Haemoglobin A1c – A Marker for Complications of Type 2 Diabetes: The Experience from the UK Prospective Diabetes Study (UKPDS)
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Susan Manley
Abstract
Haemoglobin A1c (HbA1c) is the pre-eminent factor for quantifying the risk of complications in patients with diabetes and for monitoring glycaemia. Intervention to lower blood glucose in the two landmark clinical trials, the UK Prospective Diabetes Study (UKPDS) and the Diabetes Control and Complications Trial (DCCT), led to a reduction in the microvascular complications of diabetes.
Glycaemic status could be compared in the UKPDS and DCCT as the Bio-Rad Diamat HPLC analyser, as used in the DCCT, was introduced in 1989 for measurement of HbA1c in the UKPDS, after liaison with the DCCT. Results from other methods used for measurement of glycated haemoglobin during the UKPDS were aligned to this method. The Bio-Rad Diamat analyser in the central laboratory for the UKPDS, reference range 4.5–6.2% HbA1c, was certified as comparable to the DCCT by the National Glycohemoglobin Standardization Program in 1998.
A median difference in HbA1c of 0.9% was maintained over 10 years between the intensively and conventionally treated groups in the UKPDS (7.0% vs. 7.9% HbA1c) despite HbA1c increasing over time. Clinical care was transferred to general practitioners after the end of the main glucose control study for post-study monitoring. Over the first 3 years of post-study monitoring, HbA1c rose slightly in the previously intensively treated group with no appreciable increase in the conventional group, due to intensification of therapy.
At near-normal HbA1c, <6%, the updated mean value chosen to reflect glycaemic exposure throughout the UKPDS, the incidence of myocardial infarction was 2–3 times that of microvascular disease, with similar incidences for both complications at >10% updated mean HbA1c. Relationships between the risk of complications of type 2 diabetes and updated mean HbA1c had no observable thresholds. The UKPDS risk engine derived from the UKPDS database calculates coronary heart disease risk using HbA1c as a continuous variable and could now replace the Framingham equations for patients with type 2 diabetes.
Copyright © 2003 by Walter de Gruyter GmbH & Co. KG
Articles in the same Issue
- Editors' Introduction: Welcome to the Special Issue on Diabetes Mellitus
- Linking Research and Innovative Clinical Practice: The Story of Diabetes Mellitus
- Insulin Resistant States and Insulin Signaling
- Diabesity: An Inflammatory Metabolic Condition
- Plasma Adiponectin and Hyperglycaemia in Diabetic Patients
- Platelet Function and Acetyl-Coenzyme A Metabolism in Type 1 Diabetes Mellitus
- Oxidative Stress in Diabetes
- Carbonyl Stress and Diabetic Complications
- Chemical Modification of Proteins by Lipids in Diabetes
- Glyoxal and Methylglyoxal Levels in Diabetic Patients: Quantitative Determination by a New GC/MS Method
- Dyslipidemia in Patients with Type 2 Diabetes. Relationships between Lipids, Kidney Disease and Cardiovascular Disease
- Haemoglobin A1c – A Marker for Complications of Type 2 Diabetes: The Experience from the UK Prospective Diabetes Study (UKPDS)
- Glycated Hemoglobin Standardization – National Glycohemoglobin Standardization Program (NGSP) Perspective
- Haemoglobin A1c: Analysis and Standardisation
- Point-of-Care Testing in Diabetes Mellitus
- Evaluation of Portable Blood Glucose Meters. Problems and Recommendations
- Measurements of Glucose on the Skin Surface, in Stratum Corneum and in Transcutaneous Extracts: Implications for Physiological Sampling
- Biological Variability of Albumin Excretion Rate and Albumin-to-Creatinine Ratio in Hypertensive Type 2 Diabetic Patients
- Clinical and Laboratory Evaluation of Specific Chemiluminescence Assays for Intact and Total Proinsulin
- Clinical Impact of the New Criteria for the Diagnosis of Diabetes Mellitus
- The Effect of the New ADA and WHO Guidelines on the Number of Diagnosed Cases of Diabetes Mellitus
- Detecting Type 2 Diabetes by a Single Post-Challenge Blood Sample
- Laboratory Tests in Diagnosis and Management of Diabetes Mellitus. Practical Considerations
- Obesity, Glucose Intolerance and Diabetes and Their Links to Cardiovascular Disease. Implications for Laboratory Medicine
- Meetings and Awards
Articles in the same Issue
- Editors' Introduction: Welcome to the Special Issue on Diabetes Mellitus
- Linking Research and Innovative Clinical Practice: The Story of Diabetes Mellitus
- Insulin Resistant States and Insulin Signaling
- Diabesity: An Inflammatory Metabolic Condition
- Plasma Adiponectin and Hyperglycaemia in Diabetic Patients
- Platelet Function and Acetyl-Coenzyme A Metabolism in Type 1 Diabetes Mellitus
- Oxidative Stress in Diabetes
- Carbonyl Stress and Diabetic Complications
- Chemical Modification of Proteins by Lipids in Diabetes
- Glyoxal and Methylglyoxal Levels in Diabetic Patients: Quantitative Determination by a New GC/MS Method
- Dyslipidemia in Patients with Type 2 Diabetes. Relationships between Lipids, Kidney Disease and Cardiovascular Disease
- Haemoglobin A1c – A Marker for Complications of Type 2 Diabetes: The Experience from the UK Prospective Diabetes Study (UKPDS)
- Glycated Hemoglobin Standardization – National Glycohemoglobin Standardization Program (NGSP) Perspective
- Haemoglobin A1c: Analysis and Standardisation
- Point-of-Care Testing in Diabetes Mellitus
- Evaluation of Portable Blood Glucose Meters. Problems and Recommendations
- Measurements of Glucose on the Skin Surface, in Stratum Corneum and in Transcutaneous Extracts: Implications for Physiological Sampling
- Biological Variability of Albumin Excretion Rate and Albumin-to-Creatinine Ratio in Hypertensive Type 2 Diabetic Patients
- Clinical and Laboratory Evaluation of Specific Chemiluminescence Assays for Intact and Total Proinsulin
- Clinical Impact of the New Criteria for the Diagnosis of Diabetes Mellitus
- The Effect of the New ADA and WHO Guidelines on the Number of Diagnosed Cases of Diabetes Mellitus
- Detecting Type 2 Diabetes by a Single Post-Challenge Blood Sample
- Laboratory Tests in Diagnosis and Management of Diabetes Mellitus. Practical Considerations
- Obesity, Glucose Intolerance and Diabetes and Their Links to Cardiovascular Disease. Implications for Laboratory Medicine
- Meetings and Awards
