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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care 2023; 46:e151-e199. [PMID: 37471273 PMCID: PMC10516260 DOI: 10.2337/dci23-0036] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association for Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (HbA1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B. Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA
| | - George L. Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, IL
| | - David E. Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA
| | - Andrea R. Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E. Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL
| | - David M. Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA
| | - M. Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clin Chem 2023:hvad080. [PMID: 37473453 DOI: 10.1093/clinchem/hvad080] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association of Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (Hb A1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA, United States
| | - George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, ILUnited States
| | - David E Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA, United States
| | - Andrea R Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL, United States
| | - David M Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA, United States
| | - M Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
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Reddy KK, Bandal H, Satyanarayana M, Goud KY, Gobi KV, Jayaramudu T, Amalraj J, Kim H. Recent Trends in Electrochemical Sensors for Vital Biomedical Markers Using Hybrid Nanostructured Materials. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:1902980. [PMID: 32670744 PMCID: PMC7341105 DOI: 10.1002/advs.201902980] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/12/2020] [Indexed: 05/09/2023]
Abstract
This work provides a succinct insight into the recent developments in electrochemical quantification of vital biomedical markers using hybrid metallic composite nanostructures. After a brief introduction to the biomarkers, five types of crucial biomarkers, which require timely and periodical monitoring, are shortlisted, namely, cancer, cardiac, inflammatory, diabetic and renal biomarkers. This review emphasizes the usage and advantages of hybrid nanostructured materials as the recognition matrices toward the detection of vital biomarkers. Different transduction methods (fluorescence, electrophoresis, chemiluminescence, electrochemiluminescence, surface plasmon resonance, surface-enhanced Raman spectroscopy) reported for the biomarkers are discussed comprehensively to present an overview of the current research works. Recent advancements in the electrochemical (amperometric, voltammetric, and impedimetric) sensor systems constructed with metal nanoparticle-derived hybrid composite nanostructures toward the selective detection of chosen vital biomarkers are specifically analyzed. It describes the challenges involved and the strategies reported for the development of selective, sensitive, and disposable electrochemical biosensors with the details of fabrication, functionalization, and applications of hybrid metallic composite nanostructures.
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Affiliation(s)
- K. Koteshwara Reddy
- Smart Living Innovation Technology CentreDepartment of Energy Science and TechnologyMyongji UniversityYonginGyeonggi‐do17058Republic of Korea
- Laboratory of Materials ScienceInstituto de Química de Recursos NaturalesUniversidad de TalcaP.O. Box 747Talca3460000Chile
| | - Harshad Bandal
- Smart Living Innovation Technology CentreDepartment of Energy Science and TechnologyMyongji UniversityYonginGyeonggi‐do17058Republic of Korea
| | - Moru Satyanarayana
- Department of ChemistryNational Institute of Technology WarangalWarangalTelangana506004India
| | - Kotagiri Yugender Goud
- Department of ChemistryNational Institute of Technology WarangalWarangalTelangana506004India
| | | | - Tippabattini Jayaramudu
- Laboratory of Materials ScienceInstituto de Química de Recursos NaturalesUniversidad de TalcaP.O. Box 747Talca3460000Chile
| | - John Amalraj
- Laboratory of Materials ScienceInstituto de Química de Recursos NaturalesUniversidad de TalcaP.O. Box 747Talca3460000Chile
| | - Hern Kim
- Smart Living Innovation Technology CentreDepartment of Energy Science and TechnologyMyongji UniversityYonginGyeonggi‐do17058Republic of Korea
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Church DL, Naugler C. Benefits and risks of standardization, harmonization and conformity to opinion in clinical laboratories. Crit Rev Clin Lab Sci 2019; 56:287-306. [PMID: 31060412 DOI: 10.1080/10408363.2019.1615408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Large laboratory systems that include facilities with a range of capabilities and capacity are being created within consolidated healthcare systems. This paradigm shift is being driven by administrators and payers seeking to achieve resource efficiencies and to conform practice to the requirements of computerization as well as the adoption of electronic medical records. Although standardization and harmonization of practice improves patient care outcomes and operational efficiencies, administratively driven practice conformity (conformity to opinion) also has serious drawbacks and may lead to significant system failure. Juxtaposition of the distinct philosophical approaches of physicians and scientists (i.e. "professionalism") versus administrators and managers (i.e. "managerialism") towards bringing about conformity of the laboratory system inherently creates conflict. Despite an administrative edict to "perform all tests using the same methods" regardless of available "best practice" evidence to do so, medical/scientific input on these decisions is critical to ensure quality and safety of patient care. Innovation within the laboratory system, including the adoption of advanced technologies, practices, and personalized medicine initiatives, will be enabled by balancing the relentless drive by non-medical administration to meet "business" requirements, the medical responsibility to provide the best care possible, and customizing practice to meet individual patient care needs.
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Affiliation(s)
- Deirdre L Church
- a Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Canada.,b Department of Medicine , University of Calgary , Calgary , Canada
| | - Christopher Naugler
- a Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Canada.,c Department of Community Health Sciences , University of Calgary , Calgary , Canada.,d Department of Family Medicine , University of Calgary , Calgary , Canada
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Król E, Bogdański P, Suliburska J, Krejpcio Z. The Relationship between Dietary, Serum and Hair Levels of Minerals (Fe, Zn, Cu) and Glucose Metabolism Indices in Obese Type 2 Diabetic Patients. Biol Trace Elem Res 2019; 189:34-44. [PMID: 30091069 PMCID: PMC6443611 DOI: 10.1007/s12011-018-1470-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022]
Abstract
The aim of this study was to assess the levels of Zn, Fe and Cu in the serum and hair, and dietary intake of type 2 diabetic patients and their association with glucose and lipid indices. The study was conducted on 62 people aged 40-78 years (31 diabetic patients and 31 healthy subjects, who were the control group). The content of trace elements in the hair and serum was analysed with the AAS method. The serum insulin, HbA1c, glucose, total cholesterol and triacylglycerol concentrations were measured by means of RIA, HPLC and colorimetric methods, respectively. The diabetic patients were found to have significantly higher dietary iron intake, higher hair Fe and lower serum Zn concentrations than the non-diabetic subjects, while the hair Zn and Cu contents were comparable in both groups. The serum Zn and Cu levels of the diabetic subjects were negatively correlated with the serum glucose, the serum Zn and Cu/Zn ratio was inversely correlated with the serum total cholesterol and the serum insulin level was positively associated with the hair Cu/Zn ratio. The results of this study indicate that the trace element status (Zn, Fe, Cu), as reflected in the blood serum and hair, may be disturbed due to metabolic derangement occurring in diabetes.
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Affiliation(s)
- Ewelina Król
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, 31 Wojska Polskiego, 60-624, Poznan, Poland.
| | - Paweł Bogdański
- Department of Internal Medicine, Metabolic Disorders and Hypertension, Poznan University of Medical Sciences, 84 Szamarzewskiego, 60-569, Poznan, Poland
| | - Joanna Suliburska
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, 31 Wojska Polskiego, 60-624, Poznan, Poland
| | - Zbigniew Krejpcio
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, 31 Wojska Polskiego, 60-624, Poznan, Poland
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Guillén-Sacoto MA, Barquiel B, Hillman N, Burgos MÁ, Herranz L. Diabetes mellitus gestacional: control glucémico durante el embarazo y su relación con los resultados neonatales en embarazos gemelares y de feto único. ENDOCRINOL DIAB NUTR 2018; 65:319-327. [DOI: 10.1016/j.endinu.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 01/24/2018] [Accepted: 01/27/2018] [Indexed: 11/29/2022]
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Gunaid AA. Microvascular Outcomes of Pediatric-Onset Type 1 Diabetes Mellitus: A Single-Center Observational Case Reviews in Sana'a, Yemen. Clin Med Insights Endocrinol Diabetes 2018; 11:1179551417749217. [PMID: 29326539 PMCID: PMC5757421 DOI: 10.1177/1179551417749217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 11/29/2017] [Indexed: 11/16/2022] Open
Abstract
Microvascular complications of pediatric-onset type 1 diabetes are common in low-income countries. In this study, we aimed at reviewing microvascular outcomes in 6 cases with type 1 diabetes over 14 to 31 years of follow-up. Severe proliferative diabetic retinopathy (PDR) and/or diabetic macular edema (maculopathy) (DME) and overt diabetic nephropathy (macroalbuminuria) were seen among 4 of 6 patients, whereas severe diabetic peripheral neuropathy with Charcot neuroarthropathy was seen in 1 patient only, who had the longest duration of follow-up. The weighted mean (SD) (95% confidence interval) hemoglobin A1c was 8.9 (1.6) (8.4-9.4)% [74 (17) (68-80) mmol/mol] for PDR/DME and 8.6 (1.7) (8.0-9.0)% [71 (19) (65-77) mmol/mol] for macroalbuminuria. Thyroid autoimmunity was positive in 3 patients with overt hypothyroidism in 2 of them. Worse microvascular outcomes among these cases might be attributed to poor glycemic control, lack of knowledge, and limited financial resources.
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Chen CW, Drechsler C, Suntharalingam P, Karumanchi SA, Wanner C, Berg AH. High Glycated Albumin and Mortality in Persons with Diabetes Mellitus on Hemodialysis. Clin Chem 2016; 63:477-485. [PMID: 27737895 DOI: 10.1373/clinchem.2016.258319] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 08/17/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Monitoring of glycemic control with hemoglobin A1c (A1c) in hemodialysis patients may be compromised by anemia and erythropoietin therapy. Glycated albumin (GA) is an alternative measure of glycemic control but is not commonly used because of insufficient evidence of association to clinical outcomes. We tested whether GA measurements were associated with mortality in hemodialysis patients with diabetes mellitus. METHODS The German Diabetes and Dialysis Study (4D) investigated effects of atorvastatin on survival in 1255 patients with diabetes mellitus receiving hemodialysis. We measured GA during months 0, 6, and 12. Cox proportional hazards analysis was used to measure associations between GA and A1c and all-cause mortality. RESULTS Patients with high baseline GA (fourth quartile) had a 42% higher 4-year mortality compared to those in the first quartile (HR 1.42; 95% CI, 1.09-1.85, P = 0.009). Repeated measurements of GA during year one also demonstrated that individuals in the top quartile for GA (analyzed as a time-varying covariate) had a 39% higher 4-year mortality (HR 1.39; 95% CI, 1.05-1.85, P = 0.022). The associations between high A1c and mortality using similar analyses were less consistent; mortality in individuals with baseline A1c values in the 3rd quartile was increased compared to 1st quartile (HR 1.36; 95% CI, 1.04-1.77, P = 0.023), but risk was not significantly increased in the 2nd or 4th quartiles, and there was a less consistent association between time-varying A1c values and mortality. CONCLUSIONS High GA measurements are consistently associated with increased mortality in patients with diabetes mellitus on hemodialysis.
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Affiliation(s)
- Christina W Chen
- Division of Nephrology and Center for Vascular Biology Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Christiane Drechsler
- Division of Nephrology, Department of Internal Medicine 1, University Hospital Würzburg and Comprehensive Heart Failure Center, Würzburg, Germany
| | | | - S Ananth Karumanchi
- Division of Nephrology and Center for Vascular Biology Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Christoph Wanner
- Division of Nephrology, Department of Internal Medicine 1, University Hospital Würzburg and Comprehensive Heart Failure Center, Würzburg, Germany
| | - Anders H Berg
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
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9
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Jain U, Chauhan N. Glycated hemoglobin detection with electrochemical sensing amplified by gold nanoparticles embedded N-doped graphene nanosheet. Biosens Bioelectron 2016; 89:578-584. [PMID: 26897102 DOI: 10.1016/j.bios.2016.02.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/05/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
In the diabetic patients the level of glucose must be determined without any short term fluctuations. The level of Glycated hemoglobin (HbA1c) is accordingly examined for checking diabetes mellitus. HbA1c is considered one of the primarily factor to discern the concentration of average plasma glucose over a long-drawn-out period. In our work, we describe a construction of biosensor which is based on fructosyl amino-acid oxidase (FAO) immobilized nitrogen-doped graphene/gold nanoparticles (AuNPs)/fluorine doped tin oxide (FTO) glass electrode. This constructed biosensor exhibits a wide linear range of 0.3 to 2000μM in response to HbA1c at +0.2V. Consequently, the detection limit of 0.2μM and good stability (4 months) were achieved. The electrocatalytic activity of this sensor was good as a result of synergistic effect of graphene and AuNPs (2D and 0D nanomaterials). The charge transfer resistance was decreased which was observed by electrochemical impedance spectroscopy (EIS) study. The graphene/AuNPs composites film reveals a distinguished electrochemical response to fructosyl valine (FV) which demonstrates a promising application for electrochemical detection of HbA1c in human blood samples.
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Affiliation(s)
- Utkarsh Jain
- Amity Institute of Nanotechnology (AINT), Amity University, Noida, 201303 Uttar Pradesh, India
| | - Nidhi Chauhan
- Amity Institute of Nanotechnology (AINT), Amity University, Noida, 201303 Uttar Pradesh, India.
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Xia D, McShine R, Berg AH. Misleading hemoglobin A1c levels in a patient with paroxysmal nocturnal hemoglobinuria. Am J Clin Pathol 2014; 142:261-5. [PMID: 25015870 DOI: 10.1309/ajcptk1hpr2kulju] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES We report a case of a patient with diabetes mellitus and unexpectedly low hemoglobin A1c results associated with paroxysmal nocturnal hemoglobinuria (PNH). We review the impact of shortened RBC half-life on the interpretation of hemoglobin A1c levels. METHODS Patient history and laboratory test results were obtained from electronic medical records and analyzed. RESULTS The patient's hemoglobin A1c declined in parallel to worsening anemia after the diagnosis of PNH. However, elevated serum glucose (random), fructosamine, and glycated albumin suggest ongoing hyperglycemia. Together, these results argue that the decline in hemoglobin A1c was due to decreased RBC survival secondary to PNH. CONCLUSIONS Hemoglobin A1c levels must be interpreted with caution in patients with hematologic diseases that change RBC survival. Serum fructosamine and glycated albumin measurements are alternative measures of time-averaged blood glucose control and may be useful in this subset of patients.
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Affiliation(s)
- Daniel Xia
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Randall McShine
- Department of Adult Medicine, South Cove Community Health Center, Boston, MA
| | - Anders H. Berg
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA.
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12
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Abstract
Haemoglobin A(1c) (HbA(1c)) has recently been adopted by the World Health Organization into its recommended criteria for diabetes diagnosis. Much debate continues regarding the relative benefits and potential disadvantages surrounding the use of HbA(1c) for this purpose. There is a lack of consensus as to whether this alteration to the definition of diabetes is a step forward or whether it could add further confusion and ambiguity to the debate on the method and criteria for the diagnosis of this globally important disease. This review provides a comprehensive overview of the current issues surrounding how HbA(1c) is measured and reported; and of the evidence for and against its use in diagnosis.
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Affiliation(s)
- M J L Hare
- Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia.
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13
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Liu G, Khor SM, Iyengar SG, Gooding JJ. Development of an electrochemical immunosensor for the detection of HbA1c in serum. Analyst 2012; 137:829-32. [DOI: 10.1039/c2an16034j] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Higgins TN, Tran D, Cembrowski GS, Shalapay C, Steele P, Wiley C. Is HbA1c a good screening test for diabetes mellitus? Clin Biochem 2011; 44:1469-72. [DOI: 10.1016/j.clinbiochem.2011.08.1138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 08/26/2011] [Accepted: 08/27/2011] [Indexed: 02/07/2023]
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Król E, Krejpcio Z, Byks H, Bogdański P, Pupek-Musialik D. Effects of chromium brewer's yeast supplementation on body mass, blood carbohydrates, and lipids and minerals in type 2 diabetic patients. Biol Trace Elem Res 2011; 143:726-37. [PMID: 21170603 DOI: 10.1007/s12011-010-8917-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 12/02/2010] [Indexed: 01/08/2023]
Abstract
Chromium(III) is considered as an essential element for carbohydrate and lipid metabolism. The aim of this clinical study was to evaluate the efficacy of Cr brewer's yeast supplementation on body mass, carbohydrate, lipids and mineral indices in type 2 diabetic patients. Twenty adult type 2 diabetic subjects (11 males and 9 females aged 37-63) were supplemented with Cr brewer's yeast in dosages of 500 μg Cr/person/day or placebo for 8 weeks in a double-blind, placebo-controlled crossover design. It was found that supplemental Cr did not affect body mass, blood lipid profile, resistin levels, and the serum and hair Zn, Fe, and Cu levels, but increased serum Cr (by 116%) and hair Cr (by 20.6%) concentrations and improved some blood carbohydrate indices (significant increase in the β cell function index by 18.8%) in type 2 diabetic patients. In conclusion, Cr brewer's yeast has a weak hypoglycemic potential, but does not affect body mass, blood biochemical profile, and microelement levels in type 2 diabetic subjects.
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Affiliation(s)
- Ewelina Król
- Department of Human Nutrition and Hygiene, Poznan University of Life Sciences, 31 Wojska Polskiego, 60-624, Poznan, Poland
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16
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, Lernmark A, Metzger BE, Nathan DM. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care 2011; 34:e61-99. [PMID: 21617108 PMCID: PMC3114322 DOI: 10.2337/dc11-9998] [Citation(s) in RCA: 316] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 02/28/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (HbA(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA.
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17
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, Lernmark A, Metzger BE, Nathan DM. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem 2011; 57:e1-e47. [PMID: 21617152 DOI: 10.1373/clinchem.2010.161596] [Citation(s) in RCA: 300] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. APPROACH An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence Based Laboratory Medicine Committee of the AACC jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. CONTENT In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A(1c) (Hb A(1c)) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of Hb A(1c). The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. SUMMARY The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892-1508, USA.
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Affiliation(s)
- Shivani Misra
- Department of Metabolic Medicine, Imperial Healthcare NHS Trust, London W6 8RF, UK.
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Hemoglobin A1C Percentage in Nonhuman Primates: A Useful Tool to Monitor Diabetes before and after Porcine Pancreatic Islet Xenotransplantation. J Transplant 2011; 2011:965605. [PMID: 21559266 PMCID: PMC3087943 DOI: 10.1155/2011/965605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 02/24/2011] [Indexed: 11/18/2022] Open
Abstract
Non-human primates (NHPs) are a very valuable experimental model for diabetes research studies including experimental pancreatic islet transplantation. In particular NHPs are the recipients of choice to validate pigs as possible source of pancreatic islets. The aim of this study was to quantify glycated hemoglobin percentage in NHPs and to assess whether changes in values reflect the metabolic trends after diabetes induction and islet transplantation. Sera from 15 NHPs were analyzed. 9 NHPs were rendered diabetic with streptozotocin (STZ), and 3 of them received porcine islet transplants. Hemoglobin A1c (HbA1c) percentage was measured with an assay based on a latex immunoagglutination inhibition methodology. Whereas diabetes and its duration were associated with increasing HbA1c levels, postislet transplantation blood glucose normalization was paralleled by a decrease in the HbA1c percentage. Our data provide evidence that HbA1c is a useful tool to monitor glucose metabolism in NHPs.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA.
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Zhu Y, Williams LM, Horne BD. Disparity in estimated average glucose due to different hemoglobin A1c methods and hemoglobin S trait. Clin Chem Lab Med 2010; 48:571-2. [DOI: 10.1515/cclm.2010.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Hemoglobin A1c (HbA1c) has been accepted as an index of glycemic control since the mid-1970s and is the best marker for diabetic microvascular complications. Clinically, it is now used to assess glycemic control in people with diabetes. Assays are most reliable when certified by the National Hemoglobin Standardization Program but are subject to confounders and effect modifiers, particularly in the setting of hematologic abnormalities. Other measures of chronic glycemic control-fructosamine and 1,5-anhydroglucitol-are far less widely used. The relationship of HbA1c to average blood glucose was intensively studied recently, and it has been proposed that this conversion can be used to report an "estimated average glucose, eAG" in milligrams/deciliter or millimolar units rather than as per cent glycated hemoglobin. Finally, HbA1c has been proposed as a useful method of screening for and diagnosing diabetes.
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Abstract
The attraction of the simple biochemical concept combined with a clinical requirement for a long-term marker of glycolic control in diabetes has made hemoglobin A1c (HbA1c) one of the most important assays undertaken in the medical laboratory. The diversity in the biochemistry of glycation, clinical requirements, and management demands has resulted in a broad range of methods being developed since HbA1c was described in the late 1960s. A range of analytic principles are used for the measurement of HbA1c. The charge difference between hemoglobin A0 and HbA1c has been widely utilized to separate these two fractions, most notably found these days in ion-exchange high-performance liquid chromatography systems; the difference in molecular structure (affinity chromatography and immunochemical methods) are becoming widely available. Different results found in different laboratories using a variety of HbA1c analyses resulted in the need for standardization, most notably in the United States, Japan, and Sweden. Designated comparison methods are now located in these three countries, but as they are arbitrarily chosen and have differences in specificity, results of these methods and the reference values and action limits of the methods differ and only harmonized HbA1c in specific geographic areas. A reference measurement system within the concept of metrological traceability is now globally accepted as the only valid analytic anchor. However, there is still discussion over the units to be reported. The consensus statement of the International Federation of Clinical Chemistry (IFCC), the American Diabetes Association, the International Diabetes Federation, and the European Association for the Study of Diabetes suggests reporting HbA1c in IFCC units (mmol/mol), National Glycohemoglobin Standardization Program units (%), and estimated average glucose (either in mg/dl or mmol/liter). The implementation of this consensus statement raised new questions, to be answered in a concerted action of clinicians, biochemists, external quality assessment organizers, patient groups, and manufacturers.
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Affiliation(s)
- Cas Weykamp
- Queen Beatrix Hospital, Queen Beatrixpark 1, the Netherlands.
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Abstract
PURPOSE OF REVIEW Description of recent developments in the standardization of HbA1c measurement and interpretation of HbA1c results. RECENT FINDINGS HbA1c is extensively used in the management of patients with diabetes. The two major schemes to standardize HbA1c produce values that differ substantially. A prospective, multinational study revealed a linear correlation between HbA1c and average blood glucose. Some, but not all, assay methods are able to accurately measure HbA1c in individuals with common hemoglobin variants. SUMMARY Progress in standardization of methods for HbA1c measurement has significantly reduced variation among different methods. The improved accuracy could allow HbA1c to be used for screening and diagnosis of diabetes. A consensus document recommends that HbA1c be reported in both NGSP (%) and IFCC (mmol/mol) units. HbA1c results can be translated into estimated average glucose (eAG), which could be reported in addition to HbA1c.
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Affiliation(s)
- Randie R Little
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri, USA
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