Hemoglobinopathies and Hemoglobin A1c in Diabetes Mellitus

Klonoff, David C.

doi:10.1177/1932296819841698

Cited by 37 publications

(28 citation statements)

References 38 publications

(49 reference statements)

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“…10 Analysis of continuous glucose monitoring (CGM) data indicated that HGI differs between individuals and is stable over 6-12 months of observation. 11 In addition, hemoglobinopathy-related HbA1c variations 12 and ethnic differences in glycation index 13 further demonstrate the wide individual variation in glycation status. These findings are supportive of data showing discordance between mean glucose and HbA1c in some patients with diabetes.…”

Section: Introductionmentioning

confidence: 96%

A Kinetic Model for Glucose Levels and Hemoglobin A1c Provides a Novel Tool for Individualized Diabetes Management

Dunn

Ajjan

2020

J Diabetes Sci Technol

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Background: Regular assessment of glycated hemoglobin (HbA1c) is central to the management of patients with diabetes. Estimated HbA1c (eHbA1c) from continuous glucose monitoring (CGM) has been proposed as a measure that reflects laboratory HbA1c. However, discrepancies between the two markers are common, limiting the clinical use of eHbA1c. Therefore, developing a glycemic maker that better reflects laboratory HbA1c will be highly relevant in diabetes management. Methods: Using CGM data from two previous clinical studies in 120 individuals with diabetes, we derived a novel kinetic model that takes into account red blood cell (RBC) turnover, cross-membrane glucose transport, and hemoglobin glycation processes to individualize the relationship between glucose levels and HbA1c. Results: Using CGM data and two laboratory HbA1c measurements, kinetic rate constants for RBC glycation and turnover were calculated. These rate constants were used to project future HbA1c, creating a new individualized glycemic marker, termed calculated HbA1c (cHbA1c). In contrast to eHbA1c, the new glycemic marker cHbA1c gave an accurate estimation of laboratory HbA1c across individuals. The model and data demonstrated a non-linear relationship between laboratory HbA1c and steady-state glucose and also showed that glycation status is modulated by age. Conclusion: Our kinetic model offers mechanistic insights into the relationship between glucose levels and glycated hemoglobin. Therefore, the new glycemic marker does not only accurately reflect laboratory HbA1c but also provides novel concepts to explain the mechanisms for the mismatch between HbA1c and average glucose in some individuals, which has implications for future clinical management.

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Section: Introductionmentioning

confidence: 96%

A Kinetic Model for Glucose Levels and Hemoglobin A1c Provides a Novel Tool for Individualized Diabetes Management

Dunn

Ajjan

2020

J Diabetes Sci Technol

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“…We here describe these gender differences without offering an explanation. Whereas disciplined nutritional habits can be assumed in the examined study population, the limited increments in HbA1c values observed here might be caused by anti-diabetic drug overdosage or one of the following enhancers/ depressors of HbA1c results: haemoglobin gene variations, even when clinically silent [48], mild haemolytic anaemia, or folic acid deficiency. Thus, the pilot Spanish epidemiology of chronic renal disease cross-sectional study [47] is consistent with the present findings of a clear distinction between female and male metabolisms.…”

Section: Discussionmentioning

confidence: 83%

“…More recently, the constitution of the glycated haemoglobin has been scrutinised as a previously unknown influence on glycated haemoglobin A1c results. Racial differences also affect this variable [48]. Efforts to comply with International Federation of Clinical Chemistry reference systems and to improve biosensing methods are maintained though [14].…”

Section: Discussionmentioning

confidence: 99%

Glycaemic patterns in healthy elderly individuals and in those with impaired glucose metabolism – exploring the relationship with nonglycaemic variables

et al. 2019

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OBJECTIVE: The SENIORLABOR study data were explored (i) to examine the evolution during senescence of the differences between measured glycated haemoglobin (HbA1c) values and the values predicted by using regression to extrapolate from measured fructosamine levels; (ii) to scrutinise the relationship between the glycation gap and insulin resistance using a homeostasis model assessment, and between the glycation gap and a low-grade inflammation marker (C-reactive protein serum concentration); and (iii) to investigate the glycation gap ranges in relation to triglyceride levels and kidney function.CONCLUSION: This is the first time that a direct comparison of healthy, prediabetic and diabetic participants, all assessed under identical conditions and using identical methodology, has clearly demonstrated a different glycation gap pattern. Thus, we contribute evidence that the glycation gap might be of interest in the care of diabetic patients and their prophylaxis, while acknowledging that more studies are needed to confirm our findings. (Trial registration number ISRCTN53778569)

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“…Hämoglobinopathien sind die häufigsten vererbten Einzelgenstörungen. Laut WHO tragen 5,2 % der Weltbevölkerung eine Variante [35].…”

Section: Besonderheiten In Der Diagnostikunclassified

“…Es resultiert eine Verkürzung der Erythrozyten-Überlebensdauer. Der HbA 1c -Wert kann aufgrund dieser verkürzten Lebensdauer falsch höher sein [35]. Aufgrund struktureller Veränderungen am Globin-Molekül können jedoch auch erniedrigte HbA 1c -Werte gemessen werden [28].…”

Section: Besonderheiten In Der Diagnostikunclassified