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By:

Smaher AL-sayed Haroon

Department of Clinical Chemistry


Batch (25)

Supervisor: Ustaz. Abubakr Hassan


Definition:
Is a disease characterized by persistent hyperglycemia
(high blood sugar level) resulting either from inadequate
secretion of hormone insulin or inadequate response of
target cell to insulin or combination of these factors, that
because insulin is a principle hormone that regulates
uptake of glucose into most cells.
And also It has been defined by WHO as fasting
venues plasma glucose concentration greater than 140
Mg /dL
Type 1
Known as insulin – dependent diabetes (IDDM)
childhood diabetes or juvenile – onset diabetes. It
most commonly diagnosed in child but can occurs
in adult it characterized by beta.cell destruction
which usually leads to an absolute deficiency of
insulin, there for insulin therapy is essential for
survival.
Type 2:
known as non insulin –dependent diabetes
(NIDDM).
It is due to combination of defective insulin
secretion and defective responsiveness to insulin
which lead to elevated level of insulin in the blood.
Onset is most usual during adult life.
Although no genetic marker have been found
There is a familial tendency
. It divides to:
1-immediate complication or acute metabolic
complication
A-diabetic keto acidosis (DKA)
B-non- ketotic hyper osmoler coma
C-hypoglycemia
2-micro & macro vascular disease
1- Urine glucose test:
If it is positive a confirmatory blood test is
needed.
2- Blood tests:
* Random blood glucose test( RBS).
* Fasting blood glucose test.
* Glucose tolerance test
* Glycated HbA1c test.
Adult Hb is composed of one major component Hb
A & several sub fractions.
G.Hb is a generic term for Hb bound irreversibly to
glucose , often the term is used to mean total G.Hb –
HbA1a,HbA1b,HbA1c & possibly HbA1d and HbA1e
which are sub fractions of G.HbA, and sometimes to
Hb A1c which is major sub fraction .
G.Hb is formed by posttranslational, non-enzymatic,
substrate- concentration dependent irreversible
process of combination of aldehyde group of glucose
with the amino-terminal valine of the beta chain of Hb
, there is two steps for the reaction between Hb &
blood glucose. The 1st step consist of the formation of
reversible aldimine form of Hb to glucose linkage .
The 2nd step the labile aldimine form is converted
slowly to the stable & irreversible ketoamine form
throught an amadori rearrangement.
The level of G.Hb in the blood is directly related to
the average of blood glucose level over the life span
of the red blood cells (RBCs), since the half life of
RBCs is about 120 days.
A single determination of G.Hb reflect the
average of blood glucose level during preceding 8-12
weeks .The test is therefore a very good monitor for
long term (2-3months) blood glucose control in
patient with diabetes mellitus.
Many diabetic patients don’t pay
enough attention to their blood glucose
and this may be due to illiteracy and
economical status.
General objective:
To follow up patients to know whether
their blood glucose has been well controlled
within the previous 3 months.

Specific objectives:
1) Measurement of glycated HbA1c.
2) Measurement of random blood glucose.
Area of study:
This study have been done in Jabeer abo-aleezs
diabetic center in Khartoum city.
Duration of study:
In the period from July to October 2006.
Sample size:
52 known diabetic patients (32 male and 20
female) were chosen for this study.
3 ml of blood were taken from each patient, 1 ml
were kept in EDTA container for measurement of
HBA1c level, and 2 ml into fluoride oxalate container
for measurement of random blood glucose.
Method: for estimation the blood glucose:
Enzymatic, colorimetric method. GOD-PAP method
(GOD) the resultant hydrogen peroxide (H2O2) is
oxidatively coupled with amino phenazone and phenol in
the presence of peroxidase (POD) to yield a red
Quinonamine dye, the concentration of dye which read at
520 nm is directly proportional to the concentration of
glucose.
Method: for estimation of glycohemoglobin HbA1c

Fast ion-Exchange Resin Separation Method

Reaction principle:

Whole blood is mixed with a lysing reagent containing a


detergent and borate ions. The hemolysate is then mixed for
5 minutes with a weakly binding cation exchange resin.
During this time, HbA1c binds to the resin. A special resin
separator is used to remove the resin from the supernatant
fluid which contains the HbA1c.

The glycomhemoglobin percentage of total hemoglobin is


determined by measuring the absorbance of the
glycomhemoglobin of the total hemoglobin fraction at 415
nm , 405 nm in comparison with a standard
glycohemoglobin .
Table.1:Number of frequency and percentage of male, female
patients and control
percen
  frequenc t
male patient 32 44.4
female
patient 20 27.8
control 20 27.8
total 72 100

Fig.1:frequency and percentage of male, female patients and control


50
45
40
35
30
frequenc
25
percent
20
15
10
5
0
male patient female control
patient
Table.2:Number of frequency and percentage of
weight distribution of all samples.

frequency percent
43-50 7 9.7
51-75 50 69.4
76-100 15 20.8
Total 72 100

Fig.2:frequency and percentage of weight


.distribution of all sample
80

70

60

50
43-50
40 51-75
76-100
30

20

10

0
frequenc percent
Table.3:Number of frequency and percentage of the duration      
of disease

frequency percent
10--1 31 59.6
20--11 15 28.8
21-30 4 7.7
31-40 2 3.8
Total 52 100

Fig.3:Frequency and percentage of the duration of disease


70

60

50

40 frequency

30 percent

20

10

0
1--10 11--20 21-30 31-40
.Table.4:Frequencies of good and bad controls in both sexes

Male Female Total


Bad control )68.8%( 22 )70%( 14 )69.2%( 36
Good control )31.3%( 10 )30%( 6 )30.8%( 16

Fig.4:Frequencies of good and bad controls in both sexes


Diabetic patient
80.0

68.8 70.0

60.0
Percent

40.0

31.3 30.0

20.0 The sex of the patie

Male patient

0.0 Female patient


Bad Control G ood Control

The groups of the patient

Also the result showed that the males control their blood
glucose better than the females do. 68% of the males have badly
controlled blood glucose whereas 70% of the females have badly
controlled blood glucose.
Table.5:Relationship between age and HBA1c level.
Age Mean of HBa1c
20-29 224
30-39 206.8
40-49 214.8
50-59 212
60-69 227
70-79 222

Fig.5:Relationship between age and HBA1c level.


230

225

220
Mean of HBA
1c

215

Mean of HBa1c

210

205

200

195
20-29 30-39 40-49 50-59 60-69 70-79
Age

The results showed that age had no effect on the level of HBA1c.
Table.6:Relationship between weight and
HBA1c level
Weight Mean of HBA1c
49-59 211.2
60-69 204.2
70-79 228.8
80-89 237.8

Fig.6:Relationship between weight and HBA1c level


250

240

230
mean of HBA1c

220

mean of HBA1c

210

200

190

180
49-59 60-69 70-79 80-89
weight

From the results it is seen that an important factor affecting the level of
HBA1c is the weight of the patient. The greater the weight of the patient
the higher the level of the HBA1c.
Table.7:Relationship between duration of disease and
HBA1c level
Duration Mean of HBA1c
5--1 206
10--6 210
16--11 210
20--17 217.6
27--21 264
40--28 277

Fig.7:Relationship between duration of disease and HBA1c level


300
277
264

250

217.6
210 210
206
200
Mean of HBA
1c

150 Mean of HBA1c

100

50

0
1--5 6--10 11--16 17--20 21--27 28--40
Duration

The duration of disease has an effect on the level of HBA1c


and the control of blood glucose so the relation between the
duration and level of HBA1c is directly proportional.
Fig.8:Relationship between HBA1c results and RBS results

450

400

350

300

250
Results

RBS
HBA1c
200

150

100

50

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
Patients

Finally the study showed that HBA1c test is better in


monitoring than the RBS test.
Glycated Hemoglobin A1c test should be recommended as a**
routine investigation for diabetic patients the same as the blood
.glucose test, mainly in central labs

Also, patients should be taught how to control their blood**


.glucose

Doctors should request for the HBA1c test for every diabetic**
.patient every 3 months