Many translated example sentences containing “hemoglobina glicosilada” metformina disminuyó la hemoglobina glicosilada A1c (HbA1c) en adolescentes [. Abstract. MUNERA-JARAMILLO, María Isabel et al. Glycosylated haemoglobin A1c compared to fasting plasma glucose in outpatients referred to a medical. This page includes the following topics and synonyms: Hemoglobin A1C, Spanish, HbA>1cA1c, hemoglobina glicosilada A.
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A reliable and accurate test for diabetes care? A prospective study in Mexico. To compare the concordance correlation coefficient for HbA1c results in an in-field experience.
A prospective study in Monterrey, Mexico from April to August was conducted to evaluate the day-to-day clinical situation when measuring HbA1c. Blood samples from 38 consecutive patients were sent to seven local laboratories and one international reference laboratory. Poor concordance was found in 4 out of 7 laboratories, moderate in 2 out of 7, and significant in just one. Standardized HbA1c measurement has not occurred worldwide. Physicians should be aware of this issue and be cautious of HbA1c guidelines on diabetes diagnosis or management until proper standardization programs are implemented.
Recognition of the clinical value of HbA1c in diabetes management led to the creation, aroundof different working groups to develop a global reference method as well as a standardization of the HbA1c measurement. Many Mexican healthcare providers, on a daily basis, likely rely on a non-standardized HbA1c test for diabetes screening, diagnosis, and treatment. As a consequence, we decided to carry out a glicosllada study to evaluate the day-to-day clinical situation that a type 2 diabetes Mexican patient faces when a blood sample for HbA1c measurement is taken.
Secondary end points were: Approval was obtained from the Institutional Review Board and informed consent was obtained gllcosilada all participants. Male or female patients between 18 and 70 years of age with diabetes mellitus were included.
Pregnant women and all clinically well-recognized situations that may lead to erroneous HbA1c values were excluded. The sample was sent to eight laboratories. The glicosi,ada laboratories were the largest routine clinical laboratories in the metropolitan area of Monterrey, Mexico.
Table I shows the methods for HbA1c determination used in each selected gkicosilada laboratory. Three used ionic exchange high-pressure liquid chromatography IE-HPLC with different commercial products; two laboratories used cationic exchange resin by spectrophotometry S-CER ; one laboratory used an immunoassay of cationic exchange resin I-CERand the last one utilized turbid metric immunoassay TI.
As a reference for comparison, the eighth laboratory was a central, certified laboratory for HbA1c measurement in the United States Quintiles, Durham, NC. The intraassay and interassay coefficient of variation CV of the laboratories participating in this study are shown in Table I. Descriptive statistical analysis was used for quantitative variables, measures of central tendency and dispersion.
In the case of qualitative variables, frequencies were glicosjlada. For concordance correlation analysis, Lin CCC was calculated. The mean age of the participants was All participants had type 2 diabetes. Selecting the result of the reference laboratory, there were nine participants with an HbA1c value between 5. A value greater than 7.
Hemoglobin A1c – H | Pointe Scientific
There were no cases with a value greater than Variation, dispersion and concordance of the HbA1c results. Laboratory 7 had the hemog,obina CV On the other hand, the lowest CV was found in laboratory 4 There was not a trend to better agreement of any local clinical laboratory in HbA1c values higher or lower than 8. In values lower or equal than 8. The CCC of laboratory three vlicosilada in the same category moderate concordance but laboratory 2 and 5 showed a worse performance two from significant to moderate concordance, and five from moderate to poor concordance.
In HbA1c values higher than 8. No laboratory showed excellent, significant or moderate concordance. Laboratories that had a better performance as a whole 2, 3 and 5 all had poor concordance. Laboratories 2, 3 and 5 had the best agreement again Table IV. Laboratories 4, 6 and 7 had unacceptable HbA1c agreement values. Clinical impact of the disagreement in HbA1c results. Classification of the differences in the HbA1c results in each patient between the reference laboratory and each local laboratory is shown in Table V.
The HbA1c results were classified into four categories of range dissimilarity: Most cases in laboratory 4 had an HbA1c result above the result greater than 1. The opposite was found in laboratory 6 and 7, which had an HbA1c result below the value greater than 1. In our study, blood samples from 38 participants sent to seven of the most important local laboratories in a metropolitan area in a large city in Mexico and to one reference laboratory showed that 4 out of glicosilqda laboratories had a poor concordance or agreement by different statistical methods and analytical procedures.
This lack of agreement resulted in glicosiladw greater lack of precision or reliability with higher HbA1c values when population was divided into cases above or below 8.
These findings reveal a huge problem in diabetes management in our large population, that could be present in many other communities or hdmoglobina in daily clinical practice, glicosilaca the characteristics of our study design is illustrative of a real-life type 2 diabetes patient when HbA1c is measured. Many clinical situations are well-recognized causes of misleading values of HbA1c.
The physician should take all these situations into consideration in day-to-day clinical practice of type 1 and type 2 diabetes patients when assessing the quality of chronic glycemic control by an HbA1c measurement.
Nevertheless, incorrect HbA1c values, in a wide error range, due to problems in laboratory measurements are not easy to suspect and could lead the physician to make a mistake in the classification of the quality of glycemic control and the decision-making process on pharmacological management in patients with diabetes. A recent paper has mentioned that the first recommendation has been completed worldwide.
The robust clinical significance of our results would not change with involvement of more clinical laboratories or subjects.
Our study was carried out in the largest clinical laboratories of the metropolitan area of a big community in Mexico. Some studies have revealed concordance with some of our findings.
Análisis de sangre: hemoglobina A1c
This finding makes HbA1c measurement unacceptable in our population in a daily clinical practice. A limitation of our study is the lack of participation of other cities in Mexico; it is necessary to extend this study to other countries. It is likely that our medical scenario is still occurring in many places in the world with high diabetes prevalence.
The lack of this valuable assessment tool makes it very difficult to follow international diabetes screening diagnosis and management recommendations. As a consequence, hemotlobina would be urgent that health authorities in many countries linked to these international academic organizations in diabetes carry out an international certification procedure of clinical laboratories to obtain a license for standardized HbA1c measurement.
Patients are still less aware of the use of IFCC units. Most physicians related with diabetes care are not aware of the advantages of this new way to report HbA1c results but this issue increases the complexity of the implementation of strategies for HbA1c clinical interpretation and standardization all over the world. In conclusion, in some locations there is still a serious problem in HbA1c measurements as a result of a lack of standardization of the methods in clinical routine laboratories.
This situation makes it difficult to apply many important recommendations on diabetes patient management and, as a consequence, patients are at greater risk of developing chronic diabetes complications.
In the case of diabetes screening or diagnosis, the unreliability and dispersion of our HbA1c findings makes this strategy a risk for under or over diagnosis of diabetes. All recommendations or guidelines related to HbA1c use in clinical practice must be strong and clear, pointing out that they apply only with standardized laboratories.
In daily clinical practice, however, physicians do not ask whether the HbA1c result comes from a standardized laboratory or not. It is necessary to carry out randomized studies to evaluate the reliability of the HbA1c results in everyday management of patients with diabetes, particularly in countries that are likely in the same situation as us. Once this situation has been solved, it could be valuable to go for implementation of HbA1c in IFCC units and other issues with a less valuable clinical relevance in day-to-day diabetes care.
We wish to thank Dr. Gonzalez, for their critical reading of the manuscript and statistical advice, respectively. HbA 1c in diabetes. Case studies using IFCC units.
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