetes added the A1c ≥ 6. therefore.Wikipedia.
Switch to IFCC units
The American Diabetes Association (ADA). immunoassay Point of care (e. HbA1c is to be reported in the International Federation of Clinical Chemistry (IFCC) units. Measuring glycated hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation. Laboratories use: high-performance liquid chromatography (HPLC): The HbA1c result is calculated as a ratio to total haemoglobin by using a chromatogram. POC A1C tests are certified by the National Glycohemoglobin Standardization Program (NGSP) to standardise them against the results of the 1993 Diabetes Control and Complications Trial (DCCT).org/…/Glycated_hemoglobin
Glycated hemoglobin . Some researchers state that the major proportion of its value is related to a rather shorter period of two to four weeks. Conversion between the units is by the following equation: IFCC-HbA1c (mmol/mol) = [DCCT-HbA1c (%) 2. Once a hemoglobin molecule is glycated.929 DCCT. the f…
In the normal 120-day lifespan of the red blood cell. in the future.0 5. IFCC reporting was introduced in Europe except for the UK in 2003.0 (mmol/mol) 20 31
…wikipedia. European Association for the Study of Diabetes (EASD) and International Diabetes Federation (IDF) have agreed that. glucose molecules react with hemoglobin. forming glycated hemoglobin.g.5% as another criterion for the diagnosis of diabetes.HbA1c IFCC-HbA1c (%) 4. it remains that way. the quantities of these glycated hemoglobins are much higher than in healthy people. The HbA1c level is proportional to average blood glucose concentration over the previous four weeks to three months. A buildup of glycated hemoglobin within the red cell. reflects the average level of glucose to which the cell has been exposed during its life-cycle. and the UK has as of 1 June 2009 introduced dual reporting until 1 June 2011.
There are a number of techniques used to measure A1C.15] × 10. In individuals with poorly controlled diabetes. doctor's surgery) devices use: immunoassay boronate affinity chromatography In the United States. but this is controversial and has not been universally adopted.
.0 7. while American Diabetes Association recommends that the HbA1c be below 7. A diabetic person with good glucose control has a HbA1c level that is close to or within the reference range. patients with diabetes mellitus are scolded by their doctors for having an HbA1c which is too low.0 6.0 10. For example.5% had an increased mortality rate.0% for most patients. the patient is seized with a feeling of panic. patients at high risk of microvascular complications may gain further benefits from reducing A1C below 7%. Two individuals with the same average blood sugar can have A1C values that differ by as much as 3 percentage points. his/her risk of hypoglycemia.5 8. and some patients may not even consciously realize their blood sugar has dropped to dangerous
…wikipedia.9%. and the intensive glycemic control required to reach this level leads to an increased rate of dangerous hypoglycemic episodes. is about 4%–5. and his/her specific health risks when setting a target A1C level. anemia.) for the condition.0
42 48 53 59 64 75 86
Interpretation of results
Laboratory results may differ depending on the analytical technique. after administration of high-dose vitamin C. Many diabetics have died behind the wheel as a result of a low blood sugar. blood transfusions. Doctors are especially sensitive about lower level HbA1c's with patients who regularly drive. a 'good' HbA1c in a patient with diabetes can still be riddled with a history of recent hypoglycemia. While diabetic patient treatment goals vary. many include a target range of HbA1c values. or high erythrocyte turnover. and biological variation among individuals. after surgery. A retrospective study of 47. Recent results from large trials suggest that a target below 7% may be excessive: Below 7% the health benefits of reduced A1C become smaller. an increased heart rate.5 7. the age of the subject. In general. profuse sweating.5%. because a lower A1C would indicate a likelihood of frequent hypoglycemia in the recent past. this being a prime example of a short-term motivation for preventing hypoglycemia.12/22/2010
Glycated hemoglobin . Practitioners must consider an individual patient's health. and receptions are typically mixed. Higher levels of HbA1c are found in people with persistently elevated blood sugar. the reference range (that found in healthy persons). the f…
6. Regular blood glucose monitoring is still the best method for the analysis of overall vascular health with respect to blood sugar control. The International Diabetes Federation and American College of Endocrinology recommend HbA1c values below 6. Often. Because patients are responsible for averting or responding to their own hypoglycemic episodes. etc. A high HbA1c represents poor glucose control. or even spikes of hyperglycemia.0 9. the patient's input and the doctor's assessment of the patient's self-care skills are also important. or erythropoetin treatment. especially for the reason that frequent hypoglycemia results in a higher tolerance (sometimes. in the presence of chronic renal or liver disease. for example. This is often assessed with blood sugar data. Results can be unreliable in many circumstances.Wikipedia. A balance of long-term health (hyperglycemia prevention) versus short-term health (hypoglycemia prevention) is always a constant concern for both patients and their doctors. such as after blood loss. However. as in diabetes mellitus.970 diabetes patients found that patients with an A1C greater than 6.
therefore. neuropathy (loss of sensation.9) (mg/dL) 97 (76–120) 126 (100–152) 154 (123–185) 183 (147–217) 212 (170–249)
13.5–8.3–19. heart attack.9 (12.5) 8. the f…
levels. and gastroparesis (slowed emptying of the stomach).7 eAG(mmol/l) = 1. Poor blood glucose control also increases the risk of short-term complications of surgery such as poor wound healing. erectile dysfunction.8–10.Wikipedia.7) 7. or any other condition causing premature red blood cell death. such as with Vitamin B12 or folate deficiency. For a single blood sample. such as with glucose-6-phosphate dehydrogenase deficiency.5 (13.4 (4.2 (8. stroke. the use of alcohol and certain drugs (marijuana. The American Diabetes Association guidelines are similar to others in advising that the glycosylated hemoglobin test be performed at least two times a year in patients with diabetes that are meeting treatment goals (and that have stable glycemic control) and quarterly in patients with diabetes whose therapy has changed or that are not meeting glycemic
…wikipedia.3) 298 (240–347)
Indications and use
Glycated hemoglobin testing is recommended for both (a) checking blood sugar control in people who might be pre-diabetic and (b) monitoring blood sugar control in patients with more elevated levels. On the converse. especially in the feet). HbA1c) increase the risk for the long-term vascular complications of diabetes such as coronary disease. kidney failure. gangrene.7 × A1C − 46.4 (10.6 (6.59 × A1C − 2. for example) can create moderately similar symptoms to those of hypoglycemia (especially when used in combination) and for this reason the patient may not realize he/she has developed hypoglycemia.3) 10. heart failure.1–12. termed diabetes mellitus.4–13.12/22/2010
Glycated hemoglobin .2–6.0 (5. Lower-than-expected levels of HbA1c can be seen in people with shortened red blood cell lifespan.5) 269 (217–314) 16. There is a significant proportion of people who are unaware of their elevated HbA1c level before they have blood lab work. higher-than-expected levels can be seen in people with a longer red blood cell lifespan.8 (9. In addition to acquired tolerance. sickle-cell disease.org/…/Glycated_hemoglobin 4/8
.59 Data in parentheses are 95% confidence intervals HbA1c eAG (estimated average glucose) (%) 5 6 7 8 9 10 11 12 (mmol/L) 5.0–17. blindness.1) 11. it provides far more revealing information on glycemic behavior than a fasting blood sugar value: Fasting blood sugar tests are crucial in making treatment decisions.7–15.7) 240 (193–282) 14. Persistent elevations in blood sugar (and. The approximate mapping between HbA1c values and eAG (estimated average glucose) measurements is given by the following equation: eAG(mg/dl) = 28.
since the sensors must be changed at least weekly.8 %. both in diabetic patients and in patients with renal failure. Likewise. suggests the A1C level of 6. hemolytic anemia.12/22/2010
Glycated hemoglobin .5 Anhydroglucitol. also known as GlycoMark. Diagnosis of diabetes during pregnancy continues to require fasting and glucose tolerance measurements for gestational diabetes.org/…/Glycated_hemoglobin
. testing every few minutes. In autoimmune hemolytic anemia.Wikipedia. and the American Diabetes Association (ADA). Hence.5% as a diagnostic level. The Committee Report further states that.0% or less should be provided additional testing to determine whether the HbA1c values are due to averaging out high blood glucose (hyperglycemia) with low blood glucose (hypoglycemia) or the HbA1c is more reflective of an elevated blood glucose that does not vary much throughout the day.6–0. people with recent blood loss. Glycated hemoglobin measurement is not appropriate where there has been a change in diet or treatment within 6 weeks. The alternative fructosamine test may be used in these circumstances and it also reflects an average of blood glucose levels over the preceding 2 to 3 weeks. The supplies tend to be expensive. All the major institutions like International Expert Committee Report. GlycoMark reflects only the times that the person experiences hyperglycemia above 180 mg/dL over a two-week period. Continuous use of blood glucose monitors is becoming more common. when A1C testing cannot be done. People with hemoglobin A1C values at 8. and the devices are covered by many health insurance plans but not by Medicare. The average effect of the training programs included reductions of glycosylated hemoglobin of 0. Concentrations of hemoglobin A1 (HbA1) are increased. Administration of prednisolone (PSL) will allow the HbA1 to be detected. drawn from the International Diabetes Federation (IDF). or genetic differences in the hemoglobin molecule (hemoglobinopathy) such as sickle-cell disease and other conditions. which was a result similar to that of long-term diet and drug or insulin therapy (which result in a reduction of 0. additional measures should be checked in patients at or near recommended goals. Due to glycated hemoglobin's variability (as shown in the table above). and not the glycated hemoglobin. the European Association for the Study of diabetes (EASD).
Modification by exercise training
Research done to identify the effect of two different kinds of training programs (combined aerobic and eccentric resistance exercise program and aerobic exercise only) on the glycosylated hemoglobin levels of individuals with T2DM found that the effect of combining resistance exercise with aerobic exercise improved the glucose control more than just the aerobics alone. the f…
goals. as well as those that have donated blood recently.
…wikipedia. The thiobarbituric acid method (a chemical method specific for the detection of glycation) shows that patients with renal failure have values for glycated hemoglobin similar to those observed in normal subjects. Devices such as continuous blood glucose monitoring allow people with diabetes to determine their blood glucose levels on a continuous basis. the test assumes a normal red blood cell aging process and mix of hemoglobin subtypes (predominantly HbA in normal adults). Another test that is useful in determining if HbA1c values are due to wide variations of blood glucose throughout the day is 1. concentrations of hemoglobin A1 (HbA1) is undetectable. when measured by ion-exchange chromatography. are not suitable for this test.8 %). suggesting that the high values in these patients are a result of binding of something other than glucose to hemoglobin. the fasting and glucose tolerance tests be done.
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Standardization & traceability
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.nih.org/wiki/Glycated_hemoglobin" Categories: Blood tests | Diabetes-related tests | Diabetes | Blood proteins | Hemoproteins This page was last modified on 11 December 2010 at 17:30.edu/mdrtc/cores/ChemCore/hemoa1c.org/cgi/reprint/30/3/485.jp/yunoca/A02/A020052000103.com/ivdt/archive/08/07/009.pace-med-apps.com/a1ccalc. EBSCO.
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…wikipedia.pdf) . 12 Oct.2337%2Fdc07-S004) .gov/pubmed/17192377) .