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Glycated Hemogl..

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In January 2010, the American Diabetes Association (ADA) released new standards of care recommendations for diabetes. According to the revised standards of care, it is now recommended that Hemoglobin A1c (Hgb A1c) should now be used for the diagnosis of diabetes.1 Hgb A1c has the ability to reflect an average blood glucose level over the past 2 to 3 months, which is critical for monitoring the therapeutic management of a diabetic patient. It is also known to correlate closely with microvascular and macrovascular complications. In the past, it has not been recommended as a diagnostic tool due to the varying assay methods available. However, an International Expert Committee along with the ADA has now recommended its use with a threshold of >6.5% and should be measured using a method that is certified by the National Glycohemoglobin Standardization Program (NGSP)1. This program excludes the use of point of care assays as diagnostic aides. There are several advantages to the use of Hgb A1c; however, there are limitations to this tool. Limitations include patients with certain forms of anemia and hemoglobinopathies as it can give false results and the use of glucose criteria should be used.1

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Recently, a randomized controlled trial by Selvin and colleagues was designed to compare the relationships between values of glycated hemoglobin and fasting glucose to the risk of diabetes, coronary heart disease, ischemic stroke and death from any cause. The patients compared did not have a history of diabetes and were enrolled in the Atherosclerosis Risk in Communities (ARIC) study.2 This study population consisted of 15,792 middles aged adults from four US communities. With this study, frozen whole blood samples from the 2nd visit in the ARIC study (during 1990-1992) were thawed for the measurement of Hgb A1c. Participants were excluded if they were identified as other than white or black or who had a self-diagnosis of diabetes, cardiovascular disease or experienced a cardiovascular event. The final sample size was 11,092 patients. Other information gathered for these patients included serum glucose, plasma lipid level, body mass index, waist to hip ratio, blood pressure, education level, alcohol use, smoking status and level of physical activity. All patients were evaluated by three models. Model one was adjusted for age, sex, and race. Model two was adjusted for age, sex, race, low-density and high-density cholesterol levels, triglyceride level, BMI, waist to hip ratio, hypertension, family history of diabetes, education level, alcohol use, physical activity and smoking status. Model three was adjusted for all variables in Model two plus either baseline fasting glucose level or baseline Hgb A1c level. Models one, two, or three were evaluated further with regard to the Hgb A1c categories (Model 1a, 2a, and 3a) and also for standard fasting glucose categories (model 1b, 2b, and 3b).

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The median follow up time was approximately 14 years. A baseline Hgb A1c of less than 5% was associated with approximately half the risk of a Hgb A1c of 5 to 5.5% of diagnosed or visit based diabetes. There were also significant trends of an ...

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