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Sakane N, Hirota Y, Yamamoto A, Miura J, Takaike H, Hoshina S, Toyoda M, Saito N, Hosoda K, Matsubara M, Tone A, Kawashima S, Sawaki H, Matsuda T, Domichi M, Suganuma A, Sakane S, Murata T. Factors associated with hemoglobin glycation index in adults with type 1 diabetes mellitus: The FGM-Japan study. J Diabetes Investig 2023; 14:582-590. [PMID: 36789495 PMCID: PMC10034957 DOI: 10.1111/jdi.13973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 02/16/2023] Open
Abstract
AIMS/INTRODUCTION The discrepancy between HbA1c and glucose exposure may have significant clinical implications; however, the association between the hemoglobin glycation index (HGI) and clinical parameters in type 1 diabetes remains controversial. This study aimed to find the factors associated with HGI (laboratory HbA1c - predicted HbA1c derived from the continuous glucose monitoring [CGM]). MATERIALS AND METHODS We conducted a cross-sectional study of adults with type 1 diabetes (n = 211, age 50.9 ± 15.2 years old, female sex = 59.2%, duration of CGM use = 2.1 ± 1.0 years). All subjects wore the CGM for 90 days before HbA1c measurement. Data derived from the FreeStyle Libre sensor were used to calculate the glucose management indicator (GMI) and glycemic variability (GV) parameters. HGI was defined as the difference between the GMI and the laboratory HbA1c levels. The participants were divided into three groups according to the HGI tertile (low, moderate, and high). Multivariate regression analyses were performed. RESULTS The female sex ratio, HbA1c, and % coefficient of variation (%CV) significantly increased over the HGI tertile, while eGFR and Hb decreased over the HGI tertile. In multivariate analysis, the factors associated with HGI were %CV and eGFR, after adjusting for HbA1c level and sex (R2 = 0.44). CONCLUSIONS This study demonstrated that HGI is associated with female sex, eGFR, and some glycemic variability indices, independently of HbA1c. Minimizing glycemic fluctuations might reduce HGI. This information provides diabetic health professionals and patients with personalized diabetes management for adults with type 1 diabetes.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Akane Yamamoto
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hiroko Takaike
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Sari Hoshina
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Nobumichi Saito
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masaki Matsubara
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of General Medicine, Nara Medical University, Nara, Japan
| | - Atsuhito Tone
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | | | - Hideaki Sawaki
- Sawaki Internal Medicine and Diabetes Clinic, Osaka, Japan
| | | | - Masayuki Domichi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Seiko Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Murata
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Johnson MP, Keyho R, Blackburn NB, Laston S, Kumar S, Peralta J, Thapa SS, Towne B, Subedi J, Blangero J, Williams-Blangero S. Glycated Serum Protein Genetics and Pleiotropy with Cardiometabolic Risk Factors. J Diabetes Res 2019; 2019:2310235. [PMID: 31089471 PMCID: PMC6476113 DOI: 10.1155/2019/2310235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/20/2018] [Accepted: 01/12/2019] [Indexed: 01/08/2023] Open
Abstract
Measurements of fasting glucose (FG) or glycated hemoglobin A1c (HbA1c) are two clinically approved approaches commonly used to determine glycemia, both of which are influenced by genetic factors. Obtaining accurate measurements of FG or HbA1c is not without its challenges, though. Measuring glycated serum protein (GSP) offers an alternative approach for assessing glycemia. The aim of this study was to estimate the heritability of GSP and GSP expressed as a percentage of total serum albumin (%GA) using a variance component approach and localize genomic regions (QTLs) that harbor genes likely to influence GSP and %GA trait variation in a large extended multigenerational pedigree from Jiri, Nepal (n = 1,800). We also performed quantitative bivariate analyses to assess the relationship between GSP or %GA and several cardiometabolic traits. Additive genetic effects significantly influence variation in GSP and %GA levels (p values: 1.15 × 10-5 and 3.39 × 10-5, respectively). We localized a significant (LOD score = 3.18) and novel GSP QTL on chromosome 11q, which has been previously linked to type 2 diabetes. Two common (MAF > 0.4) SNPs within the chromosome 11 QTL were associated with GSP (adjusted pvalue < 5.87 × 10-5): an intronic variant (rs10790184) in the DSCAML1 gene and a 3'UTR variant (rs8258) in the CEP164 gene. Significant positive correlations were observed between GSP or %GA and blood pressure, and lipid traits (p values: 0.0062 to 1.78 × 10-9). A significant negative correlation was observed between %GA and HDL cholesterol (p = 1.12 × 10-5). GSP is influenced by genetic factors and can be used to assess glycemia and diabetes risk. Thus, GSP measurements can facilitate glycemic studies when accurate FG and/or HbA1c measurements are difficult to obtain. GSP can also be measured from frozen blood (serum) samples, which allows the prospect of retrospective glycemic studies using archived samples.
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Affiliation(s)
- Matthew P. Johnson
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
| | - Ryan Keyho
- The University of Texas at Austin, Austin, Texas 78705, USA
| | - Nicholas B. Blackburn
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
| | - Sandra Laston
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
| | - Satish Kumar
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
| | - Juan Peralta
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Suman S. Thapa
- Tilganga Institute of Ophthalmology, Gaushala, Bagmati Bridge, P.O. Box 561, Kathmandu, Nepal
| | - Bradford Towne
- Department of Population Health and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Kettering, Ohio 45435, USA
| | - Janardan Subedi
- Department of Sociology and Gerontology, College of Arts and Science, Miami University, Oxford, Ohio 45056, USA
| | - John Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
| | - Sarah Williams-Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, Texas 78520, USA
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Zemlin AE, Barkhuizen M, Kengne AP, Erasmus RT, Matsha TE. Performance of glycated albumin for type 2 diabetes and prediabetes diagnosis in a South African population. Clin Chim Acta 2018; 488:122-128. [PMID: 30395867 DOI: 10.1016/j.cca.2018.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/19/2018] [Accepted: 11/01/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the utility of glycated albumin (GA%) as a diagnostic marker of type 2 diabetes and prediabetes in an African population. METHODS GA% levels were determined in a sample of 1294 mixed ancestry adults (74.2% women) residing in Cape Town using an enzymatic method. The participants' glycemic status was based on oral glucose tolerance test (OGTT). RESULTS The mean age was 47.8 years with a mean body mass index (BMI) of 28.7 kg/m2. Obesity was more pronounced in the screen-detected diabetes and prediabetes groups with mean BMI's of 32.5 kg/m2 and 31.5 kg/m2 respectively. The optimal thresholds of GA% to diagnose screen-detected diabetes and prediabetes, were 14.90% and 12.75% respectively. For screen-detected diabetes, the C-statistic was higher for HbA1c than GA% (p = .034) with values of 0.899 (95% CI 0.855-0.943) and 0.873 (0.782-0.892) respectively. The agreement between GA% and HbA1c at their optimal thresholds for diagnosing screen-detected diabetes, was kappa = 0.33 (95% CI 0.26-0.40) and was higher than the agreement for prediabetes, kappa = 0.16 (0.11-0.21). The performance of GA% to identify screen-detected diabetes at the optimal threshold of 14.90%, was 64.8% (95% CI 54.1%-74.6%) for sensitivity and 93.5% (92.0%-94.9%) for specificity. GA% was significantly less sensitive, but more specific than HbA1c (at the optimal threshold of 6.15%) for screen-detected diabetes diagnosis (both p ≤ .002 from McNemar tests for sensitivity and specificity comparisons). CONCLUSIONS GA% performed less well than HbA1c to identify participants with OGTT-diagnosed type 2 diabetes or prediabetes (HbA1c cut-off of 6.15% and 5.95% respectively) in this population.
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Affiliation(s)
- Annalise E Zemlin
- Department of Pathology, Chemical Pathology Division, National Health Laboratory Service (NHLS) and University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa.
| | - Marizna Barkhuizen
- Department of Pathology, Chemical Pathology Division, National Health Laboratory Service (NHLS) and University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Andre P Kengne
- Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, South Africa; Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Rajiv T Erasmus
- Department of Pathology, Chemical Pathology Division, National Health Laboratory Service (NHLS) and University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Tandi E Matsha
- Department of Biomedical Sciences, Cape Peninsula University of Technology, South Africa.
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Musha I, Mochizuki M, Kikuchi T, Akatsuka J, Ohtake A, Kobayashi K, Kikuchi N, Kawamura T, Yokota I, Urakami T, Sugihara S, Amemiya S. Estimation of glycaemic control in the past month using ratio of glycated albumin to HbA 1c. Diabet Med 2018; 35:855-861. [PMID: 29653463 DOI: 10.1111/dme.13640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 12/28/2022]
Abstract
AIMS To evaluate comprehensively the use of the glycated albumin to HbA1c ratio for estimation of glycaemic control in the previous month. METHODS A total of 306 children with Type 1 diabetes mellitus underwent ≥10 simultaneous measurements of glycated albumin and HbA1c . Correlation and concordance rates were examined between HbA1c measurements taken 1 month apart (ΔHbA1c ) and glycated albumin/HbA1c ratio fluctuations were calculated as Z-scores from the cohort value at enrolment of this study cohort (method A) or the percent difference from the individual mean over time (method B). RESULTS Fluctuations in glycated albumin/HbA1c ratio (using both methods) were weakly but significantly correlated with ΔHbA1c , whereas concordance rates were significant for glycaemic deterioration but not for glycaemic improvement. Concordance rates were higher using method B than method A. CONCLUSIONS The glycated albumin/HbA1c ratio was able to estimate glycaemic deterioration in the previous month, while estimation of glycaemic improvement in the preceding month was limited. Because method B provided a better estimate of recent glycaemic control than method A, the individual mean of several measurements of the glycated albumin/HbA1c ratio over time may also identify individuals with high or low haemoglobin glycation phenotypes in a given population, such as Japanese children with Type 1 diabetes, thereby allowing more effective diabetes management.
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Affiliation(s)
- I Musha
- Department of Paediatrics, Saitama Medical University, Saitama, Japan
| | - M Mochizuki
- Department of Paediatrics, University of Yamanashi, Yamanashi, Japan
| | - T Kikuchi
- Department of Paediatrics, Saitama Medical University, Saitama, Japan
| | - J Akatsuka
- Department of Paediatrics, Saitama Medical University, Saitama, Japan
| | - A Ohtake
- Department of Paediatrics, Saitama Medical University, Saitama, Japan
| | - K Kobayashi
- Department of Paediatrics, University of Yamanashi, Yamanashi, Japan
| | - N Kikuchi
- Department of Paediatrics, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - T Kawamura
- Department of Paediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - I Yokota
- Division of Paediatrics Endocrinology and Metabolism, Shikoku Medical Centre for Children and Adults, Kagawa, Japan
| | - T Urakami
- Department of Paediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - S Sugihara
- Department of Paediatrics, Tokyo Women's Medical University Medical Centre East, Tokyo, Japan
| | - S Amemiya
- Department of Paediatrics, Saitama Medical University, Saitama, Japan
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Kim MK, Jeong JS, Kwon HS, Baek KH, Song KH. Concordance the hemoglobin glycation index with glycation gap using glycated albumin in patients with type 2 diabetes. J Diabetes Complications 2017; 31:1127-1131. [PMID: 28487124 DOI: 10.1016/j.jdiacomp.2017.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/24/2017] [Accepted: 04/12/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The hemoglobin glycation index (HGI) is an index of differences in the glycation of hemoglobin according to blood glucose level. The glycation gap (G-gap) is an empiric measure of the extent of disagreement between hemoglobin A1C (HbA1C) and glycated albumin (GA). The aim of this study was to investigate the extent of agreement between the HGI and G-gap with respect to GA level, and to elucidate factors related to a high HGI. METHOD Data were obtained from 105 patients with type 2 diabetes, and fasting blood glucose (FBG), HbA1c, and GA values were measured simultaneously. The G-gap was calculated as the difference between the measured and GA-based predicted HbA1c levels. HGI was calculated as the difference between measured and FBG-based predicted HbA1c levels. RESULTS The HGI and G-gap were highly correlated according GA (r=0.722, P<0.001). In general, the two indices were similar in terms of both direction and magnitude. The classification of patients as high, moderate, or low glycators based on HGI versus G-gap was consistent for the majority of the population and only 5% of patients were reclassified from high to low or low to high. Fasting C-peptide levels decreased linearly, and the percentage of patients using insulin increased linearly, between the lowest and highest HGI tertile (both P<0.05). CONCLUSIONS There was 95% agreement between the HGI and G-gap using GA among type 2 diabetes patients. Furthermore, a high HGI was associated with a higher prevalence of insulin use among type 2 diabetes patients.
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Affiliation(s)
- Mee Kyoung Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jee Sun Jeong
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Hyun Baek
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Ho Song
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Paleari R, Bonetti G, Callà C, Carta M, Ceriotti F, Di Gaetano N, Ferri M, Guerra E, Lavalle G, Cascio CL, Martino FG, Montagnana M, Moretti M, Santini G, Scribano D, Testa R, Vero A, Mosca A. Multicenter evaluation of an enzymatic method for glycated albumin. Clin Chim Acta 2017; 469:81-86. [PMID: 28365449 DOI: 10.1016/j.cca.2017.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 03/28/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND The use of glycated albumin (GA) has been proposed as an additional glycemic control marker particularly useful in intermediate-term monitoring and in situation when HbA1c test is not reliable. METHODS We have performed the first multicenter evaluation of the analytical performance of the enzymatic method quantILab Glycated Albumin assay implemented on the most widely used clinical chemistry analyzers (i.e. Abbott Architect C8000, Beckman Coulter AU 480 and 680, Roche Cobas C6000, Siemens ADVIA 2400 and 2400 XPT). RESULTS The repeatability of the GA measurement (expressed as CV, %) implemented in the participating centers ranged between 0.9% and 1.2%. The within-laboratory CVs ranged between 1.2% and 1.6%. A good alignment between laboratories was found, with correlation coefficients from 0.996 to 0.998. Linearity was confirmed in the range from 7.6 to 84.7%. CONCLUSION The new enzymatic method for glycated albumin evaluated by our investigation is suitable for clinical use.
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Affiliation(s)
- Renata Paleari
- Dip. di Fisiopatologia Medico-Chirurgica e dei Trapianti and Centro per la Riferibilità Metrologica in Medicina di Laboratorio (CIRME), Università degli Studi di Milano, Milano, Italy
| | - Graziella Bonetti
- Laboratorio Analisi Chimico Cliniche, ASST Spedali Civili, Brescia, Italy
| | - Cinzia Callà
- Polo Scienze delle Immagini, di Laboratorio ed Infettivologiche. Fondazione Policlinico Universitario A. Gemelli, Università Cattolica Sacro Cuore, Roma, Italy
| | | | - Ferruccio Ceriotti
- Central Laboratory, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Di Gaetano
- Instrumentation Laboratory - A Werfen Company, R&D Department, Milano, Italy
| | - Marilisa Ferri
- Laboratorio Analisi di Urbino, Azienda Sanitaria Unica Regione Marche Area Vasta 1, Fano, PU, Italy
| | - Elena Guerra
- Laboratorio di Standardizzazione, Servizio Medicina di Laboratorio, Ospedale S. Raffaele, Milano, Italy
| | | | - Claudia Lo Cascio
- UOC Laboratorio Analisi, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | | | - Martina Montagnana
- Sezione di Biochimica Clinica, Dip. di Neuroscienze, Biomedicina e Movimento, Università degli Studi di Verona, Verona, Italy
| | - Marco Moretti
- Patologia Clinica Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro, Italy
| | - Gabriele Santini
- Instrumentation Laboratory - A Werfen Company, R&D Department, Milano, Italy
| | - Donata Scribano
- Polo Scienze delle Immagini, di Laboratorio ed Infettivologiche. Fondazione Policlinico Universitario A. Gemelli, Università Cattolica Sacro Cuore, Roma, Italy
| | - Roberto Testa
- Modelli di Integrazione Multidisciplinare in Patologia Clinica, INRCA-IRCCS, Ancona, Italy
| | - Anna Vero
- Laboratorio di Analisi Chimico-Clinica, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | - Andrea Mosca
- Dip. di Fisiopatologia Medico-Chirurgica e dei Trapianti and Centro per la Riferibilità Metrologica in Medicina di Laboratorio (CIRME), Università degli Studi di Milano, Milano, Italy.
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