Hemoglobin A(1c) - infatuation or the real thing?

Article Abstract:

Glycosylated hemoglobin, a minor form of the hemoglobin pigment molecule that is responsible for carrying oxygen in the body, can be identified by electrophoresis or ion exchange chromatograph. These methods use various physical principles to separate different fractions of hemoglobin and allow for quantitative determinations of their presence in blood. The rapid oscillations in blood sugar (glucose) that normally occur are smoothed out and the long-term level of glucose is now available to clinicians, because glycosylated hemoglobin has been shown to correlate with the integrated average blood consumption of glucose over the previous six to eight weeks. Clinicians can now use these assays to monitor levels of glycosylated hemoglobin and adjust the insulin dosages of patients with insulin-dependent diabetes mellitus (IDDM; sugar diabetes) as a means of achieving proper sustained blood sugar levels. A report in the October 11, 1990 issue of The New England Journal of Medicine reports on the value of monitoring glycosylated hemoglobin in the clinical management of IDDM patients. In this study, diabetic patients were divided into two groups and had quarterly measurements of glycosylated hemoglobin as well as blood and urinary glucose tests. Measurements of glycosylated hemoglobin were given to the physicians of only one of the two groups of patients. The results clearly demonstrate that better glycemic control was achieved by including glycosylated hemoglobin levels in the management of IDDM patients. The study strongly suggests that dietary control, and monitoring glucose and glycosylated hemoglobin are important in adjusting insulin doses and avoiding hospitalizations of diabetic patients. Whether this enhanced control will lead to long-term improvement and control of other complications associated with elevated blood sugar levels has, however, not yet been proven. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Effect of long-term monitoring of glycosylated hemoglobin levels in insulin-dependent diabetes mellitus

Article Abstract:

The concentration of glycosylated hemoglobin (a red-colored, oxygen-carrying pigment within red blood cells) is proportional to the level of blood sugar (glucose) over a long period of time. While blood glucose measurements are rapidly and greatly affected by the amount of glucose ingested, and the level of insulin in the body, the value of glycosylated hemoglobin moderates slowly. This parameter is, therefore, potentially useful to clinicians for assessing the average level of glucose in a patient. In other words, monitoring glycosylated hemoglobin may be an effective means of adjusting insulin therapy for diabetic patients. The present study of 240 patients with insulin-dependent diabetes mellitus (IDDM) was carried out over a one-year period. Levels of glycosylated hemoglobin measured on a quarterly basis, and the 240 participants were divided into two groups. The results of one group were made available to their physicians and were used to adjust insulin dosages. The results of the other group were not made available to their physicians, who adjusted insulin levels and made other clinical judgement based on standard diagnostic tests (such as blood glucose measurements, and urine glucose levels). At the end of the one-year period, 222 of the original group remained in the study. Results revealed that the diabetic patients, whose glycosylated hemoglobin values were made available to their physicians, were significantly better controlled than the other group. In addition, the rate of hospitalization of these patients was nearly one half that of the group whose physicians did not know their glycosylated hemoglobin levels. Regular measurement of glycosylated hemoglobin is important in the control of diabetes and in reducing the morbidity associated with this condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Blood sugar monitoring, Blood glucose test

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Glycosylated hemoglobin and the risk of microalbuminuria in patients with insulin-dependent diabetes mellitus

Article Abstract:

Maintaining glycosylated hemoglobin levels in diabetic patients at approximately 10% may reduce their risk of end-stage kidney disease. Measuring glycosylated hemoglobin is another way of measuring blood sugar. A 10% level is approximately equivalent to a blood sugar of 200 milligrams per deciliter. Researchers measured a glycosylated hemoglobin called hemoglobin A1 in 1,613 diabetic patients who had been diagnosed with microalbuminuria. Microalbuminuria is an increase in albumin excretion in the urine, which can be a sign of early kidney disease. The risk of microalbuminuria increased as the level of hemoglobin A1 increased. Twelve percent of those with the lowest hemoglobin A1 levels had microalbuminuria, compared to 36% of those with the highest levels. A 10% hemoglobin A1 level appeared to be the cut-off point below which diabetic patients had little risk of microalbuminuria and above which they had a greatly increased risk of microalbuminuria.

Risk factors, Physiological aspects, Blood sugar, Blood glucose, Albuminuria

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