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Verougstraete N, Stove V, Stove CP. Remote HbA 1c testing via microsampling: fit for purpose? Clin Chem Lab Med 2024; 62:3-17. [PMID: 37419657 DOI: 10.1515/cclm-2023-0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023]
Abstract
The collection of capillary blood microsamples via finger-prick has several advantages over traditional blood collection. It is considered convenient and more patient-centric, enabling collection of the sample by the patient at her/his home with subsequent analysis in the lab following postal shipment. Determination of the diabetes biomarker HbA1c in self-collected microsamples to remotely monitor diabetes patients seems to be a very promising option which could eventually lead to better treatment adaptations and disease control. This is especially convenient/relevant for patients living in areas where venipuncture is impractical, or to support virtual consultations using telemedicine. Over the years, a substantial numbers of reports on HbA1c and microsampling have been published. However, the heterogeneity of the applied study designs and data evaluation is remarkable. This review provides a general and critical overview of these papers, along with specific points of attention that should be dealt with when aiming at implementing microsampling for reliable HbA1c determination. We focus on the used (dried) blood microsampling techniques, collection conditions, stability of the microsamples, sample extraction, analytical methods, method validation, correlation studies with conventional venous blood samples and patient satisfaction. Lastly, the possibility of using liquid instead of dried blood microsamples is discussed. Liquid blood microsampling is expected to have similar advantages as dried blood microsampling and several studies suggest it to be a suitable approach to collect samples remotely for subsequent HbA1c analysis in the lab.
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Affiliation(s)
- Nick Verougstraete
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Veronique Stove
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Christophe P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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2
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Núñez-Jurado D, Montenegro-Martínez J, Rubio-Sánchez R, Conde-Sánchez M, Domínguez-Pascual I. Evaluation of the Premier Hb9210 instrument for HbA1c determination. Scand J Clin Lab Invest 2023; 83:569-575. [PMID: 38037903 DOI: 10.1080/00365513.2023.2281400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023]
Abstract
Background: Glycated hemoglobin measurements are a valuable tool for long-term blood glucose monitoring and the diagnosis of diabetes. Its widespread use has been made possible due to the development of new analytical methods with improved performances and standardization with reference materials. The aim of the present study was to evaluate the Trinity Biotech Premier Hb9210 analyzer for the measurement of HbA1c.Methods: The precision was assessed using the CLSI EP-15A3 and EP-10A3 protocols. The latter was also used to investigate linearity, carryover, and linear drift. The comparison study was performed between Premier Hb910 and Tosoh HLC-723 G8 through Passing-Bablok regression and the Bland-Altman plot. The Fleiss Kappa index was used to assess the degree of agreement. The interference of Hb variants was investigated using samples with Hb variants S, C, D, E, J, and Seville.Results: Within-run and between-run imprecision fell between 0.37% and 1.16%. No statistically significant nonlinearity, carry-over, and/or drift were observed. The resulting regression line of the Passing-Bablok analysis was y = 0.00 + 1.00x. The Pearson correlation coefficient was 0.997. In the Bland-Altman plot, the relative bias was 0.01%. The overall Fleiss Kappa index was 0.9. No interference from hemoglobin variants was observed.Conclusion: The Premier Hb9210 demonstrated a high degree of automation, reproducibility, good agreement, minimal carry-over effect, and excellent linearity across the wide range of HbA1c levels commonly found in diabetic patients and was not influenced by Hb variants.
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Affiliation(s)
- David Núñez-Jurado
- Department of Clinical Biochemistry, Virgen del Rocío University Hospital, Seville, Spain
| | | | | | - Manuel Conde-Sánchez
- Department of Clinical Biochemistry, Virgen del Rocío University Hospital, Seville, Spain
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3
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Gao W, Li W, Zheng Q, Jiang N, Tang H. Case report: Effect of Hb E heterozygosity on HbA1c value by the Tosoh HLC-723G11. Front Public Health 2023; 11:1217662. [PMID: 37601204 PMCID: PMC10434524 DOI: 10.3389/fpubh.2023.1217662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Objective We report the effect of Hb E heterozygosity on HbA1c value by the Tosoh HLC-723G11. Case report A 45 years-old Chinese woman presented with an abnormally low HbA1c level of 3.7% (3.9%-6.1%) in a health examination. Fasting blood glucose was normal. Blood routine examination and serum bilirubin were in the normal range. HbA1c was determined by Tosoh HLC-723G11. There was an abnormal peak between A1c and A0 on the chromatogram. Hemoglobin electrophoresis indicated that the Hb E zone accounted for 25.1%. The β-thalassemia-related genes (mutant type) were βE M/N, and the related gene CD26 (A > G) was mutated. OGTT indicated prediabetes. Conclusion Hb E heterozygosity may reduce HbA1c value with abnormal chromatograms, as determined by a Tosoh HLC G11 analyzer. The Tosoh HLC G11 analyzer can well identify Hb E variation. In this case, further blood glucose-related tests should be performed to avoid missed diagnoses. However, a large sample size is needed to confirm this conclusion.
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Affiliation(s)
- Wei Gao
- Health Management Center, General Practice Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenyu Li
- Health Management Center, General Practice Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Zheng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Nenggang Jiang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Huairong Tang
- Health Management Center, General Practice Center, West China Hospital, Sichuan University, Chengdu, China
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Choi YJ, Kang H, Cho CI, Rim JH, Lee SG, Lim JB. Performance Evaluation of the DxC 700 AU Chemistry Analyzer in Hemoglobin A1c Measurement. Ann Lab Med 2023; 43:167-173. [PMID: 36281510 PMCID: PMC9618898 DOI: 10.3343/alm.2023.43.2.167] [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: 04/03/2022] [Revised: 07/17/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
Background Accurate measurement of glycated hemoglobin (HbA1c) is crucial for a diabetes diagnosis and subsequent patient management. The detection method and presence of variant Hb can interfere with HbA1c measurements. We evaluated the HbA1c-measuring performance of the DxC 700 AU (Beckman Coulter, Brea, CA, USA) immunoassay-based device in comparison with another immunoassay device and the reference method. Methods A total of 120 normal and 14 variant Hb samples were analyzed using the Cobas c 513 (Roche Diagnostics, Mannheim, Germany) and DxC 700 AU analyzers. Variant Hb samples were also analyzed using the reference method, along with 20 normal samples. The accuracy, precision, linearity, and carryover were determined. Results DxC 700 AU results strongly correlated with those of Cobas c 513 and exhibited accuracy in comparison with the reference method. The within-run, between-run, between-day, and total imprecision (%CV) values for the low- and high-concentration control materials were below 2%. The results of DxC 700 AU were linear over a wide HbA1c range (3.39%-18.30%). Although DxC 700 AU performed well in the presence of variant Hb, the HbA1c concentration was underestimated in the presence of fetal Hb. The possibility of interference from a high HbH proportion could not be ruled out. Conclusions The overall analytical performance of DxC 700 AU was acceptable. The device is accurate, precise, and linear over a wide HbA1c concentration range. Although DxC 700 AU results highly correlated with those of Cobas c 513, caution should be exercised in cases of high HbF and HbH concentrations.
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Affiliation(s)
- Yu Jeong Choi
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyein Kang
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chan-Ik Cho
- Korea Disease Control and Prevention Agency, Osong Health Technology Administration Complex, Cheongju, Korea
| | - John Hoon Rim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Baeck Lim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
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5
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Fırat Oğuz E, Eren F, Neşelioğlu S, Akbıyık F, Erel Ö. Comparison of three different HbA1c measurement methods - the Atellica ®CH930, Capillary 3 Tera, and BioRad Variant Turbo II. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:218-225. [PMID: 35341436 DOI: 10.1080/00365513.2022.2051070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM HbA1c measurement is very useful for the follow-up and detection of glycemic disorder, since it is easier and faster test and is independent of the patient's fasting status. In this study, we aimed to perform the comparative evaluation of 3 different methods for HbA1c measurement including capillary electrophoresis, immunoturbidimetric assay and high-performance liquid chromatography-HPLC. MATERIALS AND METHODS This study comprised 134 leftover whole blood samples obtained from the subjects submitted for routine HbA1c testing. All blood samples were collected in EDTA-containing vacutainer tubes. The HbA1c levels were measured simultaneously using three different methods. Bias estimation, method agreement and concordance between the pairwise methods comparisons were evaluated by Bland-Altman plot and Passing-Bablok regression test. RESULTS HbA1c levels ranged from 3.8% to 13.4% and measured by three different methods to make the comparison. The median values of samples based on immunoturbidimetric method (6.05%, IQR = 1.80) were higher than capillary electrophoresis method (5.90%, IQR = 1.80) and HPLC (5.85%, IQR = 1.80) method. The study group was classified into three subgroups based on the HbA1c levels measured with the HPLC method: Group 1 (n = 57) was composed of subjects with HbA1c levels less than 5.7%, Group 2 (n = 35) had HbA1c levels between 5.7% and 6.4%, Group 3 (n = 42) had HbA1c levels equal and more than 6.5%. CONCLUSION To our knowledge, there is no study evaluating the HbA1c measurement on the Atellica® CH 930 Analyzer. We compared the Atellica®CH930 Analyzer with both HPLC and capillary electrophoresis. The Atellica®CH930 Analyzer showed acceptable performance and a strong correlation with both mentioned methods.
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Affiliation(s)
- Esra Fırat Oğuz
- Clinical Biochemistry Laboratory, Ankara City Hospital, Ankara, Turkey
| | - Funda Eren
- Clinical Biochemistry Laboratory, Ankara City Hospital, Ankara, Turkey
| | - Salim Neşelioğlu
- Clinical Biochemistry Laboratory, Ankara City Hospital, Ankara, Turkey.,Department of Biochemistry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Filiz Akbıyık
- Siemens Healthineers, Ankara City Hospital Laboratory, Ankara, Turkey
| | - Özcan Erel
- Clinical Biochemistry Laboratory, Ankara City Hospital, Ankara, Turkey.,Department of Biochemistry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Gao W, Jin Y, Wang M, Huang Y, Tang H. Case Report: Abnormally Low Glycosylated Hemoglobin A1c Caused by Clinically Silent Rare β-Thalassemia in a Tujia Chinese Woman. Front Endocrinol (Lausanne) 2022; 13:878680. [PMID: 35600576 PMCID: PMC9114733 DOI: 10.3389/fendo.2022.878680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Glycosylated hemoglobin A1c (HbA1c) is an important means of monitoring blood glucose and diagnosing diabetes. High-performance liquid chromatography (HPLC) is the most widely used method to detect HbA1c in clinical practice. However, the results of HbA1c by HPLC are susceptible to hemoglobinopathy. Here, we report a case of discordantly low HbA1c with an abnormal chromatogram caused by rare β-thalassemia. CASE DESCRIPTION A 36-year-old Tujia Chinese woman presented with an abnormally low HbA1c level of 3.4% by HPLC in a health check-up. The chromatogram of HbA1c showed an abnormal peak. Fasting blood glucose, routine blood tests and serum bilirubin were normal. Her body mass index was 27.86 kg/m2. Hemoglobin electrophoresis showed low hemoglobin A and abnormal hemoglobin β-chain variants. The thalassemia gene test suggested a rare type of β-thalassemia (gene sequencing HBB: c.170G>A, Hb J-Bangkok (GGC->GAC at codon 56) in a beta heterozygous mutation). Glycated albumin (GA) was slightly increased. Oral glucose tolerance tests (OGTT) and insulin release tests indicated impaired glucose tolerance and insulin resistance. The hematologist advised follow-up visits. The endocrinologist recommended that the patient adopt lifestyle intervention. Three months later, GA returned to normal, and impaired glucose tolerance and insulin resistance improved. CONCLUSIONS Clinically silent β-thalassemia may lead to low HbA1c values and abnormal chromatograms by HPLC. In these circumstances, differential diagnosis is important. Checking the chromatogram may be helpful in interpreting HbA1c as well as identifying hemoglobinopathy. Further tests, such as GA, OGTT, hemoglobin electrophoresis and genetic tests, are needed for differential diagnosis.
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Affiliation(s)
- Wei Gao
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanwen Jin
- Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Huang
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huairong Tang
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Huairong Tang,
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7
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Loh TP, Smith AF, Bell KJL, Lord SJ, Ceriotti F, Jones G, Bossuyt P, Sandberg S, Horvath AR. Setting analytical performance specifications using HbA1c as a model measurand. Clin Chim Acta 2021; 523:407-414. [PMID: 34666026 DOI: 10.1016/j.cca.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/19/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022]
Abstract
Analytical performance specifications (APS) for measurands describe the minimum analytical quality requirements for their measurement. These APS are used to monitor and contain the systematic (trueness/bias) and random errors (precision/imprecision) of a laboratory measurement to ensure the results are "fit for purpose" in informing clinical decisions about managing a patient's health condition. In this review, we highlighted the wide variation in the setting of APS, using different levels of evidence, as recommended by the Milan Consensus, and approaches. The setting of a priori defined outcome-based APS for HbA1c remains challenging. Promising indirect alternatives seek to link the clinical utility of HbA1c and APS by defining statistical confidence for interpreting the laboratory values, or through simulation of clinical performance at varying levels of analytical performance. APS defined based on biological variation estimates in healthy individuals using the current formulae are unachievable by nearly all routine laboratory methods for HbA1c testing. On the other hand, the APS employed in external quality assurance programs have been progressively tightened, and greatly facilitate the improved quality of HbA1c testing. Laboratories should select the APS that fits their intended clinical use and should document the data and rationale underpinning those selections. Where possible common APS should be adopted across a region or country to facilitate the movement of patients and patient data across health care facilities.
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Affiliation(s)
- Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore.
| | - Alison F Smith
- Test Evaluation Group, Academic Unit of Health Economics, University of Leeds, Leeds, UK; NIHR Leeds In Vitro Diagnostic (IVD) Co-operative, Leeds, UK
| | - Katy J L Bell
- School of Public Health, The University of Sydney, New South Wales, Australia
| | - Sarah J Lord
- School of Medicine, University of Notre Dame, Darlinghurst, New South Wales, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ferruccio Ceriotti
- Clinical Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Graham Jones
- Department of Chemical Pathology, SydPath, St Vincent's Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick Bossuyt
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam University Medical Centers, the Netherlands
| | - Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway; Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Institute of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Andrea Rita Horvath
- Department of Clinical Chemistry and Endocrinology, New South Wales Health Pathology, Prince of Wales Hospital, Sydney, Australia
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Rohlfing C, Hanson S, Estey MP, Bordeleau P, Little RR. Evaluation of interference from hemoglobin C, D, E and S traits on measurements of hemoglobin A1c by fifteen methods. Clin Chim Acta 2021; 522:31-35. [PMID: 34352282 DOI: 10.1016/j.cca.2021.07.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hemoglobin C, D Punjab, E or S trait can interfere with hemoglobin A1c (HbA1c) results. We assessed whether they affect results obtained with 15 current assay methods. METHODS Hemoglobin AA (HbAA), HbAC, HbAD Punjab, HbAE and HbAS samples were analyzed on 2 enzymatic, 4 ion-exchange HPLC and 9 immunoassay methods. Trinity Premier Hb9210 boronate affinity HPLC was the comparative method. An overall test of coincidence of least-squared linear regression lines was performed to determine if HbA1c results were statistically significantly different from those of HbAA samples. Clinically significant interference was defined as >6% difference from HbAA at 6 or 9% HbA1c compared to Premier Hb9210 using Deming regression. RESULTS All methods showed statistically significant effects for one or more variants. Clinically significant effects were observed for the Tosoh G11 variant mode (HbAD), Roche b 101 (HbAC and HbAE) and Siemens DCA Vantage (HbAE and HbAS). All other methods (Beckman Coulter B93009 and B00389 on DxC700AU, and Unicel DxC, Ortho Clinical Vitros 5.1, Roche cobas c 513, Siemens Dimension RxL and Vista, and Enzymatic on Advia and Atellica, Tosoh G8 5.24 and 5.28, and GX) showed no clinically significant differences. CONCLUSIONS A few methods showed interference from one or more variants. Laboratories need to be aware of potential HbA1c assay interferences.
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Affiliation(s)
- Curt Rohlfing
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, USA.
| | - Steven Hanson
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, USA
| | | | | | - Randie R Little
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, USA
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Lenters-Westra E, English E. Are hemoglobin A1c point-of-care analyzers fit for purpose? The story continues. Clin Chem Lab Med 2020; 59:765-774. [DOI: 10.1515/cclm-2020-1308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/20/2020] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Point-of-care (POC) analyzers are playing an increasingly important role in diabetes management but it is essential that we know the performance of these analyzers in order to make appropriate clinical decisions. Whilst there is a growing body of evidence around the more well-known analyzers, there are many ‘new kids on the block’ with new features, such as displaying the presence of potential Hb-variants, which do not yet have a proven track record.
Methods
The study is a comprehensive analytical and usability study of six POC analyzers for HbA1c using Clinical and Laboratory Standards Institute (CLSI) protocols, international quality targets and certified International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and National Glycohemoglobin Standardization Program (NGSP) Secondary Reference Measurement Procedures (SRMP). The study includes precision (EP-5 and EP-15), trueness (EP-9), linearity (EP-6), sample commutability (fresh, frozen and lyophilized), interference of Hb-variants (fresh and frozen samples).
Results
Only two of the six analyzers performed to acceptable levels over the range of performance criteria. Hb-variant interference, imprecision or variability between lot numbers are still poor in four of the analyzers.
Conclusions
This unique and comprehensive study shows that out of six POC analyzers studied only two (The Lab 001 and Cobas B101) met international quality criteria (IFCC and NGSP), two (A1Care and Innovastar) were borderline and two (QuikReadgo and Allegro) were unacceptable. It is essential that the scientific and clinical community are equipped with this knowledge in order to make sound decisions on the use of these analyzers.
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Affiliation(s)
- Erna Lenters-Westra
- Isala , Department of Clinical Chemistry , Zwolle , The Netherlands
- European Reference Laboratory for Glycohemoglobin, Location Zwolle , Isala , The Netherlands
| | - Emma English
- University of East Anglia, Faculty of Medicine and Health, Norwich Research Park , Norwich , UK
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Lee JH, Kim S, Jun S, Seo JD, Nam Y, Song SH, Lee K, Song J. Analytical performance evaluation of the Norudia HbA 1c assay. J Clin Lab Anal 2020; 34:e23504. [PMID: 33463769 PMCID: PMC7676213 DOI: 10.1002/jcla.23504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hemoglobin A1c (HbA1c) is arguably the most important biomarker used in the diagnosis and treatment monitoring of diabetes mellitus. We evaluated the analytical performance of the Norudia HbA1c assay (Sekisui Medical Co., LTD), which uses an enzymatic method incorporated into a fully automated, high-throughput system. METHODS The precision, linearity, and carryover of the Norudia HbA1c assay were evaluated. Using 60 patient samples, comparative analysis of HbA1c measurements with two commonly used HbA1c assays, the D100 (Bio-Rad Laboratories, Inc) and HLC-723 G11 (Tosoh), was undergone. Thirteen commutable samples with known HbA1c concentrations measured using an IFCC reference measurement procedure were used to compare accuracy between methods. Interference of HbA1c measurement by Hb variants was evaluated using 16 known Hb variant samples. RESULTS Repeatability (% CV) for low and high concentrations ranged from 1.12%-1.50% and 0.66%-0.75%, respectively, and within-laboratory precision for low and high concentrations ranged from 1.73%-2.89% and 0.98%-1.64%, respectively. For linearity, the coefficient of determination was 0.9987. No significant carryover was observed. When compared to the D100 and HLC-723 G11 assays, the Norudia HbA1c assay showed the best accuracy with the lowest mean bias (-1.72%). Furthermore, the Norudia was least affected by Hb variants and gave the most reliable HbA1c measurements. CONCLUSION The Norudia HbA1c showed excellent analytical performance with good precision and linearity, and minimal carryover. When compared to other routine HbA1c methods, the Norudia HbA1c assay showed the highest accuracy and was least affected by Hb variants.
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Affiliation(s)
- Joon Hee Lee
- Department of Laboratory MedicineSeoul National University College of MedicineSeoulKorea
- Department of Laboratory MedicineSeoul National University Bundang HospitalSeongnamKorea
| | - Sungmin Kim
- Department of Laboratory MedicineSeoul National University Bundang HospitalSeongnamKorea
| | - Sun‐Hee Jun
- Department of Laboratory MedicineSeoul National University Bundang HospitalSeongnamKorea
| | - Jong Do Seo
- Department of Laboratory MedicineSeoul National University College of MedicineSeoulKorea
- Department of Laboratory MedicineSeoul National University HospitalSeoulKorea
| | - Youngwon Nam
- Department of Laboratory MedicineSeoul National University College of MedicineSeoulKorea
- Department of Laboratory MedicineSeoul National University Bundang HospitalSeongnamKorea
| | - Sang Hoon Song
- Department of Laboratory MedicineSeoul National University College of MedicineSeoulKorea
- Department of Laboratory MedicineSeoul National University HospitalSeoulKorea
| | - Kyunghoon Lee
- Department of Laboratory MedicineSeoul National University College of MedicineSeoulKorea
- Department of Laboratory MedicineSeoul National University Bundang HospitalSeongnamKorea
| | - Junghan Song
- Department of Laboratory MedicineSeoul National University College of MedicineSeoulKorea
- Department of Laboratory MedicineSeoul National University Bundang HospitalSeongnamKorea
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11
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Affiliation(s)
- James P McCormack
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Daniel T Holmes
- St Paul's Hospital, Department of Pathology and Laboratory Medicine, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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12
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Sriwimol W, Choosongsang P, Choosongsang P, Treerut P, Muenniam B, Makkong P, Pocathikorn A. Strong correlation and high comparability of capillary electrophoresis and three different methods for HbA1c measurement in a population without hemoglobinopathy. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 80:139-150. [PMID: 31841038 DOI: 10.1080/00365513.2019.1703213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The present study aimed to investigate the comparability of capillary electrophoresis (CE) and three different methods for HbA1c measurement. The 270 whole blood samples with normal hemoglobin profiles were analyzed for HbA1c values by the Roche turbidimetric inhibition immunoassay (TINIA), the Mindray enzymatic assay (EA), the Arkray high-performance liquid chromatography (HPLC) in comparison with the Sebia CE. The within-laboratory coefficient of variation of all four methods was within the accepted goal (<2%), showing good performance of all of these methods. Pairwise comparisons of HbA1c values obtained by CE and other methods were determined in both total group and subgroups (HbA1c levels of <6.5%, 6.5-8% and >8%). Mean differences of HbA1c values in all groups were very small in which the mean HbA1c value measured by EA was lower while those by TINIA and HPLC were higher than that of CE. The majority of different values were within the limits of agreement in Bland-Altman analysis, indicating good agreement between CE and the others. Less than 5% of percentage differences were out of the total allowable error limit in all groups, showing that differences of HbA1c values between CE and other methods were not clinically significant. Pairwise comparisons of HbA1c values of CE and the others in Passing-Bablok regression and Spearman rank correlation studies displayed high concordance and strong correlation in all groups. In conclusion, the present study showed strong correlation, high comparability and consistent results for HbA1c measurement between capillary electrophoresis and the other three different methods.
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Affiliation(s)
- Wilaiwan Sriwimol
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pensiri Choosongsang
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Phattanapong Choosongsang
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pittaya Treerut
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Baralee Muenniam
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Paspimon Makkong
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Anothai Pocathikorn
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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13
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Gifford JL, Higgins T, Sadrzadeh SMH. A high-throughput test for diabetes care: An evaluation of the next generation Roche Cobas c 513 hemoglobin A 1C assay. Pract Lab Med 2019; 17:e00147. [PMID: 31799362 PMCID: PMC6881683 DOI: 10.1016/j.plabm.2019.e00147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/31/2019] [Accepted: 11/07/2019] [Indexed: 01/15/2023] Open
Abstract
Objectives The level of glycated hemoglobin A (HbA1C) in blood is the preferred marker for diabetes monitoring and treatment. Here, we evaluate the analytical performance of the Roche Diagnostics Cobas c 513, a stand-alone HbA1C immunoassay analyzer. Design and Methods Performance was assessed with regards to imprecision, accuracy, linearity, method comparison against the Roche Cobas Integra 800 CTS, specimen stability, interference from common hemoglobin variants and hemoglobin F, and throughput. Results Within-run and between-run precisions were 0.5–0.7 and 0.8–1.3%CV, respectively. An average bias of −1.6% to proficiency survey samples was observed. The c 513 correlated well with the Integra (slope = 0.94, y-intercept = 0.50, and correlation coefficient = 0.998). The effect of hemoglobin variants on this assay was negligible while specimens containing ≥10% HbF demonstrated a negative bias. The c 513 instrument can process up to 340 samples per hour. Conclusions The c 513 is a precise, accurate, automated high throughput analyzer for measuring HbA1C in large laboratories.
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Key Words
- Automated analyzer
- CAP, College of American Pathologists
- CI, confidence interval
- CLSI, Clinical Laboratory Standards Institute
- CV, coefficient of variation
- Diabetes mellitus
- HPLC, high-performance liquid chromatography
- Hb, hemoglobin
- HbA, adult hemoglobin
- HbA1C, glycated hemoglobin A1C
- Hemoglobin A1C
- High through-put
- IFCC, International Federation of Clinical Chemistry and Laboratory Medicine
- Immunoassay
- LoB, Limit of Blank
- LoD, Limit of Detection
- Method evaluation
- NGSP, National Glycohemoglobin Standardization Program
- TE, total error
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Affiliation(s)
- Jessica L Gifford
- Calgary Laboratory Services, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - Trefor Higgins
- DynaLIFE Medical Labs, 200, 10150-102 St, Edmonton, AB, T5J 5E2, Canada.,Department of Laboratory Medicine & Pathology, University of Alberta, 8440-112 St, Edmonton, AB, T6G 2B7, Canada
| | - S M Hossein Sadrzadeh
- Calgary Laboratory Services, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
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14
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English E, Weykamp C, Ji L, Siebelder C, Shan Z, Wang Y, Li H, Garry John W. The global impact of the International Federation of Clinical Chemistry and Laboratory Medicine, Education and Management Division: engaging stakeholders and assessing HbA1c quality in a multicentre study across China. Clin Chem Lab Med 2019; 57:288-295. [PMID: 30044761 DOI: 10.1515/cclm-2018-0434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/12/2018] [Indexed: 11/15/2022]
Abstract
Background Diabetes mellitus is a major global issue and high quality testing is essential for the diagnosis and treatment of the disease. The IFCC Committee for the Education in the Utility of Biomarkers in Diabetes (C-EUBD) plays a global role in improving knowledge and understanding around diabetes testing. This paper describes a multi-stakeholder approach, to improving diagnostic and therapeutic testing for diabetes, using a multicentre study in China as an example of the global impact of the group. Methods Educational workshops were developed to support the scientific aims of the study in which 30 centres around China received identical, fresh frozen whole blood samples with values assigned using IFCC secondary reference methods and undertook precision (EP-5) and trueness studies. Performance was assessed using sigma metrics. Results A successful multi-stakeholder group was developed and sustained throughout the study through several educational workshops, which enabled the formation of a long-term collaboration with key opinion leaders and policy makers in China. All 30 centres showed good performance with within and between laboratory coefficient of variations (CVs) below 3% in SI units at both low and high haemoglobin A1c (HbA1c) levels. All individual laboratories met the criteria of a sigma of two or more at a total allowable error (TAE) of 5 mmol/mol (0.46% NGSP). Conclusions The study led to a successful multi-partner approach to improving diabetes testing in China. All centres involved in the study meeting the published IFCC quality criteria, paving the way for future clinical trials and an expanded role for HbA1c testing across the country.
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Affiliation(s)
- Emma English
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, NR4 7TJ, UK
| | - Cas Weykamp
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, TheNetherlands.,European Reference Laboratory, Location Queen Beatrix Hospital, Winterswijk, TheNetherlands
| | - Linong Ji
- Peking University People's Hospital, Beijing, P.R.China
| | - Carla Siebelder
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, TheNetherlands.,European Reference Laboratory, Location Queen Beatrix Hospital, Winterswijk, TheNetherlands
| | - Zhongyan Shan
- First Hospital of China Medical University, Shenyang, P.R.China
| | - Yufei Wang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai, P.R.China
| | - Huijun Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R.China
| | - W Garry John
- Department of Clinical Biochemistry and Immunology, Norfolk and Norwich University Hospital, Norwich, UK
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15
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Serdar MA, Serteser M, Ucal Y, Karpuzoglu HF, Aksungar FB, Coskun A, Kilercik M, Ünsal İ, Özpınar A. An Assessment of HbA1c in Diabetes Mellitus and Pre-diabetes Diagnosis: a Multi-centered Data Mining Study. Appl Biochem Biotechnol 2019; 190:44-56. [DOI: 10.1007/s12010-019-03080-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
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16
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Little RR, Rohlfing C, Sacks DB. The National Glycohemoglobin Standardization Program: Over 20 Years of Improving Hemoglobin A1c Measurement. Clin Chem 2019. [DOI: 10.1373/clinchem.2018.296962 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Measurement of hemoglobin A1c (HbA1c) in the blood is integral to and essential for the treatment of patients with diabetes mellitus. HbA1c reflects the mean blood glucose concentration over the preceding 8 to 12 weeks. Although the clinical value of HbA1c was initially limited by large differences in results among various methods, the investment of considerable effort to implement standardization has brought about a marked improvement in analysis.
CONTENT
The focus of this review is on the substantial progress that has been achieved in enhancing the accuracy and, therefore, the clinical value of HbA1c assays.
SUMMARY
The interactions between the National Glycohemoglobin Standardization Program and manufacturers of HbA1c methods have been instrumental in standardizing HbA1c. Proficiency testing using whole blood has allowed accuracy-based assessment of methods in individual clinical laboratories that has made an important contribution to improving the HbA1c measurement in patient samples. These initiatives, supported by the efforts of the IFCC network, have led to a continuing enhancement of HbA1c methods.
Many of the factors that previously influenced HbA1c results independently of blood glucose have been eliminated from most modern methods. These include carbamylation, labile intermediates, and common hemoglobin variants. Nevertheless, some factors (e.g., race and aging) may alter HbA1c interpretation, but whether these differences have clinical implications remains contentious. HbA1c has a fundamental role in the diagnosis and management of diabetes. Ongoing improvements in HbA1c measurement and quality will further enhance the clinical value of this analyte.
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Affiliation(s)
- Randie R Little
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO
| | - Curt Rohlfing
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO
| | - David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
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17
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Little RR, Rohlfing C, Sacks DB. The National Glycohemoglobin Standardization Program: Over 20 Years of Improving Hemoglobin A 1c Measurement. Clin Chem 2018; 65:839-848. [PMID: 30518660 DOI: 10.1373/clinchem.2018.296962] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Measurement of hemoglobin A1c (HbA1c) in the blood is integral to and essential for the treatment of patients with diabetes mellitus. HbA1c reflects the mean blood glucose concentration over the preceding 8 to 12 weeks. Although the clinical value of HbA1c was initially limited by large differences in results among various methods, the investment of considerable effort to implement standardization has brought about a marked improvement in analysis. CONTENT The focus of this review is on the substantial progress that has been achieved in enhancing the accuracy and, therefore, the clinical value of HbA1c assays. SUMMARY The interactions between the National Glycohemoglobin Standardization Program and manufacturers of HbA1c methods have been instrumental in standardizing HbA1c. Proficiency testing using whole blood has allowed accuracy-based assessment of methods in individual clinical laboratories that has made an important contribution to improving the HbA1c measurement in patient samples. These initiatives, supported by the efforts of the IFCC network, have led to a continuing enhancement of HbA1c methods.Many of the factors that previously influenced HbA1c results independently of blood glucose have been eliminated from most modern methods. These include carbamylation, labile intermediates, and common hemoglobin variants. Nevertheless, some factors (e.g., race and aging) may alter HbA1c interpretation, but whether these differences have clinical implications remains contentious. HbA1c has a fundamental role in the diagnosis and management of diabetes. Ongoing improvements in HbA1c measurement and quality will further enhance the clinical value of this analyte.
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Affiliation(s)
- Randie R Little
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO;
| | - Curt Rohlfing
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO
| | - David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
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18
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Atabi F, Mohammadi R. External Quality Assessment of Glycated Hemoglobin in Iran: Comparison of Five Different Commercial Methods with Two Different Total Allowable Errors. J Med Biochem 2018; 37:397-405. [PMID: 30584398 PMCID: PMC6298484 DOI: 10.1515/jomb-2017-0057] [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: 12/25/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Glycated hemoglobin (HbA1c) measuring has a critical role in the monitoring and diagnosis of diabetes. So, the analytical performance of its measuring method must be acceptable. Clinical laboratories should continuously monitor the performance of their commercial methods, both by using proper internal quality control (IQC) and by participating in external quality assessment schemes (EQAS). METHODS In January and August 2016, two different freshly prepared commutable patient QC samples were sent to over 1000 laboratories, but 682 and 925 different laboratories which were used five common commercial methods for measuring HbA1c, included in this study during 23th and 24th runs of the external quality assessment program (EQAP), respectively. Target values for total group and also for peer groups were calculated. The performance of each method and laboratory were determined according to two different allowable total errors (TEa), including ±6% and ±20%, which are suggested by the National Glycohemoglobin Standardization Program (NGSP) and Reference Health Laboratory of Iran, respectively. RESULTS Considering TEa of ±20% in evaluating HbA1c commercial methods and laboratory performances, pass rates ranged from 97% to 98% during EQAP-23 and EQAP-24, respectively. But when this evaluation was performed according to TEa of ±6%, pass rates decreased significantly to 60% and 62%, respectively. CONCLUSIONS Using improper analytical goals has led to misinterpretation of EQA results. In order to maintain the clinical usefulness of HbA1c results, we need to reduce TEa of ±20% to ±6% and improve HbA1c measuring method performance. Although, with TEa of ±6% our pass rates are not so bad.
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Affiliation(s)
- Fereshteh Atabi
- Department of Biochemistry and Pharmacology, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
| | - Reza Mohammadi
- Department of Biochemistry and Pharmacology, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
- Department of Biochemistry of External Quality Assessment Program, Iranian Association of Clinical Laboratory Doctors, Tehran, Iran
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19
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Verougstraete N, Stove V, Stove C. Wet absorptive microsampling at home for HbA1c monitoring in diabetic children. ACTA ACUST UNITED AC 2018; 56:e291-e294. [DOI: 10.1515/cclm-2018-0207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/15/2018] [Indexed: 11/15/2022]
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20
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Jaisson S, Leroy N, Soulard M, Desmons A, Guillard E, Gillery P. Evaluation of the analytical performances of the Cobas c513 analyser for HbA 1c assay. Biochem Med (Zagreb) 2018; 28:030708. [PMID: 30429676 PMCID: PMC6214704 DOI: 10.11613/bm.2018.030708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/04/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Haemoglobin A1c (HbA1c) is considered to be the gold standard for the follow-up of glycaemic control in patients with diabetes mellitus and is also a diagnostic tool. Accordingly, reliable and efficient methods must be used for its quantification. Roche Diagnostics have recently adapted the Tina-quant® HbA1c Third Generation immunoassay on a fully dedicated analyser, the Cobas c513, which allows a high throughput of up to 400 samples per hour. The present article deals with the evaluation of the analytical performances of this system which has been recently introduced to the market. MATERIALS AND METHODS Precision, comparison with two ion-exchange high-performance liquid chromatography (HPLC) methods (Variant II and D-100 systems, BioRad Laboratories) using Passing Bablok and Bland-Altman analyses, accuracy and interference of the most frequent haemoglobin (Hb) variants on HbA1c measurement were evaluated. RESULTS Precision was high, with coefficients of variation lower than 1.1% (HbA1c values expressed in National Glycohemoglobin Standardization Program units, 1.7% for values expressed in International Federation of Clinical Chemistry and Laboratory Medicine [IFCC] units). The comparison study showed similar results with the two HPLC systems. The analysis of samples with IFCC-assigned values showed high methodological accuracy. Finally, no interference of bilirubin, triglycerides and common Hb variants (Hb AC, AD, AE, AS) was observed. CONCLUSIONS This evaluation showed that the analytical performance of the Cobas c513 analyser for HbA1c assay makes it suitable for a routine use in clinical chemistry laboratories.
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Affiliation(s)
- Stéphane Jaisson
- Biochemistry Department, University Hospital of Reims, Reims, France
| | - Nathalie Leroy
- Biochemistry Department, University Hospital of Reims, Reims, France
| | | | - Aurore Desmons
- Biochemistry Department, University Hospital of Reims, Reims, France
| | | | - Philippe Gillery
- Biochemistry Department, University Hospital of Reims, Reims, France
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21
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Weykamp C, John WG, English E, Erasmus RT, Sacks DB, Buchta C, Mueller MM, Lenga Y, Budina M, Kratochvila J, Friedecky B, Siest JP, Kaiser P, Haliassos A, Panagiotakis O, Makris K, Graham H, Kane A, Smith TP, Barrett N, Sciacovelli L, Plebani M, Faria AA, Cardoso A, Correia H, Alemany MV, Alsina CP, Gómez CG, Nordin G, Persson CK, Fried R, Akcadag F, Akgöz M, Aslan D, Jones S, Thomas A, Gillery P, Jaisson S, Mosca A, Paleari R, Slingerland RJ, Slootstra J, Leppink S, Elmgren A, Little RR, Connolly SM, Makky V, Nowicki M, Siebelder C, Schröer-Janssen L, te Winkel M, de Graaf I, Lenters-Westra E. EurA1c: The European HbA1c Trial to Investigate the Performance of HbA1c Assays in 2166 Laboratories across 17 Countries and 24 Manufacturers by Use of the IFCC Model for Quality Targets. Clin Chem 2018; 64:1183-1192. [DOI: 10.1373/clinchem.2018.288795] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/13/2018] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
A major objective of the IFCC Committee on Education and Use of Biomarkers in Diabetes is to generate awareness and improvement of HbA1c assays through evaluation of the performance by countries and manufacturers.
METHODS
Fresh whole blood and lyophilized hemolysate specimens manufactured from the same pool were used by 17 external quality assessment organizers to evaluate analytical performance of 2166 laboratories. Results were evaluated per country, per manufacturer, and per manufacturer and country combined according to criteria of the IFCC model for quality targets.
RESULTS
At the country level with fresh whole blood specimens, 6 countries met the IFCC criterion, 2 did not, and 2 were borderline. With lyophilized hemolysates, 5 countries met the criterion, 2 did not, and 3 were borderline. At the manufacturer level using fresh whole blood specimens, 13 manufacturers met the criterion, 8 did not, and 3 were borderline. Using lyophilized hemolysates, 7 manufacturers met the criterion, 6 did not, and 3 were borderline. In both country and manufacturer groups, the major contribution to total error derived from between-laboratory variation. There were no substantial differences in performance between groups using fresh whole blood or lyophilized hemolysate samples.
CONCLUSIONS
The state of the art is that 1 of 20 laboratories does not meet the IFCC criterion, but there are substantial differences between country and between manufacturer groups. Efforts to further improve quality should focus on reducing between-laboratory variation. With some limitations, fresh whole blood and well-defined lyophilized specimens are suitable for purpose.
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22
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Kilpatrick ES. Toward a Global Overview of HbA1c Test Performance. Clin Chem 2018; 64:1131-1132. [DOI: 10.1373/clinchem.2018.290965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 05/15/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Eric S Kilpatrick
- Department of Pathology, Sidra Medicine and Weill Cornell Medicine, Doha, Qatar
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23
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English E, Lenters-Westra E. HbA1c method performance: The great success story of global standardization. Crit Rev Clin Lab Sci 2018; 55:408-419. [PMID: 30001673 DOI: 10.1080/10408363.2018.1480591] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Diagnosing and monitoring the treatment of people with diabetes is a global issue and uses considerable resources in laboratories and clinics worldwide. Hemoglobin A1c (HbA1c) has been the mainstay of monitoring glycemic control in people with diabetes for many years and more recently it has been advocated as a diagnostic tool for type 2 diabetes mellitus (T2DM). Good analytical performance is key to the successful use of any laboratory test, but is critical when using the test to diagnose disease, especially when the potential number of diagnoses could exceed 500 million people. Very small variations in bias or increased imprecision could lead to either a missed diagnosis or overdiagnosis of the disease and given the scale of the global disease burden, this could mean erroneous categorization of potentially millions of people. Fundamental to good performance of diagnostic testing is standardization, with defined reference materials and measurement procedures. In this review, we discuss the historical steps to first harmonize HbA1c testing, followed by the global standardization efforts and provide an update on the current situation and future goals for HbA1c testing.
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Affiliation(s)
- Emma English
- a Faculty of Medicine and Health , University of East Anglia, Norwich Research Park , Norwich , England
| | - Erna Lenters-Westra
- b Department of Clinical Chemistry , Isala, Zwolle , the Netherlands.,c European Reference Laboratory for Glycohemoglobin , Zwolle , the Netherlands
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24
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Khashoggi H, Pignalosa S, Russo C, Pieri M, Bernardini S. New HPLC instrument performance evaluation in HbA 1c determination and comparison with capillary electrophoresis. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:393-397. [PMID: 29993292 DOI: 10.1080/00365513.2018.1487072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Glycated hemoglobin (HbA1c) measurement provides the most important medium to long-term marker of time-averaged glycemic status. Its relationship to clinical outcome in diabetes has been convincingly demonstrated for both type 1 and type 2 diabetes. The main HbA1c measurement methods for clinical routine are as follows: ion-exchange chromatography; affinity chromatography, capillary electrophoresis, immunoassay and enzymatic methods. In this study, we evaluated the analytical performances of a new HPLC instrument (Tosoh HLC-723 G11 in the VAR mode) in HbA1c analysis and compared it with a capillary electrophoresis instrument (Sebia Capillarys 2 Flex Piercing). HbA1c analysis was performed in parallel by both methods for 250 samples randomly chosen from healthy and diabetic subjects at 'Tor Vergata' University Hospital of Rome. Tosoh HLC-723 G11 showed good reproducibility for 10 days both in quality controls and in samples analyzed (%CV < 2%). We found good linearity for HbA1c values ranging from 15 mmol/mol (3.5%) to 178 mmol/mol (18.5%), with a correlation coefficient R2 = 1. In a comparison between Tosoh HLC-723 G11 and Capillarys 2FP a good correlation (r = 0.99) was found; however, Tosoh HLC-723 G11 showed higher values in the low range of HbA1c and lower in the high range (Tosoh HLC-723 G11 = 4.3043 + 0.913 Capillarys 2FP; p < 0.001). Tosoh HLC-723 G11 showed good repeatability, reproducibility, accuracy and automated simplicity, and it seemed suitable for routine use in clinical chemistry laboratories.
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Affiliation(s)
- Haneen Khashoggi
- a Department of Experimental Medicine and Surgery , "Tor Vergata" University Hospital , Rome , Italy
| | - Stefano Pignalosa
- a Department of Experimental Medicine and Surgery , "Tor Vergata" University Hospital , Rome , Italy
| | - Carmelo Russo
- a Department of Experimental Medicine and Surgery , "Tor Vergata" University Hospital , Rome , Italy
| | - Massimo Pieri
- a Department of Experimental Medicine and Surgery , "Tor Vergata" University Hospital , Rome , Italy
| | - Sergio Bernardini
- a Department of Experimental Medicine and Surgery , "Tor Vergata" University Hospital , Rome , Italy
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25
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Weykamp C, Siebelder C. Evaluation of Performance of Laboratories and Manufacturers Within the Framework of the IFCC model for Quality Targets of HbA1c. J Diabetes Sci Technol 2018; 12:747-752. [PMID: 29145735 PMCID: PMC6134299 DOI: 10.1177/1932296817741320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HbA1c is a key parameter in diabetes management. For years the test has been used exclusively for monitoring of long-term diabetic control. However, due to improvement of the performance, HbA1c is considered more and more for diagnosis and screening. With this new application, quality demands further increase. A task force of the International Federation of Clinical Chemistry and Laboratory Medicine developed a model to set and evaluate quality targets for HbA1c. The model is based on the concept of total error and takes into account the major sources of analytical errors in the medical laboratory: bias and imprecision. Performance criteria are derived from sigma-metrics and biological variation. This review shows 2 examples of the application of the model: at the level of single laboratories, and at the level of a group of laboratories. In the first example data of 125 individual laboratories of a recent external quality assessment program in the Netherlands are evaluated. Differences between laboratories as well as their relation to method principles are shown. The second example uses recent and 3-year-old data of the proficiency test of the College of American Pathologists. The differences in performance between 26 manufacturer-related groups of laboratories are shown. Over time these differences are quite consistent although some manufacturers improved substantially either by better standardization or by replacing a test. The IFCC model serves all who are involved in HbA1c testing in the ongoing process of better performance and better patient care.
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Affiliation(s)
- Cas Weykamp
- MCA Laboratory, Queen Beatrix Hospital,
Winterswijk, the Netherlands
- European Reference Laboratory, Queen
Beatrix Hospital, Winterswijk, the Netherlands
- Cas Weykamp, PhD, Queen Beatrix Hospital,
Beatrixpark 1, 7101BN Winterswijk, the Netherlands.
| | - Carla Siebelder
- MCA Laboratory, Queen Beatrix Hospital,
Winterswijk, the Netherlands
- European Reference Laboratory, Queen
Beatrix Hospital, Winterswijk, the Netherlands
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26
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Aarsand AK, Røraas T, Fernandez-Calle P, Ricos C, Díaz-Garzón J, Jonker N, Perich C, González-Lao E, Carobene A, Minchinela J, Coşkun A, Simón M, Álvarez V, Bartlett WA, Fernández-Fernández P, Boned B, Braga F, Corte Z, Aslan B, Sandberg S. The Biological Variation Data Critical Appraisal Checklist: A Standard for Evaluating Studies on Biological Variation. Clin Chem 2017; 64:501-514. [PMID: 29222339 DOI: 10.1373/clinchem.2017.281808] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/16/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Concern has been raised about the quality of available biological variation (BV) estimates and the effect of their application in clinical practice. A European Federation of Clinical Chemistry and Laboratory Medicine Task and Finish Group has addressed this issue. The aim of this report is to (a) describe the Biological Variation Data Critical Appraisal Checklist (BIVAC), which verifies whether publications have included all essential elements that may impact the veracity of associated BV estimates, (b) use the BIVAC to critically appraise existing BV publications on enzymes, lipids, kidney, and diabetes-related measurands, and (c) apply metaanalysis to deliver a global within-subject BV (CVI) estimate for alanine aminotransferase (ALT). METHODS In the BIVAC, publications were rated as A, B, C, or D, indicating descending compliance for 14 BIVAC quality items, focusing on study design, methodology, and statistical handling. A D grade indicated that associated BV estimates should not be applied in clinical practice. Systematic searches were applied to identify BV studies for 28 different measurands. RESULTS In total, 128 publications were identified, providing 935 different BV estimates. Nine percent achieved D scores. Outlier analysis and variance homogeneity testing were scored as C in >60% of 847 cases. Metaanalysis delivered a CVI estimate for ALT of 15.4%. CONCLUSIONS Application of BIVAC to BV publications identified deficiencies in required study detail and delivery, especially for statistical analysis. Those deficiencies impact the veracity of BV estimates. BV data from BIVAC-compliant studies can be combined to deliver robust global estimates for safe clinical application.
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Affiliation(s)
- Aasne K Aarsand
- Norwegian Porphyria Centre, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway; .,Norwegian Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Thomas Røraas
- Norwegian Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Pilar Fernandez-Calle
- La Paz University Hospital, Madrid, Spain.,Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Barcelona, Spain
| | - Carmen Ricos
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Barcelona, Spain
| | - Jorge Díaz-Garzón
- La Paz University Hospital, Madrid, Spain.,Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Barcelona, Spain
| | - Niels Jonker
- Certe, Wilhelmina Ziekenhuis Assen, Assen, the Netherlands
| | - Carmen Perich
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Barcelona, Spain.,Clinic Laboratory Hospital Vall d'Hebron, Barcelona, Spain
| | - Elisabet González-Lao
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Barcelona, Spain.,Catlab, Clinic Laboratory, Mutua Terrassa University Hospital, Barcelona, Spain
| | - Anna Carobene
- Servizio Medicina di Laboratorio, Ospedale San Raffaele, Milan, Italy
| | - Joana Minchinela
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Barcelona, Spain.,Metropolitana Nord Unified Laboratory (LUMN), Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | - Margarita Simón
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Barcelona, Spain.,Laboratory de l'Alt Penedés, l'Anoia i el Garraf, Barcelona, Spain
| | - Virtudes Álvarez
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Barcelona, Spain
| | | | | | - Beatriz Boned
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Barcelona, Spain.,Royo Villanova Hospital, Zaragoza, Spain
| | - Federica Braga
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Zoraida Corte
- Spanish Society of Laboratory Medicine (SEQC-ML), Analytical Quality Commission, Barcelona, Spain.,San Agustin University Hospital, Aviles, Asturias, Spain
| | - Berna Aslan
- Institute for Quality Management in Healthcare (IQMH), Centre for Proficiency Testing, Toronto, ON, Canada
| | - Sverre Sandberg
- Norwegian Porphyria Centre, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.,Norwegian Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Global Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Panteghini M, Ceriotti F, Jones G, Oosterhuis W, Plebani M, Sandberg S. Strategies to define performance specifications in laboratory medicine: 3 years on from the Milan Strategic Conference. Clin Chem Lab Med 2017; 55:1849-1856. [PMID: 29031018 DOI: 10.1515/cclm-2017-0772] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 11/15/2022]
Abstract
Measurements in clinical laboratories produce results needed in the diagnosis and monitoring of patients. These results are always characterized by some uncertainty. What quality is needed and what measurement errors can be tolerated without jeopardizing patient safety should therefore be defined and specified for each analyte having clinical use. When these specifications are defined, the total examination process will be "fit for purpose" and the laboratory professionals should then set up rules to control the measuring systems to ensure they perform within specifications. The laboratory community has used different models to set performance specifications (PS). Recently, it was felt that there was a need to revisit different models and, at the same time, to emphasize the presuppositions for using the different models. Therefore, in 2014 the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) organized a Strategic Conference in Milan. It was felt that there was a need for more detailed discussions on, for instance, PS for EQAS, which measurands should use which models to set PS and how to set PS for the extra-analytical phases. There was also a need to critically evaluate the quality of data on biological variation studies and further discussing the use of the total error (TE) concept. Consequently, EFLM established five Task Finish Groups (TFGs) to address each of these topics. The TFGs are finishing their activity on 2017 and the content of this paper includes deliverables from these groups.
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Chen X, Su T, Chen Y, He Y, Liu Y, Xu Y, Wei Y, Li J, He R. d-Ribose as a Contributor to Glycated Haemoglobin. EBioMedicine 2017; 25:143-153. [PMID: 29033370 PMCID: PMC5704047 DOI: 10.1016/j.ebiom.2017.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
Abstract
Glycated haemoglobin (HbA1c) is the most important marker of hyperglycaemia in diabetes mellitus. We show that d-ribose reacts with haemoglobin, thus yielding HbA1c. Using mass spectrometry, we detected glycation of haemoglobin with d-ribose produces 10 carboxylmethyllysines (CMLs). The first-order rate constant of fructosamine formation for d-ribose was approximately 60 times higher than that for d-glucose at the initial stage. Zucker Diabetic Fatty (ZDF) rat, a common model for type 2 diabetes mellitus (T2DM), had high levels of d-ribose and HbA1c, accompanied by a decrease of transketolase (TK) in the liver. The administration of benfotiamine, an activator of TK, significantly decreased d-ribose followed by a decline in HbA1c. In clinical investigation, T2DM patients with high HbA1c had a high level of urine d-ribose, though the level of their urine d-glucose was low. That is, d-ribose contributes to HbA1c, which prompts future studies to further explore whether d-ribose plays a role in the pathophysiological mechanism of T2DM.
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Affiliation(s)
- Xixi Chen
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Tao Su
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Yao Chen
- Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Yingge He
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Ying Liu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Yong Xu
- Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Yan Wei
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China; CAS Key Laboratory of Mental Health, Institute of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China.
| | - Juan Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Rongqiao He
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China; CAS Key Laboratory of Mental Health, Institute of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China; Alzheimer's Disease Center, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China.
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Hirst JA, McLellan JH, Price CP, English E, Feakins BG, Stevens RJ, Farmer AJ. Performance of point-of-care HbA1c test devices: implications for use in clinical practice - a systematic review and meta-analysis. Clin Chem Lab Med 2017; 55:167-180. [PMID: 27658148 DOI: 10.1515/cclm-2016-0303] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/19/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Point-of-care (POC) devices could be used to measure hemoglobin A1c (HbA1c) in the doctors' office, allowing immediate feedback of results to patients. Reports have raised concerns about the analytical performance of some of these devices. We carried out a systematic review and meta-analysis using a novel approach to compare the accuracy and precision of POC HbA1c devices. METHODS Medline, Embase and Web of Science databases were searched in June 2015 for published reports comparing POC HbA1c devices with laboratory methods. Two reviewers screened articles and extracted data on bias, precision and diagnostic accuracy. Mean bias and variability between the POC and laboratory test were combined in a meta-analysis. Study quality was assessed using the QUADAS2 tool. RESULTS Two researchers independently reviewed 1739 records for eligibility. Sixty-one studies were included in the meta-analysis of mean bias. Devices evaluated were A1cgear, A1cNow, Afinion, B-analyst, Clover, Cobas b101, DCA 2000/Vantage, HemoCue, Innovastar, Nycocard, Quo-Lab, Quo-Test and SDA1cCare. Nine devices had a negative mean bias which was significant for three devices. There was substantial variability in bias within devices. There was no difference in bias between clinical or laboratory operators in two devices. CONCLUSIONS This is the first meta-analysis to directly compare performance of POC HbA1c devices. Use of a device with a mean negative bias compared to a laboratory method may lead to higher levels of glycemia and a lower risk of hypoglycaemia. The implications of this on clinical decision-making and patient outcomes now need to be tested in a randomized trial.
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Wu X, Chao Y, Wan Z, Wang Y, Ma Y, Ke P, Wu X, Xu J, Zhuang J, Huang X. A comparative evaluation of the analytical performances of Capillarys 2 Flex Piercing, Tosoh HLC-723 G8, Premier Hb9210, and Roche Cobas c501 Tina-quant Gen 2 analyzers for HbA 1c determination. Biochem Med (Zagreb) 2017; 26:353-364. [PMID: 27812304 PMCID: PMC5082223 DOI: 10.11613/bm.2016.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/08/2016] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Haemoglobin A1c (HbA1c) is widely used in the management of diabetes. Therefore, the reliability and comparability among different analytical methods for its detection have become very important. MATERIALS AND METHODS A comparative evaluation of the analytical performances (precision, linearity, accuracy, method comparison, and interferences including bilirubin, triglyceride, cholesterol, labile HbA1c (LA1c), vitamin C, aspirin, fetal haemoglobin (HbF), and haemoglobin E (Hb E)) were performed on Capillarys 2 Flex Piercing (Capillarys 2FP) (Sebia, France), Tosoh HLC-723 G8 (Tosoh G8) (Tosoh, Japan), Premier Hb9210 (Trinity Biotech, Ireland) and Roche Cobas c501 (Roche c501) (Roche Diagnostics, Germany). RESULTS A good precision was shown at both low and high HbA1c levels on all four systems, with all individual CVs below 2% (IFCC units) or 1.5% (NGSP units). Linearity analysis for each analyzer had achieved a good correlation coefficient (R2 > 0.99) over the entire range tested. The analytical bias of the four systems against the IFCC targets was less than ± 6% (NGSP units), indicating a good accuracy. Method comparison showed a great correlation and agreement between methods. Very high levels of triglycerides and cholesterol (≥ 15.28 and ≥ 8.72 mmol/L, respectively) led to falsely low HbA1c concentrations on Roche c501. Elevated HbF induced false HbA1c detection on Capillarys 2FP (> 10%), Tosoh G8 (> 30%), Premier Hb9210 (> 15%), and Roche c501 (> 5%). On Tosoh G8, HbE induced an extra peak on chromatogram, and significantly lower results were reported. CONCLUSIONS The four HbA1c methods commonly used with commercial analyzers showed a good reliability and comparability, although some interference may falsely alter the result.
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Affiliation(s)
- Xiaobin Wu
- Department of Laboratory Science, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yan Chao
- Department of Laboratory Science, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Zemin Wan
- Department of Laboratory Science, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yunxiu Wang
- Department of Laboratory Science, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yan Ma
- Department of Laboratory Science, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Peifeng Ke
- Department of Laboratory Science, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Xinzhong Wu
- Department of Laboratory Science, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Jianhua Xu
- Department of Laboratory Science, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Junhua Zhuang
- Department of Laboratory Science, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Xianzhang Huang
- Department of Laboratory Science, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
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Dijkstra A, Lenters-Westra E, de Kort W, Bokhorst AG, Bilo HJG, Slingerland RJ, Vos MJ. Whole Blood Donation Affects the Interpretation of Hemoglobin A1c. PLoS One 2017; 12:e0170802. [PMID: 28118412 PMCID: PMC5261611 DOI: 10.1371/journal.pone.0170802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/11/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction Several factors, including changed dynamics of erythrocyte formation and degradation, can influence the degree of hemoglobin A1c (HbA1c) formation thereby affecting its use in monitoring diabetes. This study determines the influence of whole blood donation on HbA1c in both non-diabetic blood donors and blood donors with type 2 diabetes. Methods In this observational study, 23 non-diabetic blood donors and 21 blood donors with type 2 diabetes donated 475 mL whole blood and were followed prospectively for nine weeks. Each week blood samples were collected and analyzed for changes in HbA1c using three secondary reference measurement procedures. Results Twelve non-diabetic blood donors (52.2%) and 10 (58.8%) blood donors with type 2 diabetes had a significant reduction in HbA1c following blood donation (reduction >-4.28%, P < 0.05). All non-diabetic blood donors with a normal ferritin concentration predonation had a significant reduction in HbA1c. In the non-diabetic group the maximum reduction was -11.9%, in the type 2 diabetes group -12.0%. When eligible to donate again, 52.2% of the non-diabetic blood donors and 41.2% of the blood donors with type 2 diabetes had HbA1c concentrations significantly lower compared to their predonation concentration (reduction >-4.28%, P < 0.05). Conclusion Patients with type 2 diabetes contributing to whole blood donation programs can be at risk of falsely lowered HbA1c. This could lead to a wrong interpretation of their glycemic control by their general practitioner or internist.
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Affiliation(s)
| | - Erna Lenters-Westra
- Department of Clinical Chemistry, Isala Hospital, Zwolle, the Netherlands
- European Reference Laboratory for Glycohemoglobin, Isala Hospital, Zwolle, the Netherlands
| | - Wim de Kort
- Department Donor Studies, Sanquin, Amsterdam, the Netherlands
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Arlinke G. Bokhorst
- Department Medical Donor Affairs, Sanquin Blood Bank Division, Amsterdam, the Netherlands
| | - Henk J. G. Bilo
- Department of Internal Medicine, Isala Hospital, Zwolle, the Netherlands
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Robbert J. Slingerland
- Department of Clinical Chemistry, Isala Hospital, Zwolle, the Netherlands
- European Reference Laboratory for Glycohemoglobin, Isala Hospital, Zwolle, the Netherlands
| | - Michel J. Vos
- Department of Clinical Chemistry, Isala Hospital, Zwolle, the Netherlands
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Penttilä I, Penttilä K, Holm P, Laitinen H, Ranta P, Törrönen J, Rauramaa R. Methods, units and quality requirements for the analysis of haemoglobin A 1c in diabetes mellitus. World J Methodol 2016; 6:133-142. [PMID: 27376018 PMCID: PMC4921944 DOI: 10.5662/wjm.v6.i2.133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/16/2015] [Accepted: 03/25/2016] [Indexed: 02/06/2023] Open
Abstract
The formation of glycohemoglobin, especially the hemoglobin A1c (HbA1c) fraction, occurs when glucose becomes coupled with the amino acid valine in the β-chain of Hb; this reaction is dependent on the plasma concentration of glucose. Since the early 1970s it has been known that diabetics display higher values OF HbA1C because they have elevated blood glucose concentrations. Thus HbA1c has acquired a very important role in the treatment and diagnosis of diabetes mellitus. After the introduction of the first quantitative measurement OF HbA1C, numerous methods for glycohemoglobin have been introduced with different assay principles: From a simple mini-column technique to the very accurate automated high-pressure chromatography and lastly to many automated immunochemical or enzymatic assays. In early days, the results of the quality control reports for HbA1c varied extensively between laboratories, therefore in United States and Canada working groups (WG) of the Diabetes Controls and Complications Trial (DCCT) were set up to standardize the HbA1c assays against the DCCT/National Glycohemoglobin Standardization Program reference method based on liquid chromatography. In the 1990s, the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) appointed a new WG to plan a reference preparation and method for the HBA1c measurement. When the reference procedures were established, in 2004 IFCC recommended that all manufacturers for equipment used in HbA1c assays should calibrate their methods to their proposals. This led to an improvement in the coefficient of variation (CV%) associated with the assay. In this review, we describe the glycation of Hb, methods, standardization of the HbA1c assays, analytical problems, problems with the units in which HbA1c values are expressed, reference values, quality control aspects, target requirements for HbA1c, and the relationship of the plasma glucose values to HbA1c concentrations. We also note that the acceptance of the mmol/mol system for HbA1c as recommended by IFCC, i.e., the new unit and reference ranges, are becoming only slowly accepted outside of Europe where it seems that expressing HbA1c values either only in per cent units or with parallel reporting of percent and mmol/mol will continue. We believe that these issues should be resolved in the future and that it would avoid confusion if mmol/mol unit for HbA1c were to gain worldwide acceptance.
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Maesa JM, Fernández-Riejos P, Mora CS, de Toro M, Valladares PM, González-Rodriguez C. Evaluation of Bio-Rad D-100 HbA1c analyzer against Tosoh G8 and Menarini HA-8180V. Pract Lab Med 2016; 5:57-64. [PMID: 28856205 PMCID: PMC5574509 DOI: 10.1016/j.plabm.2016.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/04/2016] [Accepted: 05/11/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives To evaluate the Bio-Rad D-100®, an HPLC analyzer for glycated hemoglobin (HbA1c) determination, and to compare its performance with the Menarini HA-8180V® and Sysmex G8®. Methods Method comparison was performed according to Clinical and Laboratory Standards Institute (CLSI) EP9-A2 guidelines. We selected 100 samples from the routine laboratory workload and analyzed them in duplicate with the three analyzers. The imprecision study was performed according to CLSI EP5-A2 guidelines for both inter-assay and intra-assay variability. Bias was assessed with external quality control material. To establish linearity, CLSI EP6-A protocol was followed. Results Method comparison (95% confidence intervals in parentheses): D-100 vs G8: Passing-Bablok regression; y=0.973(0.963–0.983)×−0.07(−0.07−0.069); r=0.9989. Bland-Altman mean difference: −0.229%HbA1c (−0.256: −0.202); Relative bias plot: D-100/G8 vs D100-G8 mean ratio=0.971(0.967−0.975). D-100 vs HA-8180V: Passing-Bablok regression; y=0.944(0.932–0.958)×−0.078(0.024−0.173); r=0.9989. Bland-Altman mean difference: −0.363%HbA1c (−0.401: −0.325); Relative bias plot D-100/HA-8180V vs D100-HA-8180V mean ratio=0.955(0.952−0.958). Inter-assay coefficient of variation (CV): 0.81%. Intra-assay CV: 1.04% (low level), and 0.78% (high level). Bias against target value=2.332%. Linearity: r2=0.998 in the concentration range 4.4−13.9%HbA1c. Carry-over: 0.0024%. Conclusions The Bio-Rad D-100 shows good correlation with G8 and HA-8180V. There is a small proportional systematic difference (2.7% and 5.6%, respectively) in both comparisons. Inter and intra-assay CVs are both lower than the lowest CV obtained in studies performed with D-100 and other instruments.
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Affiliation(s)
- José María Maesa
- Clinic Biochemistry Department, Virgen Macarena University Hospital, Spain
| | | | | | - María de Toro
- Clinic Biochemistry Department, Virgen Macarena University Hospital, Spain
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Guérin R, Dugré-Brisson S. Evaluation of the long-term imprecision of the Capillarys 2 Flex Piercing® with serial differences in patient Hemoblogin A1c data: A comparison with two common immunoassays. Clin Biochem 2016; 49:502-504. [DOI: 10.1016/j.clinbiochem.2015.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 11/17/2022]
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Rohlfing C, Hanson S, Weykamp C, Siebelder C, Higgins T, Molinaro R, Yip PM, Little RR. Effects of hemoglobin C, D, E and S traits on measurements of hemoglobin A1c by twelve methods. Clin Chim Acta 2016; 455:80-3. [PMID: 26828530 PMCID: PMC4966613 DOI: 10.1016/j.cca.2016.01.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/19/2016] [Accepted: 01/28/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hemoglobin C, D Punjab, E or S trait can interfere with hemoglobin A1c (HbA1c) results. We assessed whether they affect results obtained with 12 current assay methods. METHODS Hemoglobin AA (HbAA), HbAC, HbAD Punjab, HbAE and HbAS samples were analyzed on one enzymatic, nine ion-exchange HPLC and two Capillary Electrophoresis methods. Trinity ultra(2) boronate affinity HPLC was the comparative method. An overall test of coincidence of least-squared linear regression lines was performed to determine if HbA1c results were statistically significantly different from those of HbAA samples. Clinically significant interference was defined as >7% difference from HbAA at 6 or 9% HbA1c compared to ultra(2) using Deming regression. RESULTS All methods showed statistically significant effects for one or more variants. Clinically significant effects were observed for the Tosoh G8 variant mode and GX (all variants), GX V1.22 (all but HbAE) and G11 variant mode (HbAC). All other methods (Abbott Architect c Enzymatic, Bio-Rad D-100, Variant II NU and Variant II Turbo 2.0, Menarini HA-8180T thalassemia mode and HA-8180V variant mode, Sebia Capillarys 2 and Capillarys 3) showed no clinically significant differences. CONCLUSIONS Several methods showed clinically significant interference with HbA1c results from one or more variants which could adversely affect patient care.
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Affiliation(s)
- Curt Rohlfing
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, United States.
| | - Steven Hanson
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, United States
| | - Cas Weykamp
- European Reference Laboratory, Location Queen Beatrix Hospital, Winterswijk, The Netherlands
| | - Carla Siebelder
- European Reference Laboratory, Location Queen Beatrix Hospital, Winterswijk, The Netherlands
| | - Trefor Higgins
- DynaLIFE(DX) Diagnostic Laboratory Services, Edmonton, AB, Canada
| | - Ross Molinaro
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Paul M Yip
- University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Randie R Little
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, United States
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Braga F, Panteghini M. Generation of data on within-subject biological variation in laboratory medicine: An update. Crit Rev Clin Lab Sci 2016; 53:313-25. [DOI: 10.3109/10408363.2016.1150252] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kaiser P, Spannagl M, van Campenhout C, Lenga Y, Siebelder C, Weykamp C. HbA1c: EQA in Germany, Belgium and the Netherlands using fresh whole blood samples with target values assigned with the IFCC reference system. ACTA ACUST UNITED AC 2016; 54:1769-1775. [DOI: 10.1515/cclm-2016-0123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/07/2016] [Indexed: 01/08/2023]
Abstract
AbstractBackground:External quality assessment/proficiency test (EQA/PT) organizers play an important role in monitoring the performance of HbAMethods:Throughout 2015, ten fresh whole blood samples were supplied to the participants. Aggregated results were evaluated according to the IFCC model for quality targets at four levels: overall, per country, per manufacturer, and per country per manufacturer.Results:Robust results in summer and winter demonstrated the feasibility of organizing an EQA with fresh whole blood samples in three countries. The overall performances, as well as the performance for each country were very similar: results fell within the IFCC criteria. Although substantial differences between results from different manufacturers were present, the performances of laboratories using tests of the same manufacturer were strikingly similar in the three countries, suggesting that the quality of HbA
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John WG, Little R, Sacks DB, Weykamp C, Lenters-Westra E, Hornsby T, Zhao Z, Siebelder C, Tennill A, English E. Multicentre evaluation of the Premier Hb9210 HbA1c analyser. Clin Chem Lab Med 2015; 53:319-27. [PMID: 25274956 DOI: 10.1515/cclm-2014-0589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/04/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND The accurate and precise quantification of HbA1c is essential for the diagnosis and routine monitoring of patients with diabetes. We report an evaluation of the Trinity Biotech Premier Hb9210 analyser (Bray, Ireland/Kansas City, MO, USA), a boronate affinity chromatography-based high performance liquid chromatography (HPLC) system for the measurement of glycated haemoglobin. METHODS We evaluated the analytical performance of the Hb9210 as part of a multicentre evaluation. The effect of haemoglobin variants, other potential interferences and the performance in comparison to both the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and National Glycohemoglobin Standardization Program (NGSP) reference systems, was assessed. Most of the centres participating also act as reference laboratories for both the IFCC standardisation network for HbA1c and the NGSP. RESULTS The combined data from all centres showed total coefficients of variation (CV) of 2.71%, 2.32% and 2.14% at low, medium and high values, respectively, for mmol/mol (SI units) and 1.62%, 1.59% and 1.68% for % (NGSP units), which are well below the recommended upper limits of 3% CV for mmol/mol (SI units) and 2% CV for % (NGSP). The analyser showed a good correlation to HbA1c methods currently used in clinical practice and the IFCC reference method procedure. Haemoglobin variants AC, AS, AE and AD do not affect the measurement of HbA1c. Overall the Hb9210 performs well across the whole analytical range. CONCLUSIONS The Hb9210 performs well and is suitable for clinical application in the analysis of HbA1c.
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Mosca A, Paleari R, Carobene A, Weykamp C, Ceriotti F. Performance of glycated hemoglobin (HbA1c) methods evaluated with EQAS studies using fresh blood samples: Still space for improvements. Clin Chim Acta 2015; 451:305-9. [DOI: 10.1016/j.cca.2015.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
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Amylidi S, Mosimann B, Stettler C, Fiedler GM, Surbek D, Raio L. First-trimester glycosylated hemoglobin in women at high risk for gestational diabetes. Acta Obstet Gynecol Scand 2015; 95:93-7. [PMID: 26400192 DOI: 10.1111/aogs.12784] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 09/11/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Our aim was to investigate the prognostic value of first-trimester glycosylated hemoglobin (HbA1c) in pregnant women with risk factors for developing gestational diabetes mellitus (GDM). MATERIAL AND METHODS This is an observational retrospective cohort study conducted at the Department of Obstetrics and Gynecology, University Hospital Bern, Switzerland. We included pregnant women at high risk for GDM (n = 208), who had an HbA1c measurement in the first trimester. We compared HbA1c values of women who later developed GDM with those who did not develop GDM. Diagnosis of GDM was made on the basis of a 75-g oral glucose tolerance test performed between 24 and 28 weeks of gestation. We further examined the prevalence of GDM in relation to the first-trimester HbA1c value. RESULTS The prevalence of GDM in our high-risk group was 14.7%. Women who developed GDM had significantly higher first-trimester HbA1c values [5.43 ± 0.31% (36 ± 3 mmol/mol) vs. 5.23 ± 0.28% (34 ± 3 mmol/mol); p = 0.0026]. Moreover, all pregnant women with HbA1c ≥ 6.0% (42 mmol/mol) developed GDM, whereas those with < 4.5% (26 mmol/mol) did not. CONCLUSIONS Women at risk for GDM have higher first-trimester HbA1c levels and values ≥ 6.0% (42 mmol/mol) are predictive of GDM. This information may be useful for counseling these women and providing appropriate advice on diet and lifestyle modification early in pregnancy.
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Affiliation(s)
- Sofia Amylidi
- Department for Gynecology and Obstetrics, Inselspital, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Beatrice Mosimann
- Department for Gynecology and Obstetrics, Inselspital, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Christoph Stettler
- Department for Endocrinology and Diabetes, Inselspital, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Georg Martin Fiedler
- Center of Laboratory Medicine, University Institute of Clinical Chemistry, Inselspital, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Daniel Surbek
- Department for Gynecology and Obstetrics, Inselspital, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Luigi Raio
- Department for Gynecology and Obstetrics, Inselspital, University Hospital of Bern and University of Bern, Bern, Switzerland
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Mosimann B, Amylidi S, Risch L, Wiedemann U, Surbek D, Baumann M, Stettler C, Raio L. First-Trimester Placental Growth Factor in Screening for Gestational Diabetes. Fetal Diagn Ther 2015; 39:287-91. [PMID: 26421599 DOI: 10.1159/000441027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was first to assess whether first-trimester serum concentrations of placental growth factor (PlGF) differ between patients with and without gestational diabetes (GDM) and second to test whether there is a correlation between glycosylated hemoglobin (HbA1c), a factor recently shown to be useful in predicting GDM, and PlGF. METHODS PlGF was measured at 8-14 weeks with the Kryptor Immunoassay Analyzer (Brahms, Berlin, Germany). Absolute values were converted to multiples of the median using the software provided by the Fetal Medicine Foundation London. GDM was diagnosed using internationally accepted criteria. HbA1c levels were quantified using the TOSOH G7 automated hemoglobin analyzer. RESULTS From January to December 2014, 328 women were included in the study, 51 (15.5%) of whom developed GDM. First-trimester PlGF quantification does not discriminate between women at risk to develop GDM and controls, while HbA1c is able to do so. No correlation was found between PlGF and HbA1c. CONCLUSION Our findings do not lend support to the hypothesis that early PlGF values are different in women who later develop GDM.
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Affiliation(s)
- Beatrice Mosimann
- Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern, Switzerland
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Weykamp C, John G, Gillery P, English E, Ji L, Lenters-Westra E, Little RR, Roglic G, Sacks DB, Takei I. Investigation of 2 models to set and evaluate quality targets for hb a1c: biological variation and sigma-metrics. Clin Chem 2015; 61:752-9. [PMID: 25737535 PMCID: PMC4946649 DOI: 10.1373/clinchem.2014.235333] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/29/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND A major objective of the IFCC Task Force on Implementation of HbA1c Standardization is to develop a model to define quality targets for glycated hemoglobin (Hb A1c). METHODS Two generic models, biological variation and sigma-metrics, are investigated. We selected variables in the models for Hb A1c and used data of external quality assurance/proficiency testing programs to evaluate the suitability of the models to set and evaluate quality targets within and between laboratories. RESULTS In the biological variation model, 48% of individual laboratories and none of the 26 instrument groups met the minimum performance criterion. In the sigma-metrics model, with a total allowable error (TAE) set at 5 mmol/mol (0.46% NGSP), 77% of the individual laboratories and 12 of 26 instrument groups met the 2σ criterion. CONCLUSIONS The biological variation and sigma-metrics models were demonstrated to be suitable for setting and evaluating quality targets within and between laboratories. The sigma-metrics model is more flexible, as both the TAE and the risk of failure can be adjusted to the situation-for example, requirements related to diagnosis/monitoring or international authorities. With the aim of reaching (inter)national consensus on advice regarding quality targets for Hb A1c, the Task Force suggests the sigma-metrics model as the model of choice, with default values of 5 mmol/mol (0.46%) for TAE and risk levels of 2σ and 4σ for routine laboratories and laboratories performing clinical trials, respectively. These goals should serve as a starting point for discussion with international stakeholders in the field of diabetes.
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Affiliation(s)
- Cas Weykamp
- Department of Clinical Chemistry and European Reference Laboratory, Location Queen Beatrix Hospital, Winterswijk, the Netherlands;
| | - Garry John
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Philippe Gillery
- Laboratory of Pediatric Biology and Research, University Hospital of Reims, Reims, France
| | - Emma English
- School of Medicine, University of Nottingham, Royal Derby Hospital Site, Derby, UK
| | - Linong Ji
- Peking University People's Hospital, Beijing, China
| | - Erna Lenters-Westra
- Department of Clinical Chemistry, Isala Clinics, Zwolle, the Netherlands; European Reference Laboratory, Location Isala, Zwolle, the Netherlands
| | - Randie R Little
- Departments of Pathology and Child Health, University of Missouri School of Medicine, Columbia, MO
| | - Gojka Roglic
- Department of Management of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - David B Sacks
- Department of Laboratory Medicine, NIH, Bethesda, MD
| | - Izumi Takei
- Diabetes and Endocrine Department, Ichikawa General Hospital, Ichikawa, Japan
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43
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Wong L, Liu H, Yong S, Liu Q, Lee TK. Improved Reference Measurement Method for Hemoglobin A1c by Use of Liquid Chromatography–Isotope Dilution–Tandem Mass Spectrometry. Clin Chem 2015; 61:435-6. [DOI: 10.1373/clinchem.2014.231340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lingkai Wong
- Chemical Metrology Division Applied Sciences Group Health Sciences Authority Singapore
| | - Hong Liu
- Chemical Metrology Division Applied Sciences Group Health Sciences Authority Singapore
| | - Sharon Yong
- Chemical Metrology Division Applied Sciences Group Health Sciences Authority Singapore
| | - Qinde Liu
- Chemical Metrology Division Applied Sciences Group Health Sciences Authority Singapore
| | - Tong Kooi Lee
- Chemical Metrology Division Applied Sciences Group Health Sciences Authority Singapore
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Lenters-Westra E, Røraas T, Schindhelm RK, Slingerland RJ, Sandberg S. Biological variation of hemoglobin A1c: consequences for diagnosing diabetes mellitus. Clin Chem 2014; 60:1570-2. [PMID: 25248570 DOI: 10.1373/clinchem.2014.227983] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Erna Lenters-Westra
- Department of Clinical Chemistry Isala Zwolle, the Netherlands European Reference Laboratory for Glycohemoglobin Isala Zwolle, the Netherlands
| | - Thomas Røraas
- Norwegian Quality Improvement of Primary Care Laboratories (NOKLUS) Haraldsplass Hospital Bergen, Norway
| | - Roger K Schindhelm
- Department of Clinical Chemistry Hematology & Immunology Medical Centre Alkmaar Alkmaar, the Netherlands Department of Clinical Chemistry and Hematology Gemini Hospital Den Helder the Netherlands
| | - Robbert J Slingerland
- Department of Clinical Chemistry Isala Zwolle, the Netherlands European Reference Laboratory for Glycohemoglobin Isala Zwolle, the Netherlands
| | - Sverre Sandberg
- Norwegian Quality Improvement of Primary Care Laboratories (NOKLUS) Haraldsplass Hospital Bergen, Norway Department of Global Health and Primary Health Care Faculty of Medicine and Dentistry University of Bergen, Norway Laboratory of Clinical Biochemistry Haukeland University Hospital Bergen, Norway
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Manley SE, Hikin LJ, Round RA, Manning PW, Luzio SD, Dunseath GJ, Nightingale PG, Stratton IM, Cramb R, Sikaris KA, Gough SCL, Webber J. Comparison of IFCC-calibrated HbA(1c) from laboratory and point of care testing systems. Diabetes Res Clin Pract 2014; 105:364-72. [PMID: 24985893 DOI: 10.1016/j.diabres.2014.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE WHO, IDF and ADA recommend HbA(1c) ≥6.5% (48 mmol/mol) for diagnosis of diabetes with pre-diabetes 6.0% (42 mmol/mol) [WHO] or 5.7% (39 mmol/mol) [ADA] to 6.4% (47 mmol/mol). We have compared HbA(1c) from several methods for research relating glycaemic markers. RESEARCH DESIGN AND METHODS HbA1c was measured in EDTA blood from 128 patients with diabetes on IE HPLC analysers (Bio-Rad Variant II NU, Menarini HA8160 and Tosoh G8), point of care systems, POCT, (A1cNow+ disposable cartridges and DCA 2000(®)+ analyser), affinity chromatography (Primus Ultra2) and the IFCC secondary reference method (Menarini HA8160 calibrated using IFCC SRM protocol). RESULTS Median (IQ range) on IFCC SRM was 7.5% (6.8-8.4) (58(51-68) mmol/mol) HbA(1c) with minimum 5.3%(34 mmol/mol)/maximum 11.9%(107 mmol/mol). There were positive offsets between IFCC SRM and Bio-Rad Variant II NU, mean difference (1SD), +0.33%(0.17) (+3.6(1.9) mmol/mol), r(2)=0.984, p<0.001 and Tosoh G8, +0.22%(0.20) (2.4(2.2) mmol/mol), r(2)=0.976, p<0.001 with a very small negative difference -0.04%(0.11) (-0.4(1.2) mmol/mol), r(2)=0.992, p<0.001 for Menarini HA8160. POCT methods were less precise with negative offsets for DCA 2000(®)+ analyser -0.13%(0.28) (-1.4(3.1) mmol/mol), r(2)=0.955, p<0.001 and A1cNow+ cartridges -0.70%(0.67) (-7.7(7.3) mmol/mol), r(2)=0.699, p<0.001 (n=113). Positive biases for Tosoh and Bio-Rad (compared with IFCC SRM) have been eliminated by subsequent revision of calibration. CONCLUSIONS Small differences observed between IFCC-calibrated and NGSP certified methods across a wide HbA(1c) range were confirmed by quality control and external quality assurance. As these offsets affect estimates of diabetes prevalence, the analyser (and calibrator) employed should be considered when evaluating diagnostic data.
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Affiliation(s)
- Susan E Manley
- Clinical Biochemistry and Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Division of Medical Sciences, University of Birmingham, Birmingham, UK.
| | - Laura J Hikin
- Clinical Biochemistry and Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rachel A Round
- Clinical Biochemistry and Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter W Manning
- Clinical Biochemistry and Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Peter G Nightingale
- Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Irene M Stratton
- Gloucester Diabetic Retinopathy Research Group, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Robert Cramb
- Clinical Biochemistry and Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Division of Medical Sciences, University of Birmingham, Birmingham, UK
| | | | - Stephen C L Gough
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jonathan Webber
- Diabetes Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Analytical performances of a new enzymatic assay for hemoglobin A1c. Clin Chim Acta 2014; 434:48-52. [DOI: 10.1016/j.cca.2014.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 12/19/2022]
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Heylen O, Van Neyghem S, Exterbille S, Wehlou C, Gorus F, Weets I. Evaluation of the Sebia CAPILLARYS 2 flex piercing for the measurement of HbA(1c) on venous and capillary blood samples. Am J Clin Pathol 2014; 141:867-77. [PMID: 24838332 DOI: 10.1309/ajcpru5qc2jbansv] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We evaluated the Sebia CAPILLARYS 2 Flex Piercing (Cap 2FP; Sebia, Lisses, France) for measurement of hemoglobin A1c (HbA1c) on venous and capillary blood samples. METHODS We analyzed whole-blood samples and control materials with the Cap 2FP and Tosoh G8 (Tosoh Corporation, Tokyo, Japan). Capillary blood samples were analyzed on the Cap 2FP on different storage conditions and were compared with venous samples. RESULTS Both instruments achieved total imprecision of less than 2.5% (International Federation of Clinical Chemistry units). Bias was 1 mmol/mol or less and 4 mmol/mol or less for the Cap 2FP and Tosoh G8, respectively. The Cap 2FP was not prone to common interferences. The Tosoh G8 showed significant bias only for carbamylated hemoglobin and did not completely separate hemoglobin D and hemoglobin E. On the Cap 2FP, storage of capillary blood at room temperature showed no significant bias. There was good agreement with venous blood. CONCLUSIONS The Cap 2FP and Tosoh G8 perform excellently for HbA1c determination. Capillary blood can be analyzed on the Cap 2FP as an acceptable alternative to venous blood and point-of-care testing. Home collection and central analysis of capillary blood could contribute to a reduction of health care costs without reducing quality of HbA1c determination.
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Affiliation(s)
- Olivier Heylen
- Department of Clinical Chemistry and Radio-immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Stefaan Van Neyghem
- Department of Clinical Chemistry and Radio-immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Sandra Exterbille
- Department of Clinical Chemistry and Radio-immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Charline Wehlou
- Department of Clinical Chemistry and Radio-immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Frans Gorus
- Department of Clinical Chemistry and Radio-immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ilse Weets
- Department of Clinical Chemistry and Radio-immunology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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48
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Weykamp C, Waenink-Wieggers H, Kemna E, Siebelder C. HbA1c: performance of the Sebia Capillarys 2 Flex Piercing. Clin Chem Lab Med 2014; 51:e129-31. [PMID: 23241674 DOI: 10.1515/cclm-2012-0560] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/13/2012] [Indexed: 11/15/2022]
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Sølvik UØ, Røraas T, Christensen NG, Sandberg S. Diagnosing Diabetes Mellitus: Performance of Hemoglobin A1c Point-of-Care Instruments in General Practice Offices. Clin Chem 2013; 59:1790-801. [DOI: 10.1373/clinchem.2013.210781] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Hemoglobin A1c (Hb A1c) measurement by hospital laboratory instruments, but not by point-of-care (POC) instruments, has been recommended for use to diagnose diabetes mellitus. We evaluated results from 13 Hb A1c external quality assurance (EQA) surveys over a 6-year period in Norway, from both POC instruments used in general practice (GP) offices and instruments in hospital laboratories, against the analytical quality specifications recommended for use of Hb A1c to diagnose diabetes mellitus.
METHODS
All GP offices (n = 1288) and hospital laboratories (n = 52) measuring Hb A1c in Norway participated in the EQA survey. The percentage of participants that performed measurements within the quality specifications was calculated. Pooled within-laboratory CVs were estimated for the Afinion, DCA 2000, DCA 2000+, DCA VantageTM, and Nycocard Hb A1c Reader instruments and for hospital laboratory instruments.
RESULTS
Between 60% to 90% of Afinion and DCA users and hospital laboratories performed Hb A1c measurements within the quality specifications for both trueness (6.0%) and imprecision (CV ≤2.0%) at 2 levels in each EQA survey. The pooled within-laboratory CVs for the Afinion and DCA instruments and hospital laboratories were below the recommended limit of 2.0% for most of the surveys.
CONCLUSIONS
A large proportion of GP offices using Afinion and DCA POC instruments to measure Hb A1c fulfill the analytical quality specifications for diagnosing diabetes mellitus, and these instruments demonstrate analytical quality comparable to that of hospital laboratory instruments. When GP offices participate in a stringent quality assurance program and generate Hb A1c measurements that meet analytical quality specifications, these measurements can be recommended for use to diagnose diabetes mellitus.
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Affiliation(s)
- Una Ørvim Sølvik
- Department of Global Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Thomas Røraas
- The Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Nina Gade Christensen
- The Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Department of Global Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Norway
- The Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
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50
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Verification of in vitro medical diagnostics (IVD) metrological traceability: responsibilities and strategies. Clin Chim Acta 2013; 432:55-61. [PMID: 24291059 DOI: 10.1016/j.cca.2013.11.022] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/23/2013] [Accepted: 11/19/2013] [Indexed: 01/20/2023]
Abstract
To be accurate and equivalent, laboratory results should be traceable to higher-order references. Furthermore, their analytical performance should fulfill acceptable measurement uncertainty criteria defined to fit the intended clinical use. With this aim, In Vitro Diagnostics (IVD) manufacturers should define a calibration hierarchy to assign traceable values to their system calibrators and to fulfill during this process uncertainty limits for calibrators, which should represent a proportion of the uncertainty budget allowed for laboratory results. It is important that end-users may know and verify how manufacturers have implemented the traceability of their calibrators and estimated the corresponding uncertainty. However, full information about traceability and combined uncertainty of calibrators is currently not available. Important tools for IVD traceability surveillance are the verification by laboratories of the consistency of declared performance during daily operations performed in accordance with the manufacturer's instructions and the organization of appropriately structured External Quality Assessment (EQA) programs. The former activity should be accomplished by analyzing system control materials and confirming that current measurements are in the manufacturer's established control range. With regard to EQA, it is mandatory that target values for materials are assigned with reference procedures by accredited laboratories, that materials are commutable and that a clinically allowable inaccuracy for participant's results is defined.
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