HbA1C In The Management of Diabetes Mellitus
25TH JUNE 2016
Diabetes mellitus is a non communicable disease characterized by a state of persistent hyperglycemia in the body (American Diabetes Association, 2014).
In the recent past, because of factors such as industrialization, increase in consumption of processed foods, obesity and increased intake of sugar laden products, DM has become extremely rampant and is a subject of much debate (American Diabetes Association, 2014).
As years progress there have been several studies as regarding the diagnosis and the management of the condition
Glycated hemoglobin is formed in a non enzymatic pathway that sees the bonding of glucose in the blood with the red blood cells in the lifespan of the cells of 120days.Therefore it measures the total amount of glucose that a cell was exposed to in the course of the cells lifetime. Therefore HbA1C levels detect the amount of glucose in blood in the previous two to three months (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
A study was therefore conducted in 2011 by Sung Hee C. ,Tae H.K, Lim S. et al to determine the importance of HbA1C in the management of DM (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
The study dubbed Hemoglobin A1C as a diagnostic tool for Diabetic screening and New Onset Diabetes Prediction, was a six year prospective study studied the usefulness of HbA1C levels when screening for undiagnosed DM and as a predictor of 6yr incident DM (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
The research incorporated a total of 10,038 subjects from the Amsung-Ansan cohort study in Korea. The subjects were then subjected to oral glucose tolerance testing with 75mg of glucose to determine their baseline sugar levels. This was later conducted twice every year (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
To minimize skewing of results, the subjects who previously had diabetes were excluded from the study. The ages of interests were between 40 and 69years (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
The subjects obtained were the residents within the borders of the survey area for at least 6months prior to the testing (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
At the baseline of the study following the OGTT,6.8% of the subjects were newly diagnosed with type 2 DM (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
Individuals that had a HbA1C above 5.6% had an increased risk of becoming diabetic and these were then advised on dietary modifications to prevent the progression (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
At the end of 6 years, 10.2% of the subjects had developed incident diabetes .A multivariate adjustment was then done. This then predicted that men with a baseline A1C greater than 5.6% had a 2.4 times increased risk with women with similar values had a 3.1 fold increased risk of new onset diabetes at the same baseline levels (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
Following the results obtained from the research. It was noted that HbA1C has a predictive influence on the occurrence of DM, especially new onset diabetes in patients that were prediabetic. This therefore proved quite important since this could literally prevent them from obtaining diabetes or slow down the rate at which It occurs in such individuals (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
Such patients were then advised on diet modification and were requested to seek guidance especially from the dietitians on how to manage their food intake.
HbA1C levels can also be used to affirm how well or how poorly the sugar levels are controlled in a patient who is already diabetic. In these patients, a HbA1C level of below 6.5% is desirable and a figure more than this is associated with poor prognosis(Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
Therefore, the patients that were noted to be prediabetic were really advantaged because now, they had a chance of avoiding the condition (Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
HbA1C is a marker of prolonged exposure to glucose and therefore apart from the use in determining the incidence of DM in prediabetic individuals, it can also e used to determine for how long the red blood cells have been exposed to excessive glucose (Longo L., Harrison T. R., D. L. Kasper, 2011).
By so doing, it can be used to determine how well an individuals sugar levels are controlled in the body (Colledge R., Walker R., Ralston H., 2010).
This is very important since it aids in the definitive management of DM. The higher the HbA1C levels, the poorer the control of sugar levels, especially if the levels are above 6.5%.Such patients can therefore be advised on treatment compliance or have their doses of drugs increase or have a change of medication all together to ensure their glucose levels are well controlled(Sung Hee C. ,Tae H.K, Lim S. et al, 2011).
American Diabetes Association, 2014, Standards of medical care in diabetes. Diabetes Care 34:S14
Colledge R., Walker R., Ralston H., 2010, Davidson’s Principles and Practice of Medicine. Elsevier.
Longo L., Harrison T. R., D. L. Kasper, 2011, Harrison’s Principles of Internal Medicine McGraw-Hill Medical.
Sung Hee C. ,Tae H.K, Lim S. et al, 2011, Hemoglobin A1C as a diagnostic tool for Diabetic screening and New Onset Diabetes Prediction, Health services research.
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