1
|
Li M, Wu X, Xie W, Zeng Y, Wang H, Chen H, Xu A, Liu H, Ji L. Analytical performance evaluation of the Mindray enzymatic assay for hemoglobin A 1c measurement. Sci Rep 2024; 14:12289. [PMID: 38811684 PMCID: PMC11137133 DOI: 10.1038/s41598-024-63261-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/27/2024] [Indexed: 05/31/2024] Open
Abstract
Hemoglobin A1c (HbA1c) plays a crucial role in diabetes management. We aimed to evaluate the analytical performance of a new enzymatic method kit for HbA1c measurement. The performance of the enzymatic method, including precision, accuracy, and linearity, was evaluated. Moreover, the interference effect from conventional interferents, Hb derivatives, Hb variants, and common drugs were assessed. In addition, the agreement of HbA1c results was compared between enzymatic methods, cation-exchange high-performance liquid chromatography (HPLC), and immunoassays. The intra-assay, between-assay, and total precision of HbA1c were all lower than 2%. HbA1c showed good linearity within the range of 3.96-20.23%. The enzymatic assay yielded results consistent with the external quality control samples, with a bias of less than ± 6% from the target values. The enzymatic method showed no interference from bilirubin, intralipid, vitamin C, Hb derivatives, common Hb variants, as well as antipyretic analgesics and hypoglycemic drugs. The HbA1c results of the enzymatic assay showed good agreement and accuracy compared to those obtained from the HPLC method and the immunoassay. The enzymatic method kit performed on the BS-600M chemistry analyzer is a reliable and robust method for measuring HbA1c. It is suitable for routine practice in clinical chemistry laboratories.
Collapse
Affiliation(s)
- Mingyang Li
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiongjun Wu
- Department of Laboratory Medicine, Shenzhen Integrated Traditional Chinese and Western Medicine Hospital, Shenzhen, China
| | - Weijie Xie
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yu Zeng
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Hui Wang
- Department of Clinical Laboratory, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Han Chen
- Department of Clinical Laboratory, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Anping Xu
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
| | - Helu Liu
- Department of Laboratory Medicine, Shenzhen Integrated Traditional Chinese and Western Medicine Hospital, Shenzhen, China.
| | - Ling Ji
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
| |
Collapse
|
2
|
Bastos C, Sumita NM, Vieira AO, Mendes ME, Lopes RM, Moresco RN, Nery K, Souto-Santos BCA, Brazão FV, Poloni JAT. The role of the Brazilian proficiency testing/External Quality Assessment Program in the improvement of glycated hemoglobin measurement. Clin Chem Lab Med 2024; 62:e119-e121. [PMID: 38033288 DOI: 10.1515/cclm-2023-1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Affiliation(s)
| | - Nairo M Sumita
- Divisão de Laboratório Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Grupo Fleury, São Paulo, Brazil
- Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial, Rio de Janeiro, Brazil
| | | | - Maria Elizabete Mendes
- Divisão de Laboratório Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial, Rio de Janeiro, Brazil
| | | | | | | | | | - Fábio V Brazão
- Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial, Rio de Janeiro, Brazil
- Laboratório Ruth Brazão, Belém, Brazil
- Laboratório Clínico da Unimed, Belém, Brazil
| | | |
Collapse
|
3
|
Seger C, Kessler A, Taibon J. Establishing metrological traceability for small molecule measurands in laboratory medicine. Clin Chem Lab Med 2023; 61:1890-1901. [PMID: 36622091 DOI: 10.1515/cclm-2022-0995] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/14/2022] [Indexed: 01/10/2023]
Abstract
For molecules that can be well described metrologically in the sense of the definition of measurands, and which can also be recorded analytically as individual substances, reference measurement service traceability to a metrologically sound foundation is a necessity. The establishment of traceability chains must be initiated by National Metrology Institutes (NMIs) according to applicable standards; they are at the top and leading position in this concept. If NMIs are not in the position to take up this task, alternative approaches must be sought. Traceability initiatives established by in vitro device industry or academia must meet the quality standards of NMIs. Adherence to International Organization for Standardization (ISO) procedure 15193 must be a matter of course for the establishment of reference measurement procedures (RMPs). Certified reference material (CRM) characterization must be thorough, e.g., by the application of quantitative nuclear magnetic resonance measurements and by adherence to ISO 15194. Both for RMPs and CRMs Joint Committee for Traceability in Laboratory Medicine (JCTLM) listing must be the ultimate goal. Results must be shared in a transparent manner to allow other stakeholders including NMIs to reproduce and disseminate the reference measurement procedures.
Collapse
Affiliation(s)
- Christoph Seger
- Labordiagnostic St. Gallen West AG, St. Gallen, Switzerland
- Institute of Pharmacy, CCB - Centrum of Chemistry and Biomedicine, CMBI - Center for Molecular Biosciences, University of Innsbruck, Innsbruck, Austria
| | - Anja Kessler
- Stiftung für Pathobiochemie und Molekulare Diagnostik, Bonn, Germany
| | | |
Collapse
|
4
|
Suparak S, Pratumvinit B, Ngueanchanthong K, Unpol P, Thanomsakyuth A, Setthaudom C, Kunakorn M, Rojanawiwat A, Uppapong B. External quality assessment scheme for HbA1c assays in Thailand: A 5-year experience. Pract Lab Med 2022; 31:e00288. [PMID: 35814312 PMCID: PMC9260332 DOI: 10.1016/j.plabm.2022.e00288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Thailand National External Quality Assessment Scheme (NEQAS) for HbA1c was established to evaluate the quality of HbA1c assays in Thailand in 2016. Methods HbA1c results from participating laboratories were compared to the target value assigned by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) reference system. Results The pass rates of participating laboratories during 2016–2020 were72–88%. The mean bias ranged between −0.19 and 0.20% of HbA1c. SD ranged from 0.30 to 1.08% of HbA1c. The overall coefficients of variation ranged from 4.46-15.66%. Conclusions Performance evaluation using IFCC assigned values indicated that different assay methods had an effect on HbA1c results. Participation in external quality assessment programs for HbA1c analysis is essential for improving laboratory quality and benefiting patient management. This study summarized the performance evaluation of HbA1c assays using IFCC assigned values during a 5 year period in Thailand. The most interesting finding was that the quality of HbA1c analysis varied depending on the assay method used. This finding should encourage clinical laboratories, manufacturers, and proficiency testing providers to work together to improve laboratory quality.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Delatour V, Clouet-Foraison N, Jaisson S, Kaiser P, Gillery P. Trueness assessment of HbA1c routine assays: are processed EQA materials up to the job? ACTA ACUST UNITED AC 2019; 57:1623-1631. [DOI: 10.1515/cclm-2019-0219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/07/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
With the worldwide increase of diabetes mellitus prevalence, ensuring that HbA1c assays are accurate is essential. External quality assessment (EQA) programs enable laboratories to verify that analytical methods perform according to the manufacturers’ specifications. However, assessing trueness requires commutable materials, a property that is rarely characterized for EQA materials.
Methods
The difference in bias approach was used to assess commutability of 26 processed quality control materials for 17 of the most frequently used HbA1c assays. Involved assays included immuno-assays, enzymatic assays, affinity, ion-exchange HPLC boronate affinity HPLC and capillary electrophoresis. The measurements were performed at manufacturers or expert laboratories. Assay trueness was additionally assessed against the IFCC reference measurement procedure using fresh clinical specimens that were distributed to 450 medical laboratories.
Results
Commutability of processed EQA materials was highly heterogeneous and globally insufficient to rigorously assess the trueness of HbA1c assays. Using fresh clinical specimens, mean bias was −0.13 mmol/mol for low HbA1c (34 mmol/mol), between +1.0 and +1.3 mmol/mol for intermediate HbA1c (49 and 58 mmol/mol) and +1.2 mmol/mol for elevated HbA1c (90 mmol/mol).
Conclusions
This study demonstrates that due to insufficient commutability, most processed EQA materials are unsuitable to assess trueness of HbA1c assays and agreement between the different assays. These materials can only provide information on comparability of individual laboratory results with its peers and on assay precision. Using fresh whole blood samples, this study additionally shows that most HbA1c assays are fairly accurate and meet the total allowable error quality target of 5 mmol/mol.
Collapse
Affiliation(s)
- Vincent Delatour
- Laboratoire National de Métrologie et d’Essais (LNE) , Paris , France
| | - Noémie Clouet-Foraison
- Laboratoire National de Métrologie et d’Essais (LNE) , Paris , France
- University Hospital of Reims, Laboratory of Biochemistry , Reims , France
| | - Stéphane Jaisson
- University Hospital of Reims, Laboratory of Biochemistry , Reims , France
| | | | - Philippe Gillery
- University Hospital of Reims, Laboratory of Biochemistry , Reims , France
| |
Collapse
|
7
|
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.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Nordin G. Accuracy of HbA1c as Monitored by External Quality Assessment and Compared With Patient Mean Values. J Diabetes Sci Technol 2018; 12:771-779. [PMID: 29916732 PMCID: PMC6134316 DOI: 10.1177/1932296818785622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The accuracy and trueness of results from a laboratory test, such as the HbA1c test, should not be taken for granted but must be checked continuously. A tool for this is the participation in external quality assessment (EQA) for all laboratories performing the HbA1c-test. An additional possibility to detect changes in trueness is to monitor variations in patient cohort mean or median values that is not explained by changes in treatment or selection of patients. METHODS Results reported to an EQA scheme for HbA1c during 20 years have been extracted from Equalis database. The results are compared to current analytical performance specifications (APS) and to the mean HbA1c levels for the Swedish population of persons with type 2 diabetes. RESULTS The accuracy of the HbA1c test has improved during the period. The hospital lab methods used in Sweden now fulfil APS agreed by professional organizations in Sweden. The accuracy for point-of-care tests (POCT) methods vary over time and fulfil APS for some periods. The bias found for some of the methods might explain changes seen in patient mean values for HbA1c in Sweden during the period 2007-2017. CONCLUSIONS The global standardization of HbA1c has resulted in an improved comparability for HbA1c-results worldwide. But even small variation in trueness for the methods in use might have important impact on mean HbA1c values for cohorts of patients. When a systematic error is observed for a specific method it is therefore essential that manufacturers correct the method without delay.
Collapse
|
10
|
Zhao HJ, Zhang TJ, Zeng J, Hu CH, Ma R, Zhang CB. Investigation and Analysis of Hemoglobin A1c Measurement Systems' Performance for 135 Laboratories in China. Chin Med J (Engl) 2018; 130:1079-1084. [PMID: 28469104 PMCID: PMC5421179 DOI: 10.4103/0366-6999.204932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Hemoglobin A1c (HbA1c) measurement is of great value for the diagnosis and monitoring of diabetes. Many manufacturers have developed various experiments to determine the HbA1c concentration. However, the longitudinal use of these tests requires strict quality management. This study aimed to analyze the quality of HbA1c measurement systems in China using six sigma techniques to help improve their performances. Methods: A total of 135 laboratories were involved in this investigation in 2015. Bias values and coefficients of variation were collected from an HbA1c trueness verification external quality assessment program and an internal quality control program organized by the National Center of Clinical Laboratories in China. The sigma (σ) values and the quality goal index (QGI) were used to evaluate the performances of different groups, which were divided according to principles and instruments. Results: The majority of participants (88, 65.2%) were scored as “improvement needed (σ < 3)”, suggesting that the laboratories needed to improve their measurement performance. Only 8.2% (11/135) of the laboratories were scored as “world class (σ ≥ 6)”. Among all the 88 laboratories whose σ values were below 3, 52 (59.1%) and 23 (26.1%) laboratories needed to improve measurement precision (QGI <8.0) and trueness (QGI >1.2), respectively; the remaining laboratories (13, 14.8%) needed to improve both measurement precision and trueness. In addition, 16.1% (5/31) and 15.0% (3/20) of the laboratories in “TOSOH” and “ARKRAY” groups, respectively, were scored as “world class”, whereas none of the laboratories in “BIO-RAD” group were scored as “world class”. Conclusions: This study indicated that, although participating laboratories were laboratories with better performance in China, the performances were still unsatisfactory. Actions should be taken to improve HbA1c measurement performance before we can include HbA1c assays in diabetes diagnosis in China.
Collapse
Affiliation(s)
- Hai-Jian Zhao
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing 100730, China
| | - Tian-Jiao Zhang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing 100730, China
| | - Jie Zeng
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing 100730, China
| | - Cui-Hua Hu
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing 100730, China
| | - Rong Ma
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing 100730, China
| | - Chuan-Bao Zhang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Beijing 100730, China
| |
Collapse
|
11
|
The Nanjing Glycated Hemoglobin Standardization Program: 2012 to 2015. Clin Ther 2017; 39:220-229. [DOI: 10.1016/j.clinthera.2016.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/22/2016] [Accepted: 11/14/2016] [Indexed: 11/23/2022]
|
12
|
Paleari R, Strollo M, Guerra E, Ceriotti F, Mosca A. Glycation gap: An additional tool for glycometabolic monitoring. Clin Chim Acta 2016; 463:27-31. [DOI: 10.1016/j.cca.2016.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/03/2016] [Indexed: 11/26/2022]
|
13
|
|