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Kour B, Shukla N, Bhargava H, Sharma D, Sharma A, Singh A, Valadi J, Sadasukhi TC, Vuree S, Suravajhala P. Identification of Plausible Candidates in Prostate Cancer Using Integrated Machine Learning Approaches. Curr Genomics 2023; 24:287-306. [PMID: 38235353 PMCID: PMC10790336 DOI: 10.2174/0113892029240239231109082805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 01/19/2024] Open
Abstract
Background Currently, prostate-specific antigen (PSA) is commonly used as a prostate cancer (PCa) biomarker. PSA is linked to some factors that frequently lead to erroneous positive results or even needless biopsies of elderly people. Objectives In this pilot study, we undermined the potential genes and mutations from several databases and checked whether or not any putative prognostic biomarkers are central to the annotation. The aim of the study was to develop a risk prediction model that could help in clinical decision-making. Methods An extensive literature review was conducted, and clinical parameters for related comorbidities, such as diabetes, obesity, as well as PCa, were collected. Such parameters were chosen with the understanding that variations in their threshold values could hasten the complicated process of carcinogenesis, more particularly PCa. The gathered data was converted to semi-binary data (-1, -0.5, 0, 0.5, and 1), on which machine learning (ML) methods were applied. First, we cross-checked various publicly available datasets, some published RNA-seq datasets, and our whole-exome sequencing data to find common role players in PCa, diabetes, and obesity. To narrow down their common interacting partners, interactome networks were analysed using GeneMANIA and visualised using Cytoscape, and later cBioportal was used (to compare expression level based on Z scored values) wherein various types of mutation w.r.t their expression and mRNA expression (RNA seq FPKM) plots are available. The GEPIA 2 tool was used to compare the expression of resulting similarities between the normal tissue and TCGA databases of PCa. Later, top-ranking genes were chosen to demonstrate striking clustering coefficients using the Cytoscape-cytoHubba module, and GEPIA 2 was applied again to ascertain survival plots. Results Comparing various publicly available datasets, it was found that BLM is a frequent player in all three diseases, whereas comparing publicly available datasets, GWAS datasets, and published sequencing findings, SPFTPC and PPIMB were found to be the most common. With the assistance of GeneMANIA, TMPO and FOXP1 were found as common interacting partners, and they were also seen participating with BLM. Conclusion A probabilistic machine learning model was achieved to identify key candidates between diabetes, obesity, and PCa. This, we believe, would herald precision scale modeling for easy prognosis.
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Affiliation(s)
- Bhumandeep Kour
- Department of Biotechnology, Lovely Professional University, Jalandhar, Punjab, India
- Bioclues.org, India
| | - Nidhi Shukla
- Bioclues.org, India
- Department of Biotechnology and Bioinformatics, Birla Institute of Scientific Research, Jaipur, Rajasthan, India
| | - Harshita Bhargava
- Department of Computer Science, IIS University, Jaipur, Rajasthan, India
| | - Devendra Sharma
- Urology and Renal Transplant Department of Renal Sciences, Rukmani Birla Hospital, Jaipur, Rajasthan, India
| | - Amita Sharma
- Department of Computer Science, IIS University, Jaipur, Rajasthan, India
| | - Anjuvan Singh
- Department of Biotechnology, School of Bioengineering and Biosciences, Lovely Professional University, Punjab, Phagwara, 144001, India
| | - Jayaraman Valadi
- Department of Computer Science, FLAME University, Pune, Maharashtra, India
| | - Trilok Chand Sadasukhi
- Department of Urology and Renal Transplant, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Sugunakar Vuree
- Bioclues.org, India
- MNR Foundation for Research & Innovation, MNR Medical College and Hospital, MNR University, Telangana, India
| | - Prashanth Suravajhala
- Bioclues.org, India
- Amrita School of Biotechnology, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India
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Analytical interference of 33 different hemoglobin variants on HbA1c measurements comparing high-performance liquid chromatography with whole blood enzymatic assay: A multi-center study. Clin Chim Acta 2022; 531:145-151. [DOI: 10.1016/j.cca.2022.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 12/27/2022]
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Mitchai M, Suwansaksri N, Seanseeha S, Saenboonsiri J, Kraitree P, Piyapromdee J, Silsirivanit A. Misleading HbA1c Measurement in Diabetic Patients with Hemoglobin Variants. Med Sci (Basel) 2021; 9:43. [PMID: 34200315 PMCID: PMC8293317 DOI: 10.3390/medsci9020043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Manthana Mitchai
- Medical Molecular Biology Center, Department of Clinical Pathology, Khon Kaen Hospital, Ministry of Public Health, Khon Kaen 40000, Thailand; (S.S.); (J.S.); (P.K.)
| | - Nattakarn Suwansaksri
- Department of Internal Medicine, Khon Kaen Hospital, Ministry of Public Health, Khon Kaen 40000, Thailand; (N.S.); (J.P.)
| | - Suphakdee Seanseeha
- Medical Molecular Biology Center, Department of Clinical Pathology, Khon Kaen Hospital, Ministry of Public Health, Khon Kaen 40000, Thailand; (S.S.); (J.S.); (P.K.)
| | - Jindamanee Saenboonsiri
- Medical Molecular Biology Center, Department of Clinical Pathology, Khon Kaen Hospital, Ministry of Public Health, Khon Kaen 40000, Thailand; (S.S.); (J.S.); (P.K.)
| | - Putthichai Kraitree
- Medical Molecular Biology Center, Department of Clinical Pathology, Khon Kaen Hospital, Ministry of Public Health, Khon Kaen 40000, Thailand; (S.S.); (J.S.); (P.K.)
| | - Jirasak Piyapromdee
- Department of Internal Medicine, Khon Kaen Hospital, Ministry of Public Health, Khon Kaen 40000, Thailand; (N.S.); (J.P.)
| | - Atit Silsirivanit
- Department of Biochemistry, and Center for Translational Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
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Yang JH, Kim SY, Tan AHK. Pitfalls of Measuring Hemoglobin A1c in a Patient with Sickle Cell Trait in South Korea. Korean J Fam Med 2018; 40:282-283. [PMID: 30558397 PMCID: PMC6669386 DOI: 10.4082/kjfm.18.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ji Hyun Yang
- Department of Internal Medicine, Korean Association of Health Promotion, Seoul, Korea
| | - Seong Yoon Kim
- Department of Internal Medicine, Korean Association of Health Promotion, Seoul, Korea
| | - Alice Hyun-Kyung Tan
- Department of Internal Medicine, International Health Service, Samsung Medical Center, Seoul, Korea
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Christiansen AL, Bygum A, Hother-Nielsen O, Rasmussen LM. Diagnosing diabetes mellitus in patients with porphyria cutanea tarda. Int J Dermatol 2018. [DOI: 10.1111/ijd.13938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Anne L. Christiansen
- Department of Clinical Biochemistry and Pharmacology; Odense University Hospital; Odense C Denmark
| | - Anette Bygum
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense C Denmark
| | - Ole Hother-Nielsen
- Department of Endocrinology; Odense University Hospital; Odense C Denmark
| | - Lars M. Rasmussen
- Department of Clinical Biochemistry and Pharmacology; Odense University Hospital; Odense C Denmark
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Newman CN, Litwin CM, Bowlby DA, Lewis KA, Paulo RC. Hemoglobin Providence (β82 Lys > Asn, Asp) and lower-than-expected HbA1c in a nonadherent teenager with type 1 diabetes: a case report and literature review. Clin Case Rep 2017; 5:2000-2002. [PMID: 29225844 PMCID: PMC5715421 DOI: 10.1002/ccr3.1244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/16/2017] [Accepted: 09/18/2017] [Indexed: 11/11/2022] Open
Abstract
Endocrinologists should have a high index of suspicion for a Hb variant when the HbA1c is not consistent with other indices of glycemic control.
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Affiliation(s)
- Charles N Newman
- Department of Pathology and Laboratory Medicine Medical University of South Carolina Charleston South Carolina 29425
| | - Christine M Litwin
- Department of Pathology and Laboratory Medicine Medical University of South Carolina Charleston South Carolina 29425
| | - Deborah A Bowlby
- Division of Pediatric Endocrinology Medical University of South Carolina Charleston South Carolina 29425
| | - Katherine A Lewis
- Division of Pediatric Endocrinology Medical University of South Carolina Charleston South Carolina 29425
| | - Remberto C Paulo
- Division of Pediatric Endocrinology Medical University of South Carolina Charleston South Carolina 29425
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Chan JH, Ho BS, Alvi HM, Saltzman MD, Marra G. The relationship between the incidence of adhesive capsulitis and hemoglobin A 1c. J Shoulder Elbow Surg 2017; 26:1834-1837. [PMID: 28495575 DOI: 10.1016/j.jse.2017.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have shown no correlation between adhesive capsulitis and hemoglobin A1c (HbA1c). However, HbA1c is only a measure of short-term blood sugar control. We created a previously nonvalidated variable, cumulative HbA1c, that uses HbA1c values over time to estimate the total disease burden a single individual experiences over a period. In this study, we aimed to evaluate whether a correlation exists between cumulative HbA1c levels in diabetic patients and the prevalence of frozen shoulder. We hypothesized that poor long-term glucose control would be correlated with increased incidence of adhesive capsulitis. METHODS A retrospective analysis at a single institution was performed. Data from all patients from a single institution with any HbA1c values were collected. A total of 24,417 patients met the inclusion criteria. A variable was created establishing the cumulative magnitude of abnormal HbA1c values over time, termed "cumulative HbA1c." Logistic regression analysis was performed to determine whether long-term glucose control was predictive of the development of adhesive capsulitis. RESULTS Cumulative HbA1c was positively associated with adhesive capsulitis (7.6 × 10-5) (ie, odds ratio of 1.000076). The effect size of cumulative HbA1c on adhesive capsulitis was significant; for each unit of time that the HbA1c level was greater than 7, there was a 2.77% increase in the risk of adhesive capsulitis. DISCUSSION Cumulative HbA1c was associated with an increased incidence of adhesive capsulitis. This finding suggests that the effects of diabetes that predispose patients to the development of adhesive capsulitis are dose dependent. Patients with worse blood sugar control over a longer period are at an increased risk of the development of adhesive capsulitis.
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Affiliation(s)
- Justin H Chan
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | | | - Hasham M Alvi
- Barrington Orthopedic Specialists, Schaumburg, IL, USA.
| | - Matthew D Saltzman
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Guido Marra
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
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Liu Z, Feng D, Gu D, Zheng R, Esperat C, Gao W. Differentially expressed haptoglobin as a potential biomarker for type 2 diabetic mellitus in Hispanic population. Biofactors 2017; 43:424-433. [PMID: 28218436 DOI: 10.1002/biof.1352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/06/2017] [Accepted: 01/17/2017] [Indexed: 01/01/2023]
Abstract
Glycosylated hemoglobin (HbA1c) measurement is currently a primary tool for diagnosis of type 2 diabetes mellitus (T2DM), especially for the assessment of chronic hyperglycemia. However, many studies reported the limitation of using HbA1c for T2DM diagnosis/prognosis, such as poor sensitivities, difficult standardization, and variable cut points across ethnic groups. Therefore, the aim of this study was to discover novel biomarkers associated with elevated HbA1c levels as complementary T2DM diagnostic tools. Two-dimensional difference gel electrophoresis combined with mass spectrometry were applied for protein profile analyses of two pooled serum samples collected from Hispanic T2DM subjects (n = 74) with HbA1c ≥7 and HbA1c< 7, respectively. Isoforms of haptoglobin (Hp) α1/α2 chains were significantly altered in pooled serum samples from T2DM subjects with HbA1c ≥7 compared to those with HbA1c< 7. Hp genotypes of 262 Hispanic subjects, including 109 T2DM and 153 nondiabetic controls, were further determined by PCRs and western blotting analysis. Meanwhile, a new droplet digital PCR method for Hp genotyping was also established. The distribution of Hp2 allele was higher in T2DM subjects compared to nondiabetic controls and the HbA1c levels of T2DM subjects carrying at least one Hp2 allele tended to be higher than T2DM subjects with Hp 1-1. In summary, our results indicate that differentially expressed serum Hp protein isoforms could be associated with HbA1c levels and subjects with Hp2 allele have a higher risk for the occurrence of T2DM in Hispanic population. © 2016 BioFactors, 43(3):424-433, 2017.
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Affiliation(s)
- Zhongwei Liu
- Department of Environmental Toxicology, The Institute of Environmental and Human Health, Texas Tech University, Lubbock, TX
| | - Du Feng
- School of Nursing, University of Nevada, Las Vegas, NV
| | - Danshan Gu
- Huafang College, Xuzhou Medical University, Xuzhou, China
| | - Richard Zheng
- Department of Biology, Texas Tech University, Lubbock, TX
| | - Christina Esperat
- School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Weimin Gao
- Department of Environmental Toxicology, The Institute of Environmental and Human Health, Texas Tech University, Lubbock, TX
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Tavares RS, Souza FOD, Francescantonio ICCM, Soares WC, Mesquita MM. HbA1c levels in individuals heterozygous for hemoglobin variants. Rev Assoc Med Bras (1992) 2017; 63:341-346. [DOI: 10.1590/1806-9282.63.04.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/17/2016] [Indexed: 11/22/2022] Open
Abstract
Summary Objective: To evaluate the levels of glycated hemoglobin (HbA1c) in patients heterozygous for hemoglobin variants and compare the results of this test with those of a control group. Method: This was an experimental study based on the comparison of HbA1c tests in two different populations, with a test group represented by individuals heterozygous for hemoglobin variants (AS and AC) and a control group consisting of people with electrophoretic profile AA. The two populations were required to meet the following inclusion criteria: Normal levels of fasting glucose, hemoglobin, urea and triglycerides, bilirubin > 20 mg/dL and non-use of acetylsalicylic acid. 50 heterozygous subjects and 50 controls were evaluated between August 2013 and May 2014. The comparison of HbA1c levels between heterozygous individuals and control subjects was performed based on standard deviation, mean and G-Test. Results: The study assessed a test group and a control group, both with 39 adults and 11 children. The mean among heterozygous adults for HbA1c was 5.0%, while the control group showed a rate of 5.74%. Heterozygous children presented mean HbA1c at 5.11%, while the controls were at 5.78%. G-Test yielded p=0.93 for children and p=0.89 for adults. Conclusion: Our study evaluated HbA1c using ion exchange chromatography resins, and the patients heterozygous for hemoglobin variants showed no significant difference from the control group.
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Takeda Y, Kawanami D, Utsunomiya K. Detection of hemoglobin variant HbS on the basis of discrepant HbA1c values in different measurement methods. Diabetol Int 2016; 7:199-203. [DOI: 10.1007/s13340-015-0237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022]
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Chandrashekar V. Hb A1c Separation by High Performance Liquid Chromatography in Hemoglobinopathies. SCIENTIFICA 2016; 2016:2698362. [PMID: 26989559 PMCID: PMC4771897 DOI: 10.1155/2016/2698362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/16/2016] [Accepted: 01/24/2016] [Indexed: 06/05/2023]
Abstract
Hb A1c measurement is subject to interference by hemoglobin traits and this is dependent on the method used for determination. In this paper we studied the difference between Hb A1c measured by HPLC in hemoglobin traits and normal chromatograms. We also studied the correlation of Hb A1c with age. Hemoglobin analysis was carried out by high performance liquid chromatography. Spearman's rank correlation was used to study correlation between A1c levels and age. Mann-Whitney U test was used to study the difference in Hb A1c between patients with normal hemoglobin and hemoglobin traits. A total of 431 patients were studied. There was positive correlation with age in patients with normal chromatograms only. No correlation was seen in Hb E trait or beta thalassemia trait. No significant difference in Hb A1c of patients with normal chromatograms and patients with hemoglobin traits was seen. There is no interference by abnormal hemoglobin in the detection of A1c by high performance liquid chromatography. This method cannot be used for detection of A1c in compound heterozygous and homozygous disorders.
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Affiliation(s)
- Vani Chandrashekar
- Department of Hematology, Apollo Hospitals, No. 21, Off Greams Road, Greams Lane, Chennai 600006, India
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Arakaki RF, Changcharoen B. Glycemic Assessment in a Patient with HB Leiden and Type 2 Diabetes. AACE Clin Case Rep 2016. [DOI: 10.4158/ep151004.cr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Effects of hemoglobin S variants on the measurement of glycosylated hemoglobin A1c by four analytical methods. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-014-0257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kato M, Takahashi Y, Matsushita Y, Mizoue T, Inoue M, Kadowaki T, Tsugane S, Noda M. Diabetes mellitus defined by hemoglobin A1c value: Risk characterization for incidence among Japanese subjects in the JPHC Diabetes Study. J Diabetes Investig 2014; 2:359-65. [PMID: 24843514 PMCID: PMC4019303 DOI: 10.1111/j.2040-1124.2011.00119.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
UNLABELLED Aims/Introduction: Although several risk factors for type 2 diabetes have been identified, most of them have been identified in studies on Western populations, and they should be evaluated in a Japanese population. In 2010, new diagnostic criteria for diabetes mellitus using hemoglobin A1c (HbA1c) were released and its use in epidemiological studies has many advantages. The aim of the present study was to evaluate risk factors for type 2 diabetes defined based on HbA1c values in a Japanese population. MATERIALS AND METHODS A total of 9223 subjects (3076 men and 6147 women) were followed up for 5 years. Diabetes was defined based on self-report or HbA1c value. Risk factors for diabetes were evaluated as odds ratios adjusted for potential confounding factors by logistic regression. RESULTS During the 5-year follow-up period, we documented 518 incident cases of diabetes (232 men and 286 women). Of the 518 incident cases, 310 cases were diagnosed by HbA1c alone. Among the men, age, smoking (both past smoking and current smoking) and family history of diabetes significantly increased the risk of diabetes. Among the women, body mass index, family history of diabetes and hypertension significantly increased the risk of diabetes. These results did not change markedly after adjustment for the baseline HbA1c values, and the baseline HbA1c value itself was a significant risk factor for diabetes mellitus. CONCLUSIONS Known risk factors for diabetes established in Western populations also increased the risk of diabetes in a Japanese population defined on the basis of HbA1c values. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00119.x, 2011).
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Affiliation(s)
- Masayuki Kato
- Japan Foundation for the Promotion of International Medical Research Cooperation
| | | | - Yumi Matsushita
- Department of Epidemiology and International Health, Research Institute, National Center for Global Health and Medicine
| | - Tetsuya Mizoue
- Department of Epidemiology and International Health, Research Institute, National Center for Global Health and Medicine
| | - Manami Inoue
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center
| | - Takashi Kadowaki
- Department of Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center
| | - Mitsuhiko Noda
- Department of Diabetes and Metabolic Medicine, Center Hospital
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Higa M, Yoshifuji A, Doi A, Yoshida E, Yamashita K, Ichijo T, Ouchi H, Miyazaki A, Hirose T. A diabetic patient with hemoglobin variant Hb Mito diagnosed from a change in HbA1c measurement method. Diabetol Int 2013. [DOI: 10.1007/s13340-013-0120-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- Tetsuji Okawa
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Molina-Arrebola MA, Sánchez-Crespo A, Giménez López MJ, Estévez-Escobar M, García-Bautista JA, Pérez-Moyano R, Salas-Coronas J, Avivar-Oyonarte C. Haemoglobin Kenitra detected by HPLC assay and its compromising effect on the measurement of HbA1c. Int J Lab Hematol 2013; 35:e18-20. [PMID: 23656697 DOI: 10.1111/ijlh.12098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- M-A Molina-Arrebola
- Haematology and Haemotherapy Unit, Biotechnology Department, Poniente Hospital, El Ejido, Almería, Spain.
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Nigam PK, Sharma S, Sareen R, Paul V, Lal A. Lack of precision in HbA(1c) values on variant II in cases of hemoglobin Q India. Indian J Clin Biochem 2012; 21:72-5. [PMID: 23105618 DOI: 10.1007/bf02912916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study was carried out to check the precision of HbA(1c) values on Bio-Rad Variant II in cases of a rare hemoglobin variant Q India. The study was carried out over a three month period on samples collected for HbA(1c) estimation. Seven out of eleven patients showed variable results of HbA(1c) with a very high and unacceptable intraday mean coefficient of variation (CV) of 9.93%. We conclude, that the results of HbA(1c) on Variant II can not be reported without adversely affecting HbA(1c) as a marker of long-term glycemic control in patients who have hemoglobin Q India. The HbA(1c) value of these patients needs to be assessed by a different instrument/method or the glycemic control be monitored by an alternate test like serum Fructosamine.
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Affiliation(s)
- P K Nigam
- Dr Lal PathLabs Pvt Ltd, 'ESKAY HOUSE', 54, Hanuman Road, 110001 New Delhi, India
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Kato M, Noda M, Suga H, Nakamura T, Matsumoto M, Kanazawa Y. Haemoglobin A1c cut-off point to identify a high risk group of future diabetes: results from the Omiya MA Cohort Study. Diabet Med 2012; 29:905-10. [PMID: 22248349 PMCID: PMC3504345 DOI: 10.1111/j.1464-5491.2012.03572.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS Using the HbA(1c) level to define diabetes has several advantages and these advantages also apply to define a high-risk group. However, the risk of diabetes increases as HbA(1c) increases and a certain degree of arbitrariness in the cut-off for the high risk group is unavoidable. The aim of this study was to determine the HbA(1c) cut-off for defining a high-risk group that corresponds to the fasting plasma glucose cut-off by comparing the risk of diabetes against the fasting plasma glucose and HbA(1c) levels in the Japanese population. METHODS A retrospective cohort study was conducted using data from annual health examinations performed in Omiya city. A total of 11,271 subjects between the ages of 40 and 79 years without diabetes at baseline were followed for up to 7 years. According to the new diagnostic criteria, diabetes was defined as an fasting plasma glucose level ≥ 7 mmol/l or an HbA(1c) level ≥ 48 mmol/mol (≥ 6.5%) or a self-report. The HbA(1c) cut-off corresponding to the fasting plasma glucose cut-off was determined using the incidence, hazard ratio, and a receiver operating characteristic analysis. RESULTS Eight hundred and sixty subjects developed diabetes. The incidence, hazard ratio, and receiver operating characteristic analysis all indicated that an HbA(1c) cut-off of 39 mmol/mol (5.7%) corresponded to an fasting plasma glucose level of 5.6 mmol/l. CONCLUSIONS Our results suggested that the HbA(1c) cut-off for high-risk of diabetes should be 39 mmol/mol (5.7%), consistent with the American Diabetes Association recommendation. Further research is needed to determine whether our results are applicable to other populations.
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Affiliation(s)
- M Kato
- Japan Foundation for Promotion of International Medical Research Cooperation, Saitama, Japan
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20
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Yian EH, Contreras R, Sodl JF. Effects of glycemic control on prevalence of diabetic frozen shoulder. J Bone Joint Surg Am 2012; 94:919-23. [PMID: 22617920 DOI: 10.2106/jbjs.j.01930] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is controversy regarding the influence of glycemic control in diabetic patients with frozen shoulder. To determine the relationship between glycemic control and the prevalence of frozen shoulder in diabetic patients, we hypothesized that increased glycosylated hemoglobin A1c (HbA1c) levels would correlate with an increased prevalence of frozen shoulder. METHODS A retrospective analysis with statistical review of 201,513 diabetic patients enrolled in a regional health maintenance organization in 2007 was performed. Analysis included determining the relationship between the prevalence of frozen shoulder and the following factors: HbA1c level, type of diabetes treatment, duration of diabetes treatment, and presence of end-stage diabetic manifestations. RESULTS There were 1150 diabetic patients with a diagnosis of frozen shoulder. There was no significant relationship between HbA1c level and the prevalence of frozen shoulder. Insulin-dependent patients who used or did not use oral hypoglycemics were 1.93 times more likely than non-insulin-dependent diabetic patients to have frozen shoulder, and that rate increased to 1.96 times more likely when the results were adjusted for HbA1c level. Patients who were taking oral hypoglycemic drugs were 1.5 times more likely to develop frozen shoulder than those who did not use insulin or take oral hypoglycemic drugs. Duration of diabetes was also associated with the development of frozen shoulder, after controlling for insulin use (odds ratio: 1.85 for duration of more than ten years of use compared with less than five years of use). The prevalence of end-stage diabetic manifestations was increased in patients with frozen shoulder as compared with those without frozen shoulder (p < 0.0001). CONCLUSION There was no association found between HbA1c level and the prevalence of frozen shoulder in this diabetic population.
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Affiliation(s)
- Edward H Yian
- Southern California Permanente Medical Group, 411 North Lakeview Avenue, Anaheim, CA 92807, USA
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21
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Jain N, Kesimer M, Hoyer JD, Calikoglu AS. Hemoglobin Raleigh results in factitiously low hemoglobin A1c when evaluated via immunoassay analyzer. J Diabetes Complications 2011; 25:14-8. [PMID: 19896869 DOI: 10.1016/j.jdiacomp.2009.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 08/31/2009] [Accepted: 09/25/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Glycosylated hemoglobin (HbA1c) is commonly used to assess long-term blood glucose control in patients with diabetes mellitus. Numerous conditions including hemoglobinopathies can alter HbA1c measurements and cause misleading results. OBJECTIVE To report a 13-year-old male with Type 1 diabetes mellitus who had low HbA1c measurements, despite persistent hyperglycemia. DESIGN/METHODS HbA1c was initially measured by immunoassay. Hb electrophoresis was then employed to assess potential Hb variants. Electrospray ionization (ESI) tandem mass spectrometry of isolated Hb and gene sequencing of the Hbβ gene were used to specifically identify the Hb variant. RESULTS HbA1c measurement by immunoassay revealed an unusually low HbA1c of 3.9%. Hb electrophoresis revealed an aberrant Hb. The ESI mass spectrum of the intact Hb sample revealed a variant β-chain of 15,881 Da, 14 Da heavier than the mass of the normal Hb β-chain (15,867 Da). Sequence analysis of the 965.45 Da peptide suggested a substitution of valine (Val) to acetylated alanine (Ala). The DNA sequence of the patient's Hbβ gene revealed a single-base heterozygous mutation (GTG to GCG) at Base 2 of the codon of the first amino acid, producing a Val→Ala substitution, previously termed Hb-Raleigh. Because the acetylated N-terminal amino acid of the Hb-Raleigh β chain cannot be glycated, the HbA1c immunoassay will result in falsely low HbA1c levels. CONCLUSION In managing diabetic patients, knowledge of hemoglobinopathies influencing HbA1c determination methods is essential because hemoglobin variants may cause mismanagement of diabetes. Unusual results should prompt further analysis for a hemoglobinopathy as the potential cause of aberrant results.
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Affiliation(s)
- Nina Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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22
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Ito S, Nakahari T, Yamamoto D. Relationship between impaired glycation and the N-terminal structure of the Hb Görwihl [beta5(A2)Pro-->Ala] variant. Hemoglobin 2010; 34:151-6. [PMID: 20353350 DOI: 10.3109/03630261003676785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We studied the structural environment surrounding the beta-N-terminal glycation site of a hemoglobin (Hb) molecule in which the proline residue at beta5(A2) was substituted by alanine in silico. By computer analysis that used Protein Data Bank data (PDB ID: 1BZ0), we tried to clarify the reason for impaired glycation of Hb Görwihl [beta5(A2)Pro-->Ala]. On the basis of the results, we predicted that the glycation site would have the following characteristics: 1) glycation of the beta-N-terminus of Hb is probably accelerated by the neighboring histidine residue at beta2(NA2), which acts as an acid-base catalyst via a phosphate-mediated proton transfer; and 2) the mutation beta5(A2)Pro-->Ala would bring about impaired glycation of the N-terminal residue by forming an electrostatic bond between the alpha amino group of beta1(NA1)Val and beta carboxyl group of beta79(EF3)Asp.
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Affiliation(s)
- Shigenori Ito
- Department of Physiological Chemistry, Osaka Medical College, Osaka, Japan.
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23
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Danescu LG, Levy S, Levy J. Markedly low hemoglobin A1c in a patient with an unusual presentation of beta-thalassemia minor. Endocr Pract 2010; 16:89-92. [PMID: 19703808 DOI: 10.4158/ep09160.cr] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe very low hemoglobin A1c levels in a patient with type 2 diabetes mellitus and an unusual presentation of beta-thalassemia minor. METHODS We present the clinical and laboratory findings of the study patient. RESULTS A 64-year-old African American man with type 2 diabetes mellitus was referred to the endocrinology clinic with a hemoglobin A1c level of 1.6% despite elevated blood glucose concentrations. A red blood cell survival study with chromium-51 revealed that he had a reduced erythrocyte life span less than 25% of normal. He also had a markedly elevated reticulocyte count ranging from 236 to 534 x 10(3)/microL (reference range, 25-75 x 10(3)/microL). The laboratory findings, which are not characteristic of beta-thalassemia minor, could be the cause of the markedly low hemoglobin A1c in this patient. CONCLUSIONS Although rare, when associated with marked erythrocyte turnover, beta-thalassemia minor can lead to a severe reduction in HbA1c levels. In this scenario, glycemic control is best assessed by measuring fructosamine.
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Affiliation(s)
- Liviu G Danescu
- Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA
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24
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Jung CL, Kwon KJ, Hong KS, Sung YA, Lee ST, Ki CS, Lee MA, Chung WS. Hemoglobin Yamagata: Hemoglobin Variant Detected by HbA1c Test. Ann Lab Med 2009; 29:536-40. [DOI: 10.3343/kjlm.2009.29.6.536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Chae Lim Jung
- Department of Laboratory Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyoung Joo Kwon
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Ki Sook Hong
- Department of Laboratory Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Yeon Ah Sung
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seung-Tae Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Ae Lee
- Department of Laboratory Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Wha Soon Chung
- Department of Laboratory Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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25
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Lettre à la rédaction à propos de l’article intitulé : « L’hémolyse : une cause d’erreur dans l’interprétation de l’hémoglobine glycosylée ». Rev Med Interne 2009; 30:555-6; author reply 556. [DOI: 10.1016/j.revmed.2009.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Accepted: 01/22/2009] [Indexed: 11/18/2022]
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26
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Bergman AC, Beshara S, Byman I, Karim R, Landin B. A new beta-chain variant: Hb stockholm [beta 7(A4)GluAsp] causes falsely low Hb A(1c). Hemoglobin 2009; 33:137-42. [PMID: 19373590 DOI: 10.1080/03630260902861956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A new beta-hemoglobin (Hb) variant, Hb Stockholm [beta7(A4)GluAsp], is described. The variant was characterized by mass spectrometry and DNA sequencing. The new variant is clinically silent but interferes with Hb A(1c) quantification using ion exchange chromatography, causing a falsely low Hb A(1c) level when using the Bio-Rad VARIANT II System.
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Affiliation(s)
- Ann-Charlotte Bergman
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden.
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27
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Abstract
Hemoglobin HbA(1c) (A(1c)) has been used clinically since the 1980s as a test of glycemic control in individuals with diabetes. The Diabetes Control and Complications Trial (DCCT) demonstrated that tight glycemic control, quantified by lower blood glucose and A(1c) levels, reduced the risk of the development of complications from diabetes. Subsequently, standardization of A(1c) measurement was introduced in different countries to ensure accuracy in A(1c) results. Recently, the International Federation of Clinical Chemists (IFCC) introduced a more precise measurement of A(1c) , which has gained international acceptance. However, if the IFCC A(1c) result is expressed as a percentage, it is lower than the current DCCT-aligned A(1c) result, which may lead to confusion and deterioration in diabetic control. Alternative methods of reporting have been proposed, including A(1c) -derived average glucose (ADAG), which derives an average glucose from the A(1c) result. Herein, we review A(1c) , the components involved in A(1c) formation, and the interindividual and assay variations that can lead to differences in A(1c) results, despite comparable glycemic control. We discuss the proposed introduction of ADAG as a surrogate for A(1c) reporting, review imprecisions that may result, and suggest alternative clinical approaches.
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Affiliation(s)
- Emily Jane Gallagher
- Division of Endocrinology, Diabetes and Bone Disease, Mount Sinai School of Medicine, New York City, New York 10029, USA.
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28
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Dalal BI, Brigden ML. Factitious biochemical measurements resulting from hematologic conditions. Am J Clin Pathol 2009; 131:195-204. [PMID: 19141380 DOI: 10.1309/ajcpy9rp5qytyfwc] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Factitious laboratory results often lead to unnecessary testing or treatment. This brief review of factitious biochemical results due to preexisting hematologic conditions focuses on the mechanisms underlying the factitious results and suggests ways to prevent them. An observant pathologist identifies these errors, intervenes in a timely fashion, investigates the sources of error diligently, and institutes measures to prevent their recurrence.
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Affiliation(s)
- Bakul I. Dalal
- Division of Hematopathology, Vancouver General Hospital, Vancouver, Canada
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29
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Takarabe D, Kishimoto M, Tanaka T, Takahashi Y, Kajio H, Harano K, Noda M. Hemoglobin variant HbE found in two South Asian diabetic patients. Intern Med 2009; 48:1397-401. [PMID: 19687586 DOI: 10.2169/internalmedicine.48.2219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Glycohemoglobin, also known as hemoglobin (Hb) A(1c), is a marker of long-term glycemic control in patients with diabetes. We present two South-Asian diabetic patients whose HbA(1c) peaks were not measurable using high performance liquid chromatography (HPLC). Further investigations showed that these patients were homozygous for a hemoglobin variant, HbE (beta26 Glu-->Lys). Because of the increasing numbers of immigrants in Japan, area-specific hemoglobinopathies are now encountered more frequently than before. Thus, if discrepant results are found on an HbA(1c) assay or if the HbA(1c) value cannot be measured, such patients should be screened for hemoglobinopathies and alternative measurements for monitoring diabetes should be considered.
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Affiliation(s)
- Daisuke Takarabe
- Department of Diabetes and Metabolic Medicine, International Medical Center of Japan, Toyama Hospital, Tokyo
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30
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Moiz B, Hashmi MR, Sadaf S. Performance evaluation of ion exchange and affinity chromatography for HbA1c estimation in diabetic patients with HbD: a study of 129 samples. Clin Biochem 2008; 41:1204-10. [PMID: 18644359 DOI: 10.1016/j.clinbiochem.2008.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 05/30/2008] [Accepted: 06/15/2008] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare ion exchange and boronate affinity chromatography for HbA(1c) estimation in patients with type I and II diabetes having hemoglobin D. DESIGN AND METHODS Systems based on ion exchange and boronate affinity chromatography were evaluated and compared for their performance for HbA(1c) estimation in patients with homozygous and heterozygous D disease. RESULTS Boronate affinity chromatography shows least interference by HbD in heterozygous as well as homozygous diabetic patients for HbA(1c) estimation. CONCLUSIONS The use of boronate affinity chromatography was found to be helpful in evaluating glycemic control in diabetic subjects with HbD.
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Affiliation(s)
- Bushra Moiz
- Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan.
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31
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Agorasti A, Trivellas T, Papadopoulos V, Konstantinidou D. Levels of glycated haemoglobin A--HbA1c in nondiabetic carriers of haemoglobin O-Arab. Int J Lab Hematol 2008; 31:471-4. [PMID: 18384394 DOI: 10.1111/j.1751-553x.2008.01065.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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Lee ST, Weykamp CW, Lee YW, Kim JW, Ki CS. Effects of 7 Hemoglobin Variants on the Measurement of Glycohemoglobin by 14 Analytical Methods. Clin Chem 2007; 53:2202-5. [DOI: 10.1373/clinchem.2007.093963] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: Hemoglobin variants (HbVAR) are not uncommon in the Korean population, with Hb G-Coushatta and Hb Queens being the 2 most common HbVAR. Hb G-Coushatta is also the most common HbVAR in Chinese people from the Silk Road region, as well as in some North American Indian tribes. However, data are scarce on the effect of these HbVAR on the different methods used for analyzing HbA1c.
Methods: Specimens from 24 individuals with 7 HbVAR (Hb G-Coushatta, Hb Queens, Hb G-Hsi-Tsou, Hb Ube-4, Hb G-Waimanalo, Hb Inglewood, and Hb Bologna-St.Orsola) were collected and tested using the International Federation of Clinical Chemistry primary reference method as well as 14 routine HbA1c assay methods.
Results: Hb G-Coushatta showed a clinically significant effect on the measured HbA1c, particularly when analysis was performed with ion-exchange HPLC methods with short elution times. This interference could be resolved by measuring the HbA1c using other methods such as HPLC with a long elution time, immunoassay, boronate affinity chromatography, and enzymatic assay. Hb Queens showed a clinically significant difference, defined as a >10% deviation from regression lines, in results from the 2 HPLC methods but not in the other methods. The remaining 5 rare HbVAR showed different HbA1c results in the different assays.
Conclusion: Hb G-Coushatta, Hb Queens, and other rare HbVAR can interfere with glycohemoglobin assays, including ion-exchange HPLC methods with short elution times, but the interference can be resolved using other unaffected methods. It is important to identify these HbVAR through a careful inspection of the chromatograms and apply other noninterfering methods for accurate measurements of the HbA1c.
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Affiliation(s)
- Seung-Tae Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cas W Weykamp
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, The Netherlands
| | - Yong-Wha Lee
- Department of Laboratory Medicine and Genetics, Soonchunhyang University Bucheon Hospital and Soonchunhyang University College of Medicine, Gyeonggi-do, Korea
| | - Jong-Won Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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McGill JB, Bell DSH. Anemia and the role of erythropoietin in diabetes. J Diabetes Complications 2006; 20:262-72. [PMID: 16798479 DOI: 10.1016/j.jdiacomp.2005.08.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Revised: 07/29/2005] [Accepted: 08/01/2005] [Indexed: 11/18/2022]
Abstract
Anemia is more common in patients with diabetes than without diabetes, and the problem is magnified in patients with renal impairment. Diabetic patients with anemia may be at increased risk of adverse outcomes from diabetic retinopathy, nephropathy, neuropathy, and cardiovascular disease. The etiology of anemia in diabetes is multifactorial and includes inflammation, nutritional deficiencies, concomitant autoimmune diseases, drugs, and hormonal changes in addition to kidney disease. Anemia that is associated with erythropoietin deficiency may have prognostic significance for persons with nephropathy or heart failure. In early diabetic nephropathy, damage to the peritubular fibroblasts can occur and lead to erythropoietin deficiency and anemia prior to the loss of filtration. Correction of the anemia not only leads to less fatigue, greater exercise tolerance, and an improved quality of life but also to a reduction in mortality and hospital admissions for congestive heart failure (CHF). Data are accumulating that suggest that treatment of anemia will slow the progression of microvascular and macrovascular complications, including postural hypotension from autonomic neuropathy, retinopathy, and loss of renal function from diabetic nephropathy. Promptly diagnosing and treating anemia in patients with diabetes may result in an improved quality of life and decreased morbidity and mortality.
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Affiliation(s)
- Janet B McGill
- Washington University School of Medicine, St. Louis, MO, USA
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Kapoor D, Ng JP, Jones TH. Falsely high glycated haemoglobin [HbA1C] because of haemoglobin OSU-Christiansborg. ACTA ACUST UNITED AC 2005; 27:334-5. [PMID: 16178917 DOI: 10.1111/j.1365-2257.2005.00718.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glycated haemoglobin (HbA1c) is routinely used to assess the degree of glycaemic control in diabetic patients. We report a case of a 73 year old diabetic woman who had an elevated HbA1c of 13.4%. She was on maximum oral hypoglycaemic agents and was commenced on insulin. However, her HbA1c continued to remain high at 20.4%. Subsequent tests revealed that she had a haemoglobin variant, Haemoglobin Osu-Christiansborg, causing the falsely high glycated haemoglobin.
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Affiliation(s)
- D Kapoor
- Centre for Diabetes and Endocrinology, Department of Haematology, Barnsley District General Hospital, Barnsley, UK.
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35
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Lee JH, Kim Y, Ha MY, Lee EK, Choo J. Immobilization of aminophenylboronic acid on magnetic beads for the direct determination of glycoproteins by matrix assisted laser desorption ionization mass spectrometry. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2005; 16:1456-1460. [PMID: 16023361 DOI: 10.1016/j.jasms.2005.04.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 03/31/2005] [Accepted: 04/08/2005] [Indexed: 05/03/2023]
Abstract
Aminophenylboronic acid (APBA) has been immobilized on magnetic beads for the direct determination of glycoprotein by matrix assisted laser desorption/ionizaton time of flight mass spectrometry (MALDI-TOF-MS). An APBA layer was formed on the surface of carboxylic acid terminated magnetic beads by coupling with carbodiimide and subsequently reacted with an N-hydroxysuccinimide moiety. The immobilized APBA was identified by MALDI-TOF-MS without a matrix. Glycoproteins, such as HbA1c, fibrinogen, or RNase B were separated and desalted using APBA magnetic beads by simply washing the magnetic beads and then separating them by external magnet. Proteins can be identified by direct determination of proteins on beads on MALDI plate and confirmed again by peptide mass finger printing after digestion of proteins on magnetic beads by trypsin. Fluorescence image with a FITC tagging protein using confocal laser microscopy showed the difference of immobilization efficiency between glycoproteins and nonglycoproteins. The methods developed within this work allow the simple treatment and enrichment of glycoproteins as well as direct determination of proteins on beads by MALDI-TOF-MS.
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Affiliation(s)
| | - Yangsun Kim
- Proteonik Research Laboratory, Ansan, South Korea.
| | - Mi Young Ha
- Microbiochip Center, Hanyang University, Ansan, South Korea
| | - Eun Kyu Lee
- Microbiochip Center, Hanyang University, Ansan, South Korea
| | - Jaebum Choo
- Department of Applied Chemistry, Hanyang University, Ansan, South Korea
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Schnedl WJ, Lahousen T, Wallner SJ, Krause R, Lipp RW. Silent hemoglobin variants and determination of HbA(1c) with the high-resolution program of the HPLC HA-8160 hemoglobin analyzer. Clin Biochem 2005; 38:88-91. [PMID: 15607323 DOI: 10.1016/j.clinbiochem.2004.09.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Revised: 08/27/2004] [Accepted: 09/09/2004] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Evaluation of HbA1c determination with an automated ion-exchange high-performance liquid chromatography (HPLC) method in patients with clinically silent hemoglobin (Hb) variants. DESIGN AND METHODS HbA1c values were determined with the Arkray HA-8160 ion-exchange HPLC using the high-resolution, 4.2-min beta-thalassemia screening mode in patients with silent hemoglobin (Hb) variants, namely, Hb Graz, Hb Sherwood Forest, Hb O Padova, and HbD. RESULTS All of these hemoglobin variants caused additional peaks in the chromatograms, without HbA1c results in patients with Hb Graz and Hb Sherwood Forest, and demonstrated extra peaks with HbA1c results that were clinically too low for patients with Hb O Padova and in the patient with HbD. CONCLUSIONS The development of this automated HPLC method modification with high-resolution beta-thalassemia screening mode aids identification of interference due to some clinically silent Hb variants in HbA(1c) determination.
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Affiliation(s)
- Wolfgang J Schnedl
- Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria.
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Schnedl WJ, Lahousen T, Lang T, Lipp RW, Yonehara S, Fukunaga S, Imai T, Little RR. Determination of glycated hemoglobin in clinically silent hemoglobin variants. Diabetes Metab Res Rev 2004; 20:460-5. [PMID: 15386816 DOI: 10.1002/dmrr.483] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Evaluation of glycated hemoglobin determination methods in patients with clinically silent hemoglobin variants. METHODS HbA1c results were determined with various methods, including a new enzymatic assay, a boronate affinity HPLC, immunoassays and ion-exchange HPLC in patients with the clinically silent hemoglobin variants Hb Graz, Hb Sherwood Forest, Hb D and Hb O Padova. RESULTS The effect of hemoglobin variants on glycated hemoglobin determination was method-dependent. The enzymatic and boronate affinity HPLC method did not interfere with any of the variants evaluated. In contrast, Hb Graz interfered with all immunoassay and ion-exchange HPLC methods evaluated. The Tosoh ion-exchange HPLC method HLC-723 did not detect the late migrating Hb O Padova in the chromatogram, but this hemoglobin variant still interfered causing artificially low HbA1c results. CONCLUSIONS Our study underscores the need for clinical laboratories and physicians to be aware of the limitations of their HbA1c assay methods as well as the importance of visual inspection of ion-exchange chromatograms to detect abnormalities caused by the hemoglobin variants. Samples with clinically silent Hb variants should be analyzed by a second method with a different assay principle, preferably a boronate affinity HPLC or an enzymatic assay.
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Affiliation(s)
- Wolfgang J Schnedl
- Department of Internal Medicine, Medical University, School of Medicine, Graz, Austria.
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Camargo JL, Gross JL. Conditions associated with very low values of glycohaemoglobin measured by an HPLC method. J Clin Pathol 2004; 57:346-9. [PMID: 15047733 PMCID: PMC1770269 DOI: 10.1136/jcp.2002.007088] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To identify the causes of very low glycohaemoglobin (GHb) values in a sample of patients with diabetes in southern Brazil using high performance liquid chromatography. METHODS Between August 1996 and December 2001 all samples from patients with diabetes at a university hospital with GHb values below the reference range (4.7-6.0% HbA(1c)) were submitted to cellulose acetate electrophoresis. Medical records were reviewed to identify conditions that might be associated with these low values. RESULTS Among 29 657 samples analysed, 130 patients had GHb < 4.7%. Seventy three patients (56%) were heterozygous for HbS, HbC, or HbD (19 black, two mulatto, and 52 white patients). The other 57 patients (44%) without Hb variants had low haematocrit and haemoglobin values (42 patients) or other conditions such as pregnancy, lipaemia, malignancy, cirrhosis, acetylsalicylic acid use, and absence of diabetes (15 patients). CONCLUSIONS The presence of an Hb variant may falsely lower GHb measurements. However, anaemia is also a source of negative interference. The haematological status should be considered for the correct interpretation of GHb results.
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Affiliation(s)
- J L Camargo
- Clinical Pathology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Miller AR, Etgen GJ. Novel peroxisome proliferator-activated receptor ligands for Type 2 diabetes and the metabolic syndrome. Expert Opin Investig Drugs 2003; 12:1489-500. [PMID: 12943493 DOI: 10.1517/13543784.12.9.1489] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As the incidence of Type 2 diabetes has reached near epidemic proportions, the quest for novel therapies to combat this disorder has intensified dramatically. In recent years, the peroxisome proliferator-activated receptor (PPAR) family has received tremendous attention as perhaps an ideal target class to address the multiple metabolic anomalies associated with the diabetic state. This review focuses on a variety of novel PPAR approaches currently being investigated for Type 2 diabetes or the metabolic syndrome, including the highly potent selective PPAR agonists, PPAR combination agonists and alternative PPAR ligands.
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Affiliation(s)
- Anne R Miller
- Endocrine Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46285, USA
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Polgreen PM, Putz D, Stapleton JT. Inaccurate glycosylated hemoglobin A1C measurements in human immunodeficiency virus-positive patients with diabetes mellitus. Clin Infect Dis 2003; 37:e53-6. [PMID: 12905153 DOI: 10.1086/376633] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2003] [Accepted: 04/17/2003] [Indexed: 11/03/2022] Open
Abstract
Persistent differences in blood glucose and serum glycosylated hemoglobin (HbA1C) measurements were observed in 4 human immunodeficiency virus-positive patients with diabetes mellitus, all of whom were taking drugs associated with hemolysis, which interferes with the reliability of HbA1C levels. Determination of fructosamine levels was a more accurate alternative for measuring average glycemic control in these patients.
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Affiliation(s)
- Philip M Polgreen
- Department of Internal Medicine and Research, Iowa City Veterans Administration Medical Center and University of Iowa, Iowa City, IA, USA.
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Twomey PJ, Wierzbicki AS, Reynolds TM. Issues to consider when attempting to achieve the American Diabetes Association clinical quality requirement for haemoglobin A1c. Curr Med Res Opin 2003; 19:719-23. [PMID: 14687443 DOI: 10.1185/030079903125002432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Diabetes mellitus is a chronic disease that is monitored by measurement of haemoglobin A1c (A1C) as an index of glycaemic control. The limitations of using A1C, given the consensus clinical practice recommendations made by the American Diabetes Association, need to be better understood by clinicians. These include bias between DCCT-aligned methods, analytical variation and intra-individual variation. As intra-individual variation is the principal factor determining variation in A1C in rolling means of the last four A1C results and to stable patients, clinicians may need to monitor A1C more frequently to achieve precise results. Laboratories need to report current values and the analyse six internal quality control specimens for each analytical run. 'Delta check' criteria ought to be applied and results reported to highlight acute deviations in A1C. Such procedures will aid the attainment of the clinical quality requirements and give appropriate results for audit purposes.
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Affiliation(s)
- Patrick J Twomey
- Specialist Registrar in Clinical Biochemistry, Edinburgh Royal Infirmary, Edinburgh, UK.
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Lahousen T, Roller RE, Lipp RW, Schnedl WJ. Silent haemoglobin variants and determination of HbA(1c) with the HPLC Bio-Rad Variant II. J Clin Pathol 2002; 55:699-703. [PMID: 12195002 PMCID: PMC1769758 DOI: 10.1136/jcp.55.9.699] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2002] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the determination of HbA(1c) with an automated high performance liquid chromatography (HPLC) method in patients with clinically silent haemoglobin variants. METHODS HbA(1c) values were determined with the ion exchange HPL Bio-Rad Variant II using the high resolution beta thalassaemia programme in patients with silent haemoglobin variants, namely: Hb Graz, Hb Sherwood Forest, Hb O Padova, and Hb D. RESULTS All of these haemoglobin variants caused additional peaks in the chromatograms. No clinically useful HbA(1c) results were produced for patients with Hb Graz and Hb Sherwood Forest, the results for the patient with Hb D were too low, but the results for patients with Hb O Padova were acceptable. CONCLUSIONS The development of this automated HPLC method modification with high resolution mode aids the identification of interference caused by the described clinically silent haemoglobin variants in HbA(1c) determination.
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Affiliation(s)
- T Lahousen
- Department of Internal Medicine, Karl-Franzens University School of Medicine, Auenbruggerplatz 15, A-8036 Graz, Austria
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Roberts WL, De BK, Brown D, Hanbury CM, Hoyer JD, John WG, Lambert TL, Lundell RB, Rohlfing C, Little RR. Effects of Hemoglobin C and S Traits on Eight Glycohemoglobin Methods. Clin Chem 2002. [DOI: 10.1093/clinchem/48.2.383] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- William L Roberts
- University of Utah, Department of Pathology, Salt Lake City, UT 84132
| | - Barun K De
- University of Mississippi Medical Center, Department of Pathology, Jackson, MS 39216
| | | | | | - James D Hoyer
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN 55905
| | - W Garry John
- St. Bartholomew’s Hospital, Clinical Biochemistry Department, London EC1A 7BE, United Kingdom
| | - Thomas L Lambert
- Reno Veterans Affairs Medical Center, Department of Pathology and Clinical Laboratory Services, Reno, NV 89520
| | - Ryan B Lundell
- University of Utah, Department of Pathology, Salt Lake City, UT 84132
| | - Curt Rohlfing
- University of Missouri-Columbia School of Medicine, Departments of Child Health and Pathology, Columbia, MO 65212
| | - Randie R Little
- University of Missouri-Columbia School of Medicine, Departments of Child Health and Pathology, Columbia, MO 65212
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Affiliation(s)
- Amy Yan
- Department of Chemistry and Biochemistry, Institute for Cell and Molecular Biology, University of Texas at Austin, Austin, Texas 78712, USA
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Nazliel B, Yetkin I, Irkeç C, Koçer B. Current literature in diabetes. Diabetes Metab Res Rev 2001; 17:402-9. [PMID: 11747147 DOI: 10.1002/dmrr.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 17 sections: 1 Books, Reviews & Symposia; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Prediction; 7 Prevention; 8 INTERVENTION: a&rpar General; b&rpar Pharmacology; 9 Pathology: a&rpar General; b&rpar Cardiovascular; c&rpar Neurological; d&rpar Renal; 10 Endocrinology & Metabolism; 11 Nutrition; 12 Animal Studies; 13 Techniques. Within each section, articles are listed in alphabetical order with respect to author (9 Weeks journals - Search completed at 1st Aug 2001)
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Affiliation(s)
- B Nazliel
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
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