Labile glycated hemoglobin: an underestimated laboratory marker of short term glycemia
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Joris R. Delanghe
,
Stijn Lambrecht
Abstract
Objectives
Diabetes mellitus is a major public health problem. Hemoglobin A1c (HbA1c) is a key laboratory parameter in the management of diabetes patients. However, in diabetes monitoring, interpretation of HbA1c results is hampered by the important interindividual variation in red blood cell (RBC) life span. Furthermore, HbA1c only slowly responds to changes in glucose metabolism. Besides HbA1c, there exists a labile HbA1c fraction (l-HbA1c), exhibiting much faster kinetics. As both HbA1c and l-HbA1c are measured by modern standard chromatography, we explored the possibilities of using the l-HbA1c fraction for monitoring glycemia.
Methods
l-HbA1c and HbA1c fractions were simultaneously assayed on a Tosoh G8 analyzer and expressed as %. l-HbA1c results were compared with serum glucose and HbA1c. Concomitantly, RBC distribution width (RDW) was determined on a Sysmex SN analyzer as a marker for erythrocyte life span.
Results
l-HbA1c could be measured with between-run coefficient of variations (CVs) between 2.2 and 2.3%. l-HbA1c correlated with both glycemia (r=0.80) and HbA1c results (r=0.73). In a multiple regression model (r2=0.752), glycemia and HbA1c were the most determining factors. To a lesser extent, RDW correlated with l-HbA1c (r=0.158). Furthermore, the l-HbA1c/HbA1c ratio weakly positively correlated with RDW (r=0.247).
Conclusions
L-HBA1c represents an additional marker for monitoring the rapid occurrence of glycemic disorders that escape detection when using only HbA1c and blood glucose. RDW can be used as an indicator of atypical RBCs life span, in which the l-HbA1c fraction may be helpful.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: Not applicable.
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Articles in the same Issue
- Frontmatter
- Obituary
- Dr Per Hyltoft Petersen: an appreciation
- Editorials
- Extrapolated normative GFR data for living kidney donation
- Effectiveness of interventions to improve test appropriateness
- Reviews
- The pathogenesis, epidemiology and biomarkers of susceptibility of pulmonary fibrosis in COVID-19 survivors
- S100B in cardiac surgery brain monitoring: friend or foe?
- Mini Review
- Blood lactate concentration in COVID-19: a systematic literature review
- Opinion Paper
- Commercial immunoassays for detection of anti-SARS-CoV-2 spike and RBD antibodies: urgent call for validation against new and highly mutated variants
- General Clinical Chemistry and Laboratory Medicine
- A randomized controlled study of biochemical tests in primary care: interventions can reduce the number of tests but usage does not become more appropriate
- A national surveillance program for evaluating new reagent lots in medical laboratories
- External quality assessment providers’ services appear to more impact the immunohaematology performance of laboratories than national regulatory and economic conditions
- International collaborative study to evaluate and calibrate two recombinant L chain Ferritin preparations for use as a WHO International Standard
- Method comparison of three serum free light chain assays on the Roche Cobas 6000 c501 chemistry analyzer
- Prospective urinary albumin/creatinine ratio for diagnosis, staging, and organ response assessment in renal AL amyloidosis: results from a large cohort of patients
- Analytical evaluation of the Nittobo Medical tartrate resistant acid phosphatase isoform 5b (TRACP-5b) EIA and comparison with IDS iSYS in different clinically defined populations
- Reference Values and Biological Variations
- Age-adapted percentiles of measured glomerular filtration in healthy individuals: extrapolation to living kidney donors over 65 years
- Indirectly determined hematology reference intervals for pediatric patients in Berlin and Brandenburg
- Hematology and Coagulation
- Monocyte distribution width (MDW): a useful biomarker to improve sepsis management in Emergency Department
- Diabetes
- A step towards optimal efficiency of HbA1c measurement as a first-line laboratory test: the TOP-HOLE (Towards OPtimal glycoHemOgLobin tEsting) project
- Labile glycated hemoglobin: an underestimated laboratory marker of short term glycemia
- Infectious Diseases
- Neutralizing antibody titers six months after Comirnaty vaccination: kinetics and comparison with SARS-CoV-2 immunoassays
- Letters to the Editors
- Molecular detection of SARS-CoV-2 eta VOI in Northern Italy: a case report
- Optimizing effectiveness of COVID-19 vaccination: will laboratory stewardship play a role?
- Measurement in different sample types may aid in detecting interferences and macrocomplexes affecting cardiac troponin measurements
- Which method to detect macrotroponin?
- Marked geographical variation in the prevalence of macroprolactinemia
- Pancreatic lipase assays: time for a change towards immunoassays?
- Analytical evaluation of the performances of a new procalcitonin immunoassay
- Necessity of harmonization of tissue transglutaminase IgA assays to align clinical decision making in coeliac disease
- A fortuitous but characteristic blood smear observation allowing a late diagnosis of MPS-VII
- Prognostic significance of blood-based multi-cancer detection in plasma cell-free DNA
