Rapid and slow rate of decrease in HbA1a + b and HbA1c during improved glycaemic control

Arnqvist, Hans J.; Cederblad, G.; Hermansson, Göran; Ludvigsson, Johnny; Wettre, Staffan

doi:10.3109/00365518209168084

Cited by 3 publications

(5 citation statements)

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“…In another study, we found a decrease within the first days of improved glycaemic control when HbA~ was determined without the preceding elimination of the labile fraction [24]. In that study, the patients were newly diagnosed diabetic patients in poor glycaemic control and the initial values of HbAlc were high.…”

Section: Discussionmentioning

confidence: 88%

Increase in stable glycosylated haemoglobin after induction of poor glycaemic control

et al. 1983

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Summary. Eight insulin-treated diabetic patients in good glycaemic control were studied as out-patients with frequent determinations of stable glycosylated haemoglobin (HbAlc) before, during and after 1 week of induced poor glycaemic control. Stable HbAlo was determined by cation exchange chromatography after elimination of the labile fraction by incubation in saline (0.15 tool/l). The increase in mean blood glucose was significant on the first day of reduced insulin therapy and greatest after 1 Week (6.9___ 3.9 mmol/1 above basal values). Stable HbAac increased significantly on day 7 of the reduced insulin treatment. The increase represented, on average, 0.009% of total haemoglobin per mmol/1 increase in mean blood glucose per 24 h during the period of induced hyperglycaemia. After restoring insulin therapy, a significant decrease in blood glucose was achieved on day 1 and after 2 days, the blood glucose level was similar to before the study. There was no significant decrease in stable HbAlc within the first 2 weeks of improved glycaemia.

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Section: Discussionmentioning

confidence: 88%

Increase in stable glycosylated haemoglobin after induction of poor glycaemic control

et al. 1983

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“…Diabetic patients often have high fasting blood glucose, even when they are in good diabetic control. We believe that it is especially important to eliminate the labile component before HbA 1c estimation (15)(16)(17)(18)(19)(20), although this idea is not universally accepted (39-41). Some methods, e.g., affinity chromatography, isoelectric focusing, and thiobarbituric acid colorimetry, are not affected by labile HbA, c (11)(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

“…Cation-exchange chromatography is the most commonly used laboratory method. Because it measures total HbA lc , pretreatment of the sample to remove labile HbA 1c is required to avoid false high results (15)(16)(17)(18)(19)(20). Previous methods for removing labile HbA 1c are lengthy and laborious (21)(22)(23)(24)(25)(26), and incubation at pH 5 results in Hb instability (25,(27)(28)(29).…”

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confidence: 99%

“…This may be useful when estimating HbA 1c by the manual method. Diabetes 39: [17][18][19][20][21]1990 F ormation of glycosylated hemoglobin (HbA 1c ) is a two-stage nonenzymatic process (1)(2)(3)(4)(5). Initially, a readily reversible reaction takes place between glucose and the NH 2 -terminal valine of the (3-chain of HbA to form an aldimine or Schiff base (labile HbA 1c ).…”

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confidence: 99%

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Immediate Elimination of Labile HbA1c With Allosteric Effectors of Hemoglobin

Nakashima

Hattori²,

Yamazaki³

et al. 1990

Diabetes

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Our aim was to find a simple method of removing labile glycosylated hemoglobin (HbA1c) from blood samples before it is measured by cation-exchange chromatography. Labile HbA1c is formed by the binding of glucose to the NH2-terminal valine of the beta-chain of HbA. We sought a more competitive binder for the same site to dissociate labile HbA1c to glucose and HbA. Inorganic phosphates were found to have a strong allosteric effect and a great ability to eliminate labile HbA1c. We developed our method with 4 mM tetrapolyphosphate in the hemolyzing solution to eliminate labile HbA1c during the automatic processing (at pH 6 and heated for 2 min at 45 degrees C) of blood samples for HbA1c estimation. This may be useful when estimating HbA1c by the manual method.

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“…However, HbAlc can vary rather rapidly (Boden et al 1980;Arnqvist et al 1982;Wettre et al 1983) and reflects mainly the recent few weeks. This means that for natural reasons a two month period with the same fluctuations during such a period will give different values of HbAic depending on when in relation to the fluctuations the determination is made (Fig.…”

Section: Glycosylated Proteinsmentioning

confidence: 99%

Strategy for self-monitoring of diabetic control

Ludvigsson

Hermansson

1985

Acta Endocrinologica

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Treatment of diabetes must aim at normal metabolism. Sporadic measurements of any known parameter is not a sufficient guarantee but continous regular self-monitoring is necessary. At least [ill]insulin dependent diabetes it seems reasonable that we should monitor the free insulin levels, but that still belongs to the future. As blood glucose gives us a good reflection of the hormonal and metabolic balance, this is a relevant parameter to follow. Glycosylated proteins, mainly hemoglobin, give only retrospective information of moderate value for the practical management of the disease. Furthermore, one should be aware of the different weak points of glycosylated hemoglobin which does not tell the only, total truth about glucose balance. Self-monitoring of blood glucose is a very valuable tool, especially when used in a systematic way. To get information covering the whole day every day tests for glucosuria have still a place, especially among children and young adults with rather short duration of diabetes. With a sensible approach it is possible to get good compliance among most patients. A combination of blood and urine glucose selfcontrol creates opportunities for a good metabolism in diabetes.Several studies both experimental and clinical (Ca¬ nili et al 1976; Skyler 1979) have given strong support for the importance of good metabolic control in pre¬ venting diabetic microangiopathy. Even without such proofs it is self-evident that people with diabetes shall have the same kind of metabolism as healthy people as long as nobody has shown that diabetics need an abnormal metabolism. The question is ra¬ ther: Which of all abnormal hormonal and metabolic parameters should first of all be normalized if we cannot normalize all, but have to choose? How do we know whether this goal can be reached? InsulinThe aim of diabetes treatment before the discovery of insulin was mainly to normalize the carbohydrate metabolsim as that seemed to the main error. How¬ ever, curiously enough this attitude has remained unchanged even after the insulin discovery. Thus the interest has been focused on blood glucose levels and to some extent on fat metabolism. If the main error in type I diabetes actually is the insulin deficiency or inadequate insulin levels, the main aim should reasonably be to normalize the insulin levels, but during decades this has become a secondary aim.Most treatment programmes have more or less in vain concentrated upon how to correct life of dia¬ betics including food an exercise habits to suit an abnormal insulin level. It seems reasonable that we should monitor the free insulin levels, but for the moment we know too little about what is physiolo¬ gical levels, and the less where and how to measure

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Rapid and slow rate of decrease in HbA1a + b and HbA1c during improved glycaemic control

Cited by 3 publications

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Increase in stable glycosylated haemoglobin after induction of poor glycaemic control

Increase in stable glycosylated haemoglobin after induction of poor glycaemic control

Immediate Elimination of Labile HbA1c With Allosteric Effectors of Hemoglobin

Strategy for self-monitoring of diabetic control

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