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Ray A, Atal S, Sharma S, Sampath A. Comparison of Glycated Hemoglobin (HbA1c) Values Estimated by High-Performance Liquid Chromatography and Spectrophotometry: A Pilot Study. Cureus 2024; 16:e56964. [PMID: 38665712 PMCID: PMC11044070 DOI: 10.7759/cureus.56964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Background Invasive blood sample collection followed by high-performance liquid chromatography (HPLC) based analysis is the gold standard for estimating glycated hemoglobin level or HbA1c currently. Spectrophotometry could be an alternative that holds the potential to be translated into a portable, non-invasive device for glycated hemoglobin level estimation. This study compares HbA1c values obtained from HPLC and spectrophotometry. Methods Venous blood samples were collected from both diabetic and non-diabetic participants in a cross-sectional study. The samples were subjected to both HPLC and spectrophotometry-based estimation of HbA1c%. The results obtained were compared, and the relationship between the two estimations were assessed. Results About 15 diabetic and non-diabetic individuals participated in the study and 28 samples were included in the final analysis. The Pearson's correlation coefficient was 0.65 (95% CI, 0.37-0.82), indicating that there was a strong positive association. This was further supported by the findings from linear regression analysis with a p-value of <0.001. Conclusions The positive correlation between the HPLC and spectrophotometric values supports the hypothesis that spectrophotometry could be an alternative to conventional HPLC for the measurement of HbA1c. This needs to be further validated through larger, well-powered studies.
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Affiliation(s)
- Avik Ray
- Epidemiology and Public Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Shubham Atal
- Pharmacology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Swati Sharma
- Pharmacology and Therapeutics, Cactus Communications, Mumbai, IND
| | - Ananyan Sampath
- Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Incidental Detection of Hemoglobin Variants During Evaluation of HbA1c. Indian J Clin Biochem 2021; 37:242-246. [PMID: 35463112 PMCID: PMC8994008 DOI: 10.1007/s12291-020-00936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
HemoglobinA1c (HbA1c) is used to diagnose Diabetes mellitus and monitor glycemic control over the previous eight to twelve weeks in diabetic patients. Detection of HbA1c by cation exchange-high performance liquid chromatography (CE-HPLC) gives a chromatogram by which abnormal hemoglobin variants are also picked up. Some of these may interfere with HbA1c values affecting clinical management. Due to increased inter-state migration as well as medical tourism, there is a high possibility of finding various hemoglobin variants in any part of India. We did a prospective analysis over 1.5 years, of the hemoglobin variants detected during all the HbA1c runs. The HbA1c was tested on Bio-Rad D10 dual HbA2/F/A1c platform, which uses the CE-HPLC method. Every chromatogram was carefully studied to look for unknown peaks. The samples showing unknown peaks >6% were re-run in extended HbA2/F mode to categorize the hemoglobin variants. We had 9595 HbA1c samples, of which 70 cases showed a variant window. There were 40 males and 30 females, age ranging from 28 to 76 years. The different hemoglobin variants detected were HbD, HbE and HbS in heterozygous state, high HbF (with a differential diagnosis of HPFH heterozygous and delta-beta thalassemia heterozygous), HbE homozygous, HbQ heterozygous and HbJ heterozygous. We conclude that in the process of monitoring glycemic control using HbA1c, we can also pick-up hemoglobin variants. Hence, it is essential to review HbA1c graphs, so that the diagnosis of hemoglobin variants is not missed and the HbA1c reported is reliable.
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Wang Z, Xing G, Zhang L. Glycated albumin level is significantly decreased in patients suffering nephrotic syndrome. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 162:307-319. [DOI: 10.1016/bs.pmbts.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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A case of undetectable glycosylated hemoglobin. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-015-0361-9] [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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Piehler AP, Grimholt RM, Bjerner J, Buchmann MS. Interference of common haemoglobin variants with the Tosoh G7 standard mode HbA1c method. Scandinavian Journal of Clinical and Laboratory Investigation 2015; 75:362-6. [PMID: 25858015 DOI: 10.3109/00365513.2015.1031687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND HbA1c methods may be prone to interference by the presence of haemoglobin variants. In contrast to the variant mode of the HbA1c method on the Tosoh G7 instrument, the literature lacks investigations of haemoglobin variant interference with the standard mode. The current study sought to investigate whether different haemoglobin variants interfere with the Tosoh G7 standard mode HbA1c method, and whether present haemoglobin variants are identifiable on respective chromatograms. METHODS Samples routinely analyzed for HbA1c and suspected of having haemoglobin variants (N = 103) were included. HbA1c was measured on a Tosoh G7 in standard mode (Tosoh Corporation, Japan), and on the DCA Vantage (Siemens, Germany). Haemoglobin variants were identified using the VARIANT(™)β-Thalassemia Short Program (Bio-Rad Laboratories, Hercules, CA, USA) and by DNA sequencing. RESULTS The Tosoh G7 in standard mode measured significantly lower HbA1c results (between 1.0 and 2.5 percentage points absolute bias corresponding to between 11 and 27 mmol/mol, p < 0.001) in samples in which common haemoglobin variants (HbS, HbC, HbD or HbE) were present (n = 61). No significant difference in HbA1c (0.04 percentage points, p = 0.74) was found between Tosoh G7 standard mode and DCA Vantage in samples in which haemoglobin variants were absent (n = 36). In contrast to HbS and HbD, HbE and HbC trait could be identified on respective chromatograms. CONCLUSION The presence of common haemoglobin variants results in falsely low HbA1c measurements on the Tosoh G7 in standard mode. HbS and HbD trait are not identifiable on respective haemoglobin chromatograms.
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O Ekpebegh C, Longo-Mbenza B, Blanco-Blanco E. Glycosylated haemoglobin is markedly elevated in new and known diabetes patients with hyperglycaemic ketoacidosis. Afr Health Sci 2014; 14:526-32. [PMID: 25352868 DOI: 10.4314/ahs.v14i3.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Glycosylated haemoglobin (HbA1c) and random blood glucose are markers of chronic and acute hyperglycaemia respectively. OBJECTIVE We compared HbA1c levels in ketoacidosis (DKA) occurring in known and newly diagnosed diabetes. METHODS Retrospective review of medical records for 83 DKA admissions in 2008 and 2009 with results for HbA1c at presentation. RESULTS There were 52 and 31 DKA admissions in known and newly diagnosed diabetes patients respectively. Fifty of the 83 DKA admissions were in females. The mean age (per admissions) and HbA1c of all admissions are 43.4 ± 20.3 years (n=83) and 12.7 ± 3.4 % (n=83) respectively. Mean HbA1c in known Type 1, known Type 2 and newly diagnosed diabetes patients were similarly very high: 12.4 ± 3.3 %, 12.5 ± 3.3 %, 13.1 ± 3.7 %; P = 0.6828. The HbA1c levels in newly diagnosed diabetes patients less than 30 years (likely Type 1 diabetes) and ≥ 30 years (likely Type 2 diabetes) were similar. There was a tendency to significantly positive correlation between blood glucose and HbA1c in new diabetes patients. CONCLUSIONS In our setting, DKA is associated with markedly elevated HbA1c levels in known type 1, known type 2 and new onset diabetes.
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Affiliation(s)
- Chukwuma O Ekpebegh
- Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Private Mail Bag X1, Mthatha, Postal code 5117, Mthatha, Eastern Cape Province, South Africa
| | - Benjamin Longo-Mbenza
- Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Private Mail Bag X1, Mthatha, Postal code 5117, Mthatha, Eastern Cape Province, South Africa
| | - Ernesto Blanco-Blanco
- Department of Chemical Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Private Mail Bag X1, Mthatha, Postal code 5117, Mthatha, Eastern Cape Province, South Africa
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Koga M. Glycated albumin; clinical usefulness. Clin Chim Acta 2014; 433:96-104. [PMID: 24631132 DOI: 10.1016/j.cca.2014.03.001] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/28/2014] [Accepted: 03/02/2014] [Indexed: 12/13/2022]
Abstract
The main purpose of treating diabetes is to prevent the onset and progression of diabetic chronic complications. Since the mechanism of onset of chronic complications is still not well understood, the main strategy to achieve this purpose is to bring plasma glucose levels as close as possible to those in healthy subjects and maintain good glycemic control over the long term. Since glycation among various proteins is increased in diabetic patients compared with non-diabetic subjects, glycated protein can be used as a glycemic control indicator. Currently, among these glycated proteins, HbA1c is used as the gold standard of glycemic control indicators. However, HbA1c does not accurately reflect the actual status of glycemic control in some conditions with rapid changes in glycemic control and in patients with anemia (hemolytic anemia, iron deficiency anemia, etc.) and variant hemoglobin. In comparison, glycated albumin (GA) more accurately reflects changes in plasma glucose during the short term and postprandial plasma glucose. GA also reflects glycemic control in patients with hematologic disorders whereas GA does not reflect glycemic control in patients with disorder of albumin metabolism. GA is a glycemic control indicator which overcomes most of the disadvantages of HbA1c, and could be therefore expected to replace HbA1c as the standard glycemic control indicator in the near future. However, it is necessary to accumulate more evidences from large research studies on the effective directions for measuring GA.
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Affiliation(s)
- Masafumi Koga
- Department of Internal Medicine, Kawanishi City Hospital, Hyogo, Japan.
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Mallya M, Shenoy R, Kodyalamoole G, Biswas M, Karumathil J, Kamath S. Absorption spectroscopy for the estimation of glycated hemoglobin (HbA1c) for the diagnosis and management of diabetes mellitus: a pilot study. Photomed Laser Surg 2013; 31:219-24. [PMID: 23597421 DOI: 10.1089/pho.2012.3421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore the possibility of using absorption spectroscopy technique for the estimation of glycated hemoglobin HbA1c (%). BACKGROUND DATA Glycated hemoglobin (HbA1c) is an important marker in the diagnosis and management of diabetes mellitus. Different assay techniques have been employed for the estimation of glycated hemoglobin, including ion exchange high performance liquid chromatography (HPLC), electrophoresis, affinity chromatography, immunoturbidimetric assay and colorimetric assays, which measure different glycated products and report using different units. Spectroscopic measurements have been shown to be very sensitive and nondestructive, and require very little quantity of material for analysis. In the present study, we have employed absorption spectroscopy technique for the estimation of glycated hemoglobin in hemolysate samples of diabetic patients. MATERIALS AND METHODS The blood samples of individuals with normal glycemic status and confirmed diabetic patients were collected from the Clinical Biochemistry Laboratory, Kasturba Hospital, Manipal. The absorption spectra of glycated hemoglobin (HbA1c) samples were recorded in the spectral range 200-850 nm using an optic fiber based Ocean Optics CHEMUSB4-UV-VIS single beam spectrophotometer. The parameter "area under the curve" of each baseline corrected absorption spectrum was used for the estimation of HbA1c (%). The glycated hemoglobin values obtained by this spectroscopic method were compared with the values reported by the standard ion exchange HPLC method. RESULTS A total of 30 absorption spectra were recorded from hemolysate samples with HbA1c (%) in the range 4-10.5%. A good correlation was observed between the glycated hemoglobin values obtained by the spectroscopic method and those obtained by the standard HPLC method. CONCLUSIONS It appears that the direct absorption spectroscopy of hemolysate samples, therefore, may be utilized as a supplementary technique for the estimation of HbA1c (%), even at the primary healthcare centers.
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Affiliation(s)
- Madhukar Mallya
- Department of Biochemistry, KMC International Center, Manipal University, Manipal, Karnataka, India
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Piehler AP, Grimholt RM, Bjerner J, Urdal P, Buchmann M. Discrepancy between HbA1c and fasting glucose results due to HbD. Scandinavian Journal of Clinical and Laboratory Investigation 2012. [PMID: 23198773 DOI: 10.3109/00365513.2012.744089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Çolak S, Geyikoğlu F, Aslan A, Deniz GY. Effects of lichen extracts on haematological parameters of rats with experimental insulin-dependent diabetes mellitus. Toxicol Ind Health 2012; 30:878-87. [DOI: 10.1177/0748233712466130] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of diabetes mellitus in the world is steadily increasing. Oxidative stress contributes to the development of diabetic complications, including diabetic haematological changes. Lichens are used as food supplements and are also used as possible natural antioxidant, antimicrobial and anticancer agents. We hypothesized that antioxidant activity of lichens may decrease hyperglycaemia-induced oxidative stress and prevent the development of diabetic complications, including abnormality in haematological condition. Therefore, the effects of Cetraria islandica water extract (CIWE) and Pseudevernia furfuracea water extract (PFWE) on the haematological parameters of rats with type 1 DM were investigated for the first time in the present study. Control Sprague-Dawley or streptozotocin (STZ)-induced diabetic rats were either untreated or treated with water lichen extracts (5–500 mg/kg body weight (bw)/day) for 2 weeks, starting at 72 h after STZ injection. On day 14, animals were anaesthetized and haematological and metabolic parameters were determined between control and experimental groups. In addition, the total oxidative stress (TOS), a specific indicator of oxidative stress, and the total antioxidant capacity (TAC) were measured by biochemical studies. In diabetic rats, CIWE of 250–500 mg/kg bw dose showed more prominent results when compared with doses of PFWE for TAC. The results obtained in the present study suggested that the antioxidant activities of lichens might be the possible reason behind the observed antihaematological status. However, the protective effect of lichen extracts were inadequate on diabetes-induced microcytic hypochromic anaemia. In addition, the extracts have no effect on metabolic complications. Our experimental data showed that high doses of CIWE and PFWE alone have no detrimental effect on blood cells and TOS status of plasma. Hence, they are safe and suitable for different administration routes.
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Affiliation(s)
- Suat Çolak
- Department of Biology, Faculty of Science and Arts, Artvin Çoruh University, Artvin, Turkey
| | - Fatime Geyikoğlu
- Department of Biology, Faculty of Science, Ataturk University, Erzurum, Turkey
| | - Ali Aslan
- Department of Biology, Kazim Karabekir Education Faculty, Ataturk University, Erzurum, Turkey
| | - Gülşah Yıldız Deniz
- Department of Nursing, Gumuşhane University, Health Services Vocational School, Gumuşhane, Turkey
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