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Chume FC, Freitas PAC, Schiavenin LG, Sgarioni E, Leitao CB, Camargo JL. Glycated albumin in the detection of diabetes during COVID-19 hospitalization. PLoS One 2024; 19:e0297952. [PMID: 38498483 PMCID: PMC10947635 DOI: 10.1371/journal.pone.0297952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/14/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Diabetes has emerged as an important risk factor for COVID-19 adverse outcomes during hospitalization. We investigated whether the measurement of glycated albumin (GA) may be useful in detecting newly diagnosed diabetes during COVID-19 hospitalization. METHODS In this cross-sectional test accuracy study we evaluated HCPA Biobank data and samples from consecutive in-patients, from 30 March 2020 to 20 December 2020. ROC curves were used to analyse the performance of GA to detect newly diagnosed diabetes (patients without a previous diagnosis of diabetes and admission HbA1c ≥6.5%). RESULTS A total of 184 adults (age 58.6 ± 16.6years) were enrolled, including 31 with newly diagnosed diabetes. GA presented AUCs of 0.739 (95% CI 0.642-0.948) to detect newly diagnosed diabetes. The GA cut-offs of 19.0% was adequate to identify newly diagnosed diabetes with high specificity (85.0%) but low sensitivity (48.4%). CONCLUSIONS GA showed good performance to identify newly diagnosed diabetes and may be useful for identifying adults with the condition in COVID-19-related hospitalization.
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Affiliation(s)
- Fernando Chimela Chume
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Faculty of Health Sciences, Universidade Zambeze, Beira, Mozambique
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Priscila Aparecida Correa Freitas
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Laboratory Diagnosis Division, Clinical Biochemistry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Luisa Gazzi Schiavenin
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduarda Sgarioni
- Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Cristiane Bauermann Leitao
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Joíza Lins Camargo
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Bellaver P, Schneider L, Schaeffer AF, Henrique LR, Camargo JL, Gerchman F, Leitão CB, Rech TH. Diabetes associates with mortality in critically ill patients with SARS-CoV-2 pneumonia: No diabetes paradox in COVID-19. Heliyon 2023; 9:e18554. [PMID: 37576227 PMCID: PMC10412986 DOI: 10.1016/j.heliyon.2023.e18554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Background Diabetes mellitus (DM) is not associated with increased mortality in critically ill patients, a phenomenon known as the "diabetes paradox". However, DM is a risk factor for increased mortality in patients with COVID-19. This study aims to investigate the association of DM and stress-induced hyperglycemia at intensive care unit (ICU) with mortality in this population. Methods This is a retrospective study. Electronic medical records from patients admitted from March 2020 to September 2020 were reviewed. Primary outcome was mortality. Secondary outcomes were ICU and hospital mortality and stay, and need for mechanical ventilation and renal replacement therapy. Results 187 patients were included. Overall mortality was 43.2%, higher in patients with DM (55.7% vs. 34%; p = 0.007), even after adjustment for age, hypertension, and disease severity. When patients were separated into groups, named normoglycemia (without DM and glycemia ≤140 mg/dL), stress-induced hyperglycemia (without DM and glycemia >140 mg/dL), and DM (previous diagnosis or HbA1c ≥ 6.5%), the mortality rate was 25.8%, 37.3%, and 55.7%, respectively (p = 0.021). Mortality was higher in patients with higher glycemic variability. No statistical difference related to secondary outcomes was observed. Conclusions DM, hyperglycemia, and glycemic variability associated with increased mortality in critically ill patients with severe COVID-19, but did not increase the rates of other clinical outcomes. More than stress-induced hyperglycemia, DM was associated with mortality.
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Affiliation(s)
- Priscila Bellaver
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Larissa Schneider
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ariell F. Schaeffer
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Lilian Rodrigues Henrique
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Joíza Lins Camargo
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fernando Gerchman
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Cristiane B. Leitão
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Tatiana H. Rech
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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3
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Chume FC, Camargo JL. ROC curves: stats, common sense, and caution. Endocrine 2022; 76:506-507. [PMID: 35364759 DOI: 10.1007/s12020-022-03046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Fernando Chimela Chume
- Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil
| | - Joíza Lins Camargo
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-006, Brazil.
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Chume FC, Freitas PAC, Schiavenin LG, Pimentel AL, Camargo JL. Glycated albumin in diabetes mellitus: a meta-analysis of diagnostic test accuracy. Clin Chem Lab Med 2022; 60:961-974. [PMID: 35470641 DOI: 10.1515/cclm-2022-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Guidelines recommend the diagnosis of diabetes should be based on either plasma glucose or glycated hemoglobin (HbA1C) findings. However, lately studies have advocated glycated albumin (GA) as a useful alternative to HbA1c. We conducted a systematic review and meta-analysis to determine the overall diagnostic accuracy of GA for the diagnosis of diabetes. CONTENT We searched for articles of GA diabetes diagnostic accuracy that were published up to August 2021. Studies were selected if reported an oral glucose tolerance test as a reference test, measured GA levels by enzymatic methods, and had data necessary for 2 × 2 contingency tables. A bivariate model was used to calculate the pooled estimates. SUMMARY This meta-analysis included nine studies, totaling 10,007 individuals. Of those, 3,106 had diabetes. The studies showed substantial heterogeneity caused by a non-threshold effect and reported different GA optimal cut-offs for diagnosing diabetes. The pooled diagnostic odds ratio (DOR) was 15.93 and the area under the curve (AUC) was 0.844, indicating a good level of overall accuracy for the diagnosis of diabetes. The effect of the GA threshold on diagnostic accuracy was reported at 15.0% and 17.1%. The optimal cut-off for diagnosing diabetes with GA was estimated as 17.1% with a pooled sensitivity of 55.1% (95% CI 36.7%-72.2%) and specificity of 94.4% (95% CI 85.3%-97.9%). OUTLOOK GA has good diabetes diagnostic accuracy. A GA threshold of 17.1% may be considered optimal for diagnosing diabetes in previously undiagnosed individuals.
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Affiliation(s)
- Fernando C Chume
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Faculty of Health Sciences, Universidade Zambeze, Beira, Mozambique.,Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Priscila A C Freitas
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Laboratory Diagnosis Division, Clinical Biochemistry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Luisa G Schiavenin
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ana L Pimentel
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Nuvisan Pharma Services, Porto Alegre, Brazil
| | - Joíza Lins Camargo
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Endocrinology Division and Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Lima-Morales DD, Wink PL, Volpato FCZ, Camargo JL, de-Paris F, Barth AL. SARS-CoV-2 nucleic acid shedding is variable for every person. Rev Soc Bras Med Trop 2021; 54:e10622021. [PMID: 34231777 PMCID: PMC8253572 DOI: 10.1590/0037-8682-0162-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Considering the persistent positivity on RT-qPCR tests, the results of SARS-CoV-2 were monitored to evaluate the viral RNA shedding period. METHODS: Between March and June 2020, the sequential results of 29 healthcare workers’ were monitored using RT-qPCR. RESULTS: More than 50% of the individuals remained RT-qPCR positive after 14 days. Furthermore, this is the first study to describe positive RT-qPCR for SARS-CoV-2 in a healthcare worker with mild symptoms 95 days after the first positive test. CONCLUSIONS: Sequential RT-qPCR results were heterogeneous, and the viral RNA shedding period is unique for each person.
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Affiliation(s)
- Daiana de Lima-Morales
- Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Laboratório de Pesquisa em Resistência Bacteriana (Labresis), Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Diagnóstico de SARS-CoV-2 (LabCovid), Porto Alegre, RS, Brasil
| | - Priscila Lamb Wink
- Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Laboratório de Pesquisa em Resistência Bacteriana (Labresis), Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Diagnóstico de SARS-CoV-2 (LabCovid), Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Farmácia, Programa de Pós-Graduação em Ciências Farmacêuticas, Porto Alegre, RS, Brasil
| | - Fabiana Caroline Zempulski Volpato
- Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Laboratório de Pesquisa em Resistência Bacteriana (Labresis), Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Diagnóstico de SARS-CoV-2 (LabCovid), Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brasil
| | - Joíza Lins Camargo
- Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Laboratório de Pesquisa em Resistência Bacteriana (Labresis), Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Porto Alegre, RS, Brasil
| | - Fernanda de-Paris
- Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Laboratório de Pesquisa em Resistência Bacteriana (Labresis), Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Diagnóstico de SARS-CoV-2 (LabCovid), Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Porto Alegre, RS, Brasil
| | - Afonso Luís Barth
- Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Laboratório de Pesquisa em Resistência Bacteriana (Labresis), Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Laboratório de Diagnóstico de SARS-CoV-2 (LabCovid), Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Farmácia, Programa de Pós-Graduação em Ciências Farmacêuticas, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brasil
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Chume FC, Renz PB, Hernandez MK, Freitas PAC, Camargo JL. Is there a role for glycated albumin in the diagnosis of gestational diabetes mellitus? Endocrine 2021; 72:681-687. [PMID: 33719011 DOI: 10.1007/s12020-021-02673-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/24/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies in the general population have advocated glycated albumin (GA) as a useful alternative to glycated haemoglobin (HbA1c) under conditions wherein the latter does not reflect glycaemic status accurately. There are few studies in other populations, especially in pregnant women. Therefore, the aim of this study was to assess the clinical utility of GA in the diagnosis of gestational diabetes mellitus (GDM). MATERIALS AND METHODS This diagnostic test accuracy study was performed in 149 Brazilian women at 24-28 weeks of gestation referred for an oral glucose tolerance test (OGTT) in a tertiary university hospital. Receiver Operating Characteristic (ROC) curves were used to access the performance of GA and HbA1c in the diagnosis of GDM by the reference OGTT. RESULTS GDM by OGTT (IADPSG criteria) was detected in 18.8% of participants. According to ROC analysis, the area under the curve (AUC) for GA was 0.531 (95% CI: 0.405-0.658, p = 0.065) lower than that for HbA1c [0.743 (95% CI: 0.636-0.849; p ≤ 0.001] for the detection of GDM (p = 0.004). The equilibrium cut-off value for GA was 12.6%; sensitivity and specificity in this cut-off point were 53.6% and 54.2%, respectively. CONCLUSIONS GA at 24-28 weeks of gestation does not have ability to correctly discriminate those with and without GDM. In summary, the lack of sensitivity found in our results do not support the solely use of GA in the diagnosis of GDM.
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Affiliation(s)
- Fernando Chimela Chume
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil
- Faculty of Health Sciences, Universidade Zambeze, Beira, Mozambique
| | - Paula Breitenbach Renz
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil
| | - Mayana Kieling Hernandez
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil
| | - Priscila Aparecida Correa Freitas
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil
- Laboratory Diagnosis Division, Clinical Biochemistry Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, 90035-006, Brazil
| | - Joíza Lins Camargo
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre, RS, 90035-003, Brazil.
- Endocrinology Division and Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-006, Brazil.
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Freitas PAC, Hernandez MK, Camargo JL. Factors associated with glycated albumin in adults without diabetes. Med Pharm Rep 2021; 94:170-175. [PMID: 34013187 PMCID: PMC8118215 DOI: 10.15386/mpr-1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/14/2020] [Accepted: 08/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background and aims Glycated albumin is a glycemic marker useful in short-term monitoring and in situations when a glycated hemoglobin test is not reliable. This study aims to evaluate glycated albumin levels and its associated factors in normoglycemic adults from Southern Brazil. Method 136 individuals, without diabetes or pre-diabetes, were included in this cross-sectional study. Levels of glycated albumin, glycated hemoglobin, and other biochemical markers were measured. Results Glycated albumin levels ranged from 11.1% to 17.5% (2.5th and 97.5th percentiles). Glycated albumin/glycated hemoglobin ratio was 2.8±0.2. Glycated albumin did not differ according to gender and age groups. However, in overweight individuals, levels of glycated albumin and glycated albumin/glycated hemoglobin ratio were lower and weakly and negatively correlated with body mass index. Conclusions Glycated albumin levels in Brazilians were similar to those previously described in other populations. Glycated albumin seems to be irrespective of gender or age, but weakly correlated with weight. These aspects should be taken into account in the interpretation of glycated albumin results.
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Affiliation(s)
| | - Mayana Kieling Hernandez
- Laboratory Diagnosis Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Joíza Lins Camargo
- Experimental Research Center and Endocrinology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Pimentel AL, Hernandez MK, Freitas PAC, Chume FC, Camargo JL. The usefulness of glycated albumin for post-transplantation diabetes mellitus after kidney transplantation: A diagnostic accuracy study. Clin Chim Acta 2020; 510:330-336. [PMID: 32712050 DOI: 10.1016/j.cca.2020.07.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is no study evaluating the use of glycated albumin (GA) for the detection of post-transplantation diabetes mellitus (PTDM) in kidney transplant recipients. We evaluated the overall accuracy of GA at four months after kidney transplantation. METHODS Diagnostic test accuracy study including 134 kidney transplant recipients without pre-existing diabetes. Receiver operator characteristic (ROC) curve was used to estimate sensitivity, specificity, likelihood ratios and area under the curve (AUC) for GA, considering oral glucose tolerance test (OGTT) and/or glycated hemoglobin (HbA1c) as reference criteria. RESULTS Thirty-three patients were diagnosed with PTDM by OGTT and/or HbA1c ≥ 6.5%. GA showed moderate accuracy to detect PTDM [AUC 0.673 (95% CI 0.557-0.789, p < 0.01)]. The use of OGTT and/or HbA1c ≥ 6.2% increased the number of PTDM cases from 33 to 38, and AUC was 0.713 (95% CI 0.608-0.819, p < 0.01). GA ≥ 17% showed specificity close to 90% when OGTT and/or HbA1c ≥ 6.5% were used as reference tests. CONCLUSIONS GA showed low diagnostic accuracy for the detection of PTDM at the fourth month after transplantation. The use of a single GA point is not enough for the screening and diagnosis of PTDM; however, GA ≥ 17% presented high specificity to rule in the disease after kidney transplantation.
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Affiliation(s)
- Ana Laura Pimentel
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mayana Kieling Hernandez
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Fernando Chimela Chume
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Medical Faculty, Universidade Zambeze, Beira, Mozambique
| | - Joíza Lins Camargo
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Experimental Research Centre, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Diabetes and Metabolism Group, Centro de Pesquisa Cinica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Pinto LC, Kramer CK, Camargo JL, Canani LH, Gross JL, Leitão CB. No effect of acidification or freezing on urinary metanephrine levels. J Endocrinol Invest 2020; 43:53-56. [PMID: 31228104 DOI: 10.1007/s40618-019-01076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Urinary metanephrine is a reliable method to estimate catecholamine secretion. Traditionally, urinary metanephrines are collected into chilled containers containing hydrochloric acid (HCl) and most laboratories freeze urinary samples before analysis. It is uncertain if these pre-analytic procedures alter metanephrine values. AIM To evaluate if acidifying and freezing urine samples affect the accuracy of urinary metanephrine measurements. METHODS Random urine samples from healthy individuals were collected. Urine samples were distributed into two containers: with HCl 50% homogenized with urine to obtain pH < 2, and without HCl. Each container was divided again into aliquots for immediate measurement or freezing. One aliquot with acid (group 1) and another without acid (group 2) were sent immediately to the laboratory for testing (HPLC), while the other two aliquots, one with acid (group 3) and another without it (group 4) were frozen for 3 months at - 20 °C. Bland-Altman's test was used to analyze inter-assay agreement between measurements. RESULTS A total of 15 individuals were included (mean age 27.5 ± 5.9 years, 8 male and 14 white). No difference was observed on mean urinary metanephrine/creatinine ratio between groups: group 1: 0.23 ± 0.11, group 2: 0.22 ± 0.07, group 3: 0.25 ± 0.13, group 4: 0.25 ± 0.15 mg/g creatinine; P > 0.05 for all the comparisons). Bland-Altman's analysis showed agreement between the standard method (group 1) and the experimental method (group 4). CONCLUSION Measurement of urinary metanephrines by HPLC method is not influenced by sample acidification nor freezing at - 20 °C for 3 months.
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Affiliation(s)
- L C Pinto
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil.
| | - C K Kramer
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Canada
| | - J L Camargo
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil
| | - L H Canani
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil
| | - J L Gross
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil
| | - C B Leitão
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 12, 4° Andar, Porto Alegre, RS, 90035-003, Brazil
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Chume FC, Kieling MH, Correa Freitas PA, Cavagnolli G, Camargo JL. Glycated albumin as a diagnostic tool in diabetes: An alternative or an additional test? PLoS One 2019; 14:e0227065. [PMID: 31891628 PMCID: PMC6938306 DOI: 10.1371/journal.pone.0227065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction Studies have revealed that glycated albumin (GA) is a useful alternative to HbA1c under conditions wherein the latter does not reflect glycaemic status accurately. Until now, there are few studies with non-Asians subjects that report on the validity of GA test in diagnosis of type 2 diabetes mellitus (DM). Thus, the aim of this study was to assess the clinical utility of GA in diagnosis of DM. Materials and methods This diagnostic test accuracy study was performed in 242 Brazilian individuals referred for OGTT in a tertiary university hospital. ROC curves were used to access the performance of GA and HbA1c in the diagnosis of DM by oral glucose tolerance test (OGTT). Results OGTT, HbA1c and GA were performed in all 242 participants (40.5% male, age 54.4 ± 13.0 years [mean ± SD], body mass index 28.9 ± 6.3 kg/m2). DM by OGTT was detected in 31.8% of individuals. The equilibrium threshold value of GA ≥14.8% showed sensitivity of 64.9% and specificity of 65.5% for the diagnosis of DM. The AUC for GA [0.703 (95% CI 0.631–0.775)] was lower than for HbA1c [0.802 (95% CI 0.740–0.864)], p = 0.028. A GA value of 16.8% had similar accuracy for detecting DM as defined by HbA1c ≥6.5% (48 mmol/mol) with sensitivity of 31.2% and specificity of 93.3% for both tests. However, GA detects different subjects from those detected by HbA1c and OGTT. Conclusions GA detected different individuals with DM from those detected by HbA1c, though it showed overall diagnostic accuracy similar to HbA1c in the diagnosis of DM. Therefore, GA should be used as an additional test rather than an alternative to HbA1c or OGTT and its use as the sole DM diagnostic test should be interpreted with caution.
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Affiliation(s)
- Fernando Chimela Chume
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre–RS, Brazil
- Universidade Zambeze, Beira, Mozambique
| | - Mayana Hernandez Kieling
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre–RS, Brazil
| | - Priscila Aparecida Correa Freitas
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre–RS, Brazil
- Laboratory Diagnosis Division, Clinical Biochemistry Unit, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre–RS, Brazil
| | | | - Joíza Lins Camargo
- Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul Porto Alegre, Porto Alegre–RS, Brazil
- Endocrinology Division and Experimental Research Centre, Hospital de Clinicas de Porto Alegre, Porto Alegre–RS, Brazil
- * E-mail:
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Renz PB, Hernandez MK, Camargo JL. Effect of iron supplementation on HbA1c levels in pregnant women with and without anaemia. Clin Chim Acta 2017; 478:57-61. [PMID: 29274326 DOI: 10.1016/j.cca.2017.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Iron deficiency anaemia has been associated with higher HbA1c levels. However, during and after iron supplementation there is a decrease in HbA1c results, causing a misinterpretation. Our aim was to analyse the effect of iron supplementation on HbA1c levels in nondiabetic pregnant women with and without anaemia. METHODS Pregnant women in prenatal care, without gestational diabetes (GDM) or previous diabetes mellitus (DM) that performed an oral glucose tolerance test (OGTT) in the third trimester of pregnancy were invited to participate. Clinical and laboratorial analyses were performed, including standardized questionnaire, OGTT, full blood count and HbA1c. RESULTS A total of 231 pregnant women without DM or GDM were included in the study. According to anaemia and/or iron supplementation, we divided women in: no iron and no anaemia - Group 1 (N=86); no iron and with anaemia - Group 2 (N=29); iron and no anaemia - Group 3 (N=87); iron and anaemia - Group 4 (N=29). There was statistically a significant, although no clinically relevant, difference between HbA1c values in pregnant women in Groups 1 and 4 [5.1±0.4% (32±4.4mmol/mol) and 4.8±0.3% (29±3.3mmol/mol), P<0.01; respectively]. HbA1c values in pregnant women in Groups 1, 2 and 3 were similar, independently of anaemia [5.1±0.4% (32±4.4mmol/mol); 5.0±0.4% (31±4.4mmol/mol) and 5.0±0.4% (31±4.4mmol/mol); p>0.05; respectively]. CONCLUSIONS Iron supplementation during pregnancy does not affect HbA1c levels and has no clinical impact in the final interpretation of results in the absence of anaemia or presence of mild anaemia. Interpreting HbA1c results in pregnant women during iron therapy and with moderate or severe anaemia still requires caution.
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Affiliation(s)
- Paula Breitenbach Renz
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Mayana Kieling Hernandez
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Joíza Lins Camargo
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Endocrinology Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
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Pimentel AL, Camargo JL. Variability of glycated hemoglobin levels in the first year post renal transplantation in patients without diabetes. Clin Biochem 2017; 50:997-1001. [DOI: 10.1016/j.clinbiochem.2017.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
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Coelli S, Farias CB, Soares AA, Crescente GM, Hirakata VN, Souza LB, Czepielewski MA, Camargo JL, Silveiro SP. Influence of age, gender and body mass index on late-night salivary cortisol in healthy adults. Clin Chem Lab Med 2017. [PMID: 28593924 DOI: 10.1515/cclm-2016-1100)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Late-night salivary cortisol (LNSC) is one of the most reliable tests to screen for endogenous Cushing syndrome. This test is simple, inexpensive and noninvasive and has high sensitivity and specificity. The aim of our study was to analyze the putative influence of age, gender and body mass index (BMI) on LNSC levels in a healthy population. METHODS Cross-sectional study conducted in healthy adults. Midnight saliva samples were collected at home. Participants refrained from teeth brushing, eating or drinking for 2 h prior to collection. Salivary cortisol measured by electrochemiluminescence immunoassay (ECLIA). The study was approved by the Ethics Committee of the hospital (number 140073). RESULTS We evaluated 122 nonsmoking healthy volunteers. Mean age was 35±14 years (range, 18-74 years); 63% were women. Mean BMI was 24±3 kg/m2, blood pressure 115/74 mmHg and fasting plasma glucose 4.8±0.5 mmol/L. LNSC presented a non-Gaussian distribution; the median was 3.58 (range, 0.55-8.55) nmol/L (0.13 [range, 0.02-0.31] μg/dL), and the 97.5th percentile (P97.5) was 8.3 nmol/L (0.3 μg/dL). Multiple linear regression disclosed a significant positive association between salivary cortisol levels and age (r2=0.21, p<0.001), but no association with gender (p=0.105) or BMI (p=0.119). Accordingly, participants aged >50 years had significantly higher salivary cortisol as compared to those aged <50 years (5.24 nmol/L [0.19 μg/dL] vs. 3.31 nmol/L [0.12 μg/dL], respectively, p<0.001). CONCLUSIONS The maximum reference value (P97.5) of LNSC was set at 8.3 nmol/L (0.3 μg/dL) using ECLIA. Advanced age was associated with higher LNSC levels, with no evident influence of gender or BMI.
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Freitas PAC, Ehlert LR, Camargo JL. Glycated albumin: a potential biomarker in diabetes. Arch Endocrinol Metab 2017; 61:296-304. [PMID: 28699985 PMCID: PMC10118799 DOI: 10.1590/2359-3997000000272] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 02/13/2017] [Indexed: 11/22/2022]
Abstract
Diabetes mellitus (DM) is a chronic and metabolic disease that presents a high global incidence. Glycated hemoglobin (A1C) is the reference test for long-term glucose monitoring, and it exhibits an association with diabetic chronic complications. However, A1C is not recommended in clinical situations which may interfere with the metabolism of hemoglobin, such as in hemolytic, secondary or iron deficiency anemia, hemoglobinopathies, pregnancy, and uremia. The glycated albumin (GA) is a test that reflects short-term glycemia and is not influenced by situations that falsely alter A1C levels. GA is the higher glycated portion of fructosamine. It is measured by a standardized enzymatic methodology, easy and fast to perform. These laboratory characteristics have ensured the highlight of GA in studies from the last decade, as a marker of monitoring and screening for DM, as well as a predictor of long-term outcomes of the disease. The aim of this review was to discuss the physiological and biochemistry characteristics of the GA, as well as its clinical utility in DM.
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Affiliation(s)
| | | | - Joíza Lins Camargo
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil
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Cavagnolli G, Pimentel AL, Freitas PAC, Gross JL, Camargo JL. Effect of ethnicity on HbA1c levels in individuals without diabetes: Systematic review and meta-analysis. PLoS One 2017; 12:e0171315. [PMID: 28192447 PMCID: PMC5305058 DOI: 10.1371/journal.pone.0171315] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/18/2017] [Indexed: 12/16/2022] Open
Abstract
Aims/Hypothesis Disparities in HbA1c levels have been observed among ethnic groups. Most studies were performed in patients with diabetes mellitus (DM), which may interfere with results due to the high variability of glucose levels. We conducted a systematic review and meta-analysis to investigate the effect of ethnicity on HbA1c levels in individuals without DM. Methods This is a systematic review with meta-analysis. We searched MEDLINE and EMBASE up to September 2016. Studies published after 1996, performed in adults without DM, reporting HbA1c results measured by certified/standardized methods were included. A random effects model was used and the effect size was presented as weighted HbA1c mean difference (95% CI) between different ethnicities as compared to White ethnicity. Results Twelve studies met the inclusion criteria, totalling data from 49,238 individuals. There were significant differences between HbA1c levels in Blacks [0.26% (2.8 mmol/mol); 95% CI 0.18 to 0.33 (2.0 to 3.6), p <0.001; I2 = 90%, p <0.001], Asians [0.24% (2.6 mmol/mol); 95% CI 0.16 to 0.33 (1.7 to 3.6), p <0.001; I2 = 80%, p = 0.0006] and Latinos [0.08% (0.9 mmol/mol); IC 95% 0.06 to 0.10 (0.7 to 1.1); p <0.001; I2 = 0%; p = 0.72] when compared to Whites. Conclusions/Interpretation This meta-analysis shows that, in individuals without DM, HbA1c values are higher in Blacks, Asians, and Latinos when compared to White persons. Although small, these differences might have impact on the use of a sole HbA1c point to diagnose DM in all ethnic populations.
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Affiliation(s)
- Gabriela Cavagnolli
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Centro Universitário FSG, Caxias do Sul, Brazil
| | - Ana Laura Pimentel
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Priscila Aparecida Correa Freitas
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Transplantation Immunology, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Jorge Luiz Gross
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Joíza Lins Camargo
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- * E-mail:
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Coelli S, Farias CB, Soares AA, Crescente GM, Hirakata VN, Souza LB, Czepielewski MA, Camargo JL, Silveiro SP. Influence of age, gender and body mass index on late-night salivary cortisol in healthy adults. ACTA ACUST UNITED AC 2017; 55:1954-1961. [DOI: 10.1515/cclm-2016-1100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/28/2017] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Late-night salivary cortisol (LNSC) is one of the most reliable tests to screen for endogenous Cushing syndrome. This test is simple, inexpensive and noninvasive and has high sensitivity and specificity. The aim of our study was to analyze the putative influence of age, gender and body mass index (BMI) on LNSC levels in a healthy population.Methods:Cross-sectional study conducted in healthy adults. Midnight saliva samples were collected at home. Participants refrained from teeth brushing, eating or drinking for 2 h prior to collection. Salivary cortisol measured by electrochemiluminescence immunoassay (ECLIA). The study was approved by the Ethics Committee of the hospital (number 140073).Results:We evaluated 122 nonsmoking healthy volunteers. Mean age was 35±14 years (range, 18–74 years); 63% were women. Mean BMI was 24±3 kg/mConclusions:The maximum reference value (P97.5) of LNSC was set at 8.3 nmol/L (0.3 μg/dL) using ECLIA. Advanced age was associated with higher LNSC levels, with no evident influence of gender or BMI.
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Pimentel AL, Cavagnolli G, Camargo JL. Diagnostic accuracy of glycated hemoglobin for post-transplantation diabetes mellitus after kidney transplantation: systematic review and meta-analysis. Nephrol Dial Transplant 2017; 32:565-572. [DOI: 10.1093/ndt/gfw437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/07/2016] [Indexed: 12/16/2022] Open
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Pimentel AL, Bauer AC, Camargo JL. Renal posttransplantation diabetes mellitus: An overview. Clin Chim Acta 2015; 450:327-32. [DOI: 10.1016/j.cca.2015.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/05/2015] [Accepted: 09/10/2015] [Indexed: 12/25/2022]
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Silva JF, Pimentel AL, Camargo JL. Effect of iron deficiency anaemia on HbA1c levels is dependent on the degree of anaemia. Clin Biochem 2015; 49:117-20. [PMID: 26365695 DOI: 10.1016/j.clinbiochem.2015.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Studies suggest that iron deficiency anaemia (IDA) is associated with higher HbA1c levels. We conducted a control–case study to investigate the effect of IDA on HbA1c levels, measured by two commonly used methods, in non-diabetic individuals. DESIGN AND METHODS A total of 122 patients were included, 61 patients with IDA and 61 patients without anaemia. HbA1c was measured by both ion exchange HPLC Variant II Turbo BioRad and immunoturbidimetry (IT) Tina Quant II Roche Diagnostics in each sample. HbA1c results were compared between groups. For correlation analysis, patients were considered altogether. RESULTS There was a significant difference between the results of HbA1c in patients with IDA [HPLC 5.6 ± 0.4% (38 ± 4.4 mmol/mol) and IT 5.7 ± 0.4% (39 ± 4.4 mmol/mol)] and those measured in patients without anaemia [HPLC 5.3 ± 0.4% (34 ± 4.4 mmol/mol) and IT 5.3 ± 0.3% (34 ± 3.3 mmol/mol)], (p < 0.001). Significant negative correlations were observed between total haemoglobin (Hb), haematocrit, mean corpuscular volume (MCV) and ferritin with HbA1c values measured by IT (r = − 0.557; r = − 0.539; r = − 0.488; r = − 0.499; p < 0.01; respectively). These negative correlations were weaker with HbA1c measured by HPLC (r = − 0.272; r = − 0.250; r = − 0.273; r = − 0.229 for Hb, haematocrit, MCV and ferritin; p < 0.05; respectively). HbA1c results were higher in patients with moderate and severe anaemia. However mild anaemia did not show significant effects on HbA1c results measured by both methods. CONCLUSIONS IDA affects HbA1c results and this effect is dependent on anaemia degree. These upward changes are statistically significant but they may be not clinically relevant when the overall variability of the HbA1c test is considered. The presence of slight anaemia is likely to have a minor effect on HbA1c levels favouring its use to diagnose diabetes in patients with mild anaemia.
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Affiliation(s)
- Juliana Frezza Silva
- Graduate Program of Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Brazil
| | - Ana Laura Pimentel
- Graduate Program of Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Brazil
| | - Joíza Lins Camargo
- Graduate Program of Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Brazil; Endocrinology Department, Hospital de Clínicas de Porto Alegre, Brazil.
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Cavagnolli G, Pimentel AL, Freitas PAC, Gross JL, Camargo JL. Factors affecting A1C in non-diabetic individuals: Review and meta-analysis. Clin Chim Acta 2015; 445:107-14. [PMID: 25818244 DOI: 10.1016/j.cca.2015.03.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 12/16/2022]
Abstract
We carried out a systematic review and meta-analyses of studies that evaluated the possible effects of anemia, variant hemoglobin, and uremia on A1C levels in individuals without diabetes (DM). Medline and Embase were searched for studies that measured A1C values in groups with and without iron deficiency anemia (IDA) and/or iron deficiency (ID), variant hemoglobin and/or uremia by standardized methods. The difference between A1C levels in the groups with and without interferences was obtained by using random-effects meta-analysis and the effect size was presented as absolute difference of means (95% CI). Ten studies fulfilled the inclusion criteria, providing data from 11,176 participants without DM. There were no statistically significant differences in A1C in the presence of IDA/ID, HbS, and uremia by HPLC and uremia by immunoassay [0.79% (95% IC -0.39; 1.97), -0.13% (95% IC -0.51; 0.26), 0.15% (95% CI -0.58; 0.88) and -0.19% (95% CI -0.78; 0.40), respectively]. The effects of HbAS and uremia on A1C levels are within the expected individual variation and should not affect A1C results to diagnose DM. However, the effects of IDA/ID remain inconclusive and further studies are needed to clarify the glycation mechanisms in individuals with IDA/ID without diabetes.
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Affiliation(s)
- Gabriela Cavagnolli
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Ana Laura Pimentel
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Jorge Luiz Gross
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Joíza Lins Camargo
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Pimentel AL, Carvalho LSAK, Marques SS, Franco RF, Silveiro SP, Manfro RC, Camargo JL. Role of glycated hemoglobin in the screening and diagnosis of posttransplantation diabetes mellitus after renal transplantation: A diagnostic accuracy study. Clin Chim Acta 2015; 445:48-53. [PMID: 25797896 DOI: 10.1016/j.cca.2015.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/24/2015] [Accepted: 03/03/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The role of glycated hemoglobin (A1C) in the screening and diagnosis of posttransplantation diabetes mellitus (PTDM) is still not entirely understood. We evaluated the use of A1C test in renal transplant recipients at four months after transplantation. METHODS A total of 122 out of 274 patients without previous diabetes that underwent kidney transplantation were enrolled. ROC curve was used to analyze the performance of A1C to diagnose PTDM considering OGTT as the reference standard. RESULTS OGTT identified 32 (26.2%) patients with PTDM, whereas A1C≥6.5% (48 mmol/mol) identified only 16 patients. A1C showed moderate accuracy to detect PTDM in the ROC curve [AUC 0.832 (95% CI 0.740-0.924, p<0.001)]. A1C of 5.8% (40 mmol/mol) was the equilibrium point (sensitivity 75% and specificity 72.2%) and A1C≥6.2% (44 mmol/mol) showed high specificity of 93.3%. CONCLUSIONS A1C≥6.5% (48 mmol/mol) is not enough to be used alone in the diagnosis of PTDM. The combined use of A1C cut-off points of ≤5.8% (40 mmol/mol) and ≥6.2% (44 mmol/mol) would reduce the number of OGTT by 85%. The use of an algorithm with A1C test in combination with FPG and/or 2h-PG proved to be the most efficient strategy to diagnose or rule out PTDM.
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Affiliation(s)
- Ana Laura Pimentel
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Samara Silva Marques
- Nursing School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Sandra Pinho Silveiro
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Joíza Lins Camargo
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Cheuiche AV, Soares AA, Camargo EG, Weinert LS, Camargo JL, Silveiro SP. Comparison between IDMS-traceable Jaffe and enzymatic creatinine assays for estimation of glomerular filtration rate by the CKD-EPI equation in healthy and diabetic subjects. Clin Biochem 2013; 46:1423-9. [PMID: 23747959 DOI: 10.1016/j.clinbiochem.2013.05.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 04/23/2013] [Accepted: 05/25/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this paper was to compare the agreement between creatinine measured by Jaffe and enzymatic methods and their putative influence on eGFR as calculated by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation in healthy and diabetic individuals. DESIGN AND METHODS Cross-sectional study conducted in 123 adult southern Brazilians with GFR>60 mL/min/1.73 m² (53 patients with type 2 diabetes, 70 healthy volunteers). Mean age was 49±16 years (range of 19-86). Most were female (55%) and white (83%). Creatinine was measured by a traceable Jaffe method (Modular P, Roche Diagnostic) and by an enzymatic method (CREA plus, Roche/Hitachi 917). GFR was measured by the ⁵¹Cr-EDTA single-injection method. RESULTS Serum creatinine measured by the Jaffe and enzymatic methods was similar in healthy subjects (0.79±0.16 vs. 0.79±0.15 mg/dL, respectively, P=0.76), and diabetic patients (0.96±0.22 vs. 0.92±0.29 mg/dL, respectively, P=0.17). However, the correlation between the two methods was higher in the healthy group (r=0.90 vs. 0.76, P<0.001). The difference between Jaffe creatinine and enzymatic creatinine was <10% in 63% of cases in the healthy group and 40% of cases in the diabetes group (P=0.018). In the subset of patients with diabetes, eGFR based on enzymatic assay results showed better agreement with measured GFR than did eGFR based on Jaffe results. CONCLUSION Jaffe and enzymatic creatinine methods show adequate agreement in healthy subjects, but in the presence of diabetes, the enzymatic method performed slightly better.
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Affiliation(s)
- Amanda Veiga Cheuiche
- Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
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Abstract
AIM To analyse the performance of HbA(1c) in diagnosing Type 2 diabetes based on fasting plasma glucose and/or 2-h plasma glucose measurements after a 75-g oral glucose tolerance test. METHODS This is a study of diagnostic test accuracy in individuals referred to the Clinical Pathology Department for oral glucose tolerance testing. After fasting overnight, HbA(1c), fasting plasma glucose and 2-h plasma glucose were measured. The receiver operating characteristic curve was used to evaluate the diagnostic performance of HbA(1c). RESULTS Four hundred and ninety-eight subjects (195 male, mean age 56 years) were enrolled and 115 (23.1%) were diagnosed with diabetes according to glucose-based methods and only 56 (11.2%) individuals were identified by HbA(1c) ≥ 6.5% (48 mmol/mol) (sensitivity 20.9%, specificity 95.3%). There is poor agreement between the newly recommended criterion and the current glucose-based diagnostic criteria (κ = 0.217; P < 0.001), probably because the diagnostic methods identify different populations of patients. Adding a glucose-based method into an algorithm, as proposed by the UK Department of Health, improved HbA(1c) performance. CONCLUSIONS HbA(1c) ≥ 6.5% (48 mmol/mol) showed limited sensitivity to diabetes diagnosis, although with high specificity. The results suggest that this cut-off point would not be enough to diagnose diabetes. Its use as the sole diabetes diagnostic test should be interpreted with caution to assure the correct classification of diabetic individuals.
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Affiliation(s)
- G Cavagnolli
- Postgraduate Program in Endocrinology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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25
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Wendland AE, Camargo JL, Polanczyk CA. Effect of preanalytical variables on myeloperoxidase levels. Clin Chim Acta 2010; 411:1650-5. [DOI: 10.1016/j.cca.2010.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 06/14/2010] [Accepted: 06/14/2010] [Indexed: 01/09/2023]
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26
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Weinert LS, Prates AB, do Amaral FB, Vaccaro MZ, Camargo JL, Silveiro SP. Gender does not influence cystatin C concentrations in healthy volunteers. Clin Chem Lab Med 2010; 48:405-8. [PMID: 20020822 DOI: 10.1515/cclm.2010.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current data are conflicting about the influence of gender on cystatin C concentrations. The goal of this study was to determine the reference interval for serum cystatin C in normal Brazilian subjects, taking into account the influence of gender. METHODS Ninety-seven healthy volunteers, aged 18-70 years, 44% male, had glomerular filtration rate (GFR) measured using a (51)Cr-EDTA method and estimated with the Modification of Diet in Renal Disease (MDRD) study equation. Serum cystatin C was measured using a turbidimetric method, and creatinine by the Jaffe method. RESULTS Mean serum cystatin C was not significantly different between males and females, 0.62 +/- 0.12 vs. 0.65 +/- 0.12 mg/L, respectively (p = 0.26). However, median serum creatinine was significantly higher in men [97 (80-115) vs. 80 (53-88) micromol/L; p = 0.0001]. There were also no significant differences between genders with respect to GFR measured using (51)Cr-EDTA (103 +/- 14 for males and 106 +/- 19 mL/min/1.73 m(2) for females, p = 0.47), and estimated with the MDRD equation (86 +/- 12 vs. 83 +/- 16 mL/min/1.73 m(2), respectively, p = 0.24). CONCLUSIONS There was no effect of gender on serum cystatin C, as well as on measured and estimated GFR.
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Affiliation(s)
- Letícia Schwerz Weinert
- Endocrine Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
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27
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Antunes MV, Wagner SC, Camargo JL, Linden R. Standardization of method for determining glycosylated hemoglobin (Hb A1c) by cation exchange high performance liquid chromatography. BRAZ J PHARM SCI 2009. [DOI: 10.1590/s1984-82502009000400007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hemoblobin A1c is the most important parameter for the monitoring of metabolic control of patients with diabetes mellitus. The purpose of this study was to adapt the Mono S method to a conventional HPLC system, allowing highly selective HbA1c determination without the acquisition of kits or the use of dedicated systems The results obtained were compared to the Tinaquant® immune turbidimetric method and the Bio-Rad Variant® chromatographic method. The developed method presented intra-study precision (C.V. %) of 1.39-3.65 and inter-study precision (C.V. %) of 2.80-3.02%. The determination coefficients among methods were: HPLC Mono S x Tinaquant®: r²: 0.9856 (n=60) and HPLC Mono S x HPLC Bio-Rad Variant®: r²: 0.9806 (n=16). A conversion equation between HPLC Mono S and Bio-Rad Variant® was calculated allowing yielding comparable and interchangeable values. The HPLC Mono-S is a precise, low-cost method which yields similar values to the Bio-Rad Variant® method on conventional HPLC equipment.
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28
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Soares AA, Eyff TF, Campani RB, Ritter L, Camargo JL, Silveiro SP. Glomerular filtration rate measurement and prediction equations. Clin Chem Lab Med 2009; 47:1023-32. [PMID: 19728843 DOI: 10.1515/cclm.2009.263] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic kidney disease (CKD) is defined as the presence of kidney damage or a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) for three or more months. Measurement of serum creatinine is the most commonly used method to evaluated kidney function, but it must be included in formulas to estimate GFR, adjusting for age, gender and ethnicity, such as the Modification of Diet in Renal Disease (MDRD) study equation. The performance of this equation is acceptable for patients with CKD but appears to under-estimate GFR in populations with unknown kidney status. A new formula has been developed recently. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation appears to perform better than the MDRD equation. Cystatin C has been widely evaluated as a marker for GFR and seems to be more sensitive than creatinine. The aim of this review is to discuss the recommendations for detecting CKD, emphasizing the characteristics and limitations of GFR estimating equations and pitfalls in the evaluation of urinary albumin excretion.
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Affiliation(s)
- Ariana Aguiar Soares
- Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
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29
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Iturry-Yamamoto GR, Zago AC, Moriguchi EH, Manfroi WC, Camargo JL, Gross JL, Zago AJ. Impact of metabolic syndrome and C-reactive protein on outcome after coronary stenting. J Endocrinol Invest 2009; 32:383-6. [PMID: 19636209 DOI: 10.1007/bf03345730] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Metabolic syndrome (MS) identifies cardiovascular risk; however, there is little information regarding the evolution of patients with MS after stent implantation. The aim of this single-center study is to evaluate the possible association between MS and clinical restenosis, after adjustment for highsensitivity C-reactive protein (hs-CRP) and angiographic predictors of restenosis. In a longitudinal study, 159 patients (89 with and 70 without MS) were studied. Criteria for MS were: elevated blood pressure (systolic >or=130 mmHg, diastolic >or=85 mmHg or drug treatment for hypertension; elevated fasting glucose (>100 mg/dl) or drug treatment for elevated glucose; reduced HDL-cholesterol (<40 mg/dl in men and <50 mg/dl in women) or drug treatment for reduced HDL-cholesterol; elevated triglycerides (>or=150 mg/dl) or drug treatment for elevated triglycerides; and obesity (body mass index >28.8 kg/m2). The primary end point was the rate of major adverse clinical events (MACE): cardiovascular death, myocardial infarction, or target lesion revascularization (TLR) during the 12-month follow-up period. The secondary end point was the rate of TLR. MS was neither identified as predictor of MACE [hazard ratio (HR): 0.844; 95% CI: 0.41-1.74; p=0.648], nor TLR (HR: 1.05; 95% CI: 0.44-2.50; p=0.91), even when controlled for hs-CRP levels and angiographic predictors of restenosis. Also, no significant interaction between MS and hs-CRP was found (p=0.135 and p=0.194, for MACE and TLR, respectively). This study shows that patients with MS do not have an additional risk of MACE, even when controlled for angiographic predictors of restenosis and hs-CRP.
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Affiliation(s)
- G R Iturry-Yamamoto
- Hemodynamic Unit/Cardiology Division, Clinic Hospital of Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
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Wendland AE, Azevedo MJD, Gross JL, Camargo JL. Avaliação de diferentes métodos imunoturbidimétricos para determinação de albumina urinária: impacto na classificação dos estágios da nefropatia diabética. J Bras Patol Med Lab 2007. [DOI: 10.1590/s1676-24442007000600002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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31
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Almeida JCD, Perassolo MS, Camargo JL, Bragagnolo N, Gross JL. Fatty acid composition and cholesterol content of beef and chicken meat in Southern Brazil. ACTA ACUST UNITED AC 2006. [DOI: 10.1590/s1516-93322006000100012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Abstract
Glycohemoglobin (GHb) has a key role in the assessment of glycemic control in diabetic patients. Several studies have clearly shown that improved glycemic control is strongly associated with decreased development and/or progression of diabetic complications in both type 1 and 2 diabetes mellitus. Therefore, accurate determination of GHb concentration is an important issue for clinical laboratories. Several factors may affect and lead to erroneous results. We discuss the problems of standardization of GHb measurements for monitoring glycemic control and also consider the potential interfering factors on GHb measurements. Moreover, GHb assays may be affected by interference in different ways. The effect of interference may be more clinically relevant with poor metabolic control. Laboratory staff must be aware of all pitfalls to avoid adding more confusion to the clinical interpretation of HbA1c values and physicians should contact laboratories if discrepancies between clinical impressions and laboratory data are observed.
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Affiliation(s)
- Joíza Lins Camargo
- Unidade de Bioquímica, Serviço de Patologia Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS.
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Abstract
AIMS To identify the causes of very low glycohaemoglobin (GHb) values in a sample of patients with diabetes in southern Brazil using high performance liquid chromatography. METHODS Between August 1996 and December 2001 all samples from patients with diabetes at a university hospital with GHb values below the reference range (4.7-6.0% HbA(1c)) were submitted to cellulose acetate electrophoresis. Medical records were reviewed to identify conditions that might be associated with these low values. RESULTS Among 29 657 samples analysed, 130 patients had GHb < 4.7%. Seventy three patients (56%) were heterozygous for HbS, HbC, or HbD (19 black, two mulatto, and 52 white patients). The other 57 patients (44%) without Hb variants had low haematocrit and haemoglobin values (42 patients) or other conditions such as pregnancy, lipaemia, malignancy, cirrhosis, acetylsalicylic acid use, and absence of diabetes (15 patients). CONCLUSIONS The presence of an Hb variant may falsely lower GHb measurements. However, anaemia is also a source of negative interference. The haematological status should be considered for the correct interpretation of GHb results.
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Affiliation(s)
- J L Camargo
- Clinical Pathology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Abstract
To analyse the accuracy of the conversion formulae for estimation of glycohaemoglobin (GHb) measured by different methods, we analysed 210 samples for HbA1c using HPLC. Fifty of these specimens were analysed by micro-column chromatography (MC), 43 by electrophoresis (EP), 50 by IMX system (Abbott Laboratories), 38 by Primus HPLC and 29 by Diamat HPLC. Regression analyses were performed and the equations were used to estimate HbA1c values (HbA1c calc) for the five methods. The 95% limits of agreement between HPLC and the converted results were -1.77 to 1.71%, -1.54 to 1.54%, -0.92 to 0.88%, -0.46 to 0.56%, and -0.39 to 0.41% for MC, EP, IMX, Primus and Diamat equations, respectively. The mean relative errors were 3.4 (-28.2 to 35%), 1.3 (-22.9 to 25.5%), 0.4 (-14.6 to 15.0%), 0.51 (-6.55 to 7.57%), -0.20 (-5.8 to 5.4%), for MC, EP, IMX, Primus and Diamat, respectively. These results show that conversion formulae based on methods that do not measure HbA1c (MC, EP and IMX) are inaccurate and can mask a clinically relevant variation of HbA1c. However, GHb results obtained by HPLC methods could be interchangeably converted with an absolute variation of less than 1%. Converted HbA1c results from non-standardized methods should be interpreted with caution.
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Affiliation(s)
- J L Camargo
- Department of Clinical Pathology, Hospital de Clínicas de Porto Alegre, Brazil
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Tani EM, Camargo JL. [Histological lesions of the bladder mucosa in 91 autopsies]. Rev Paul Med 1986; 104:185-8. [PMID: 3563271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Camargo JL, Angeleli AY, Burini RC, Campana AO. Hepatic lesions in protein-deficient adult rats. Br J Exp Pathol 1978; 59:158-66. [PMID: 656316 PMCID: PMC2041335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Four groups of 10 young adult Wistar male rats were fed ad libitum on a protein-free diet for periods of 7, 28, 56 and 84 days. Control groups were fed on a 20% casein diet. Food intake and body weights of rats were registered. Plasma protein levels and liver weight and fat content were determined. Sections of the caudate lobe were studied histologically. Fatty changes were classified in three grades. Protein-deficient rats exhibited loss of body weight and had low levels of plasma protein concentration. Liver lost weight after 7 days of protein deficiency; there was a gradual reduction in liver weight as periods of protein deprivation were longer. After 7 days, liver fat concentration was not significantly higher than in the respective control group; it was significantly higher in all the other malnourished animals. As periods of protein deprivation were longer, fatty changes became more severe. Other hepatic lesions were found in 5 of the 10 rats submitted to the longest period of protein deficiency. One of the rats showed a diffuse cellular atrophy, 2 animals showed an extensive haemorrhagic necrosis, another showed a focal area of reticulum collapse and the last exhibited a distortion of the normal architecture of the liver due to diffuse reticulum collapse and early nodular regeneration; these 2 last rats showed early fibrosis in portal areas. The findings suggest that other deficiencies may complicate the protein deficiency when rats are given a protein-free diet over prolonged periods. Even if the proteindeficient diet has protective nutrients, it may be that, when rats eat less food, as occurs in prolonged experiments, deficiency of one or all of these elements can occur, depending on their relative amount in diet.
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