Glycated Hemoglobin

Glycated hemoglobin is a form of hemoglobin that is chemically linked to a sugar. Most monosaccharides, including glucose, galactose and fructose, spontaneously bond with hemoglobin, when present in the bloodstream of humans.

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Also Known as: A1c, HbA1c, Glycohemoglobin, Glycated Hemoglobin, Glycosylated Hemoglobin,Hemoglobin A1C, HgbA1c

Test Purpose:

1. This test is used to monitor diabetes control.
2. This test tells us the patient average glucose index over a long period of time (2 to 3 months).
3. It tracks glucose in the milder form of diabetes.
4. It helps to determine which type of drugs may be needed.
5. Its measurement is of value in a specific group of patients like:
   • Diabetic children
   • Diabetic patients whose renal threshold for glucose is abnormal.
   • Unstable diabetes type I, taking insulin.
   • Type II diabetic women who become pregnant.
   • Patients with changing dietary or other habits.
6. It should be repeated every 3 to 4 months.

Sample Required:

1. The blood sample is taken in the EDTA 3 to 4 ml.
2. Washed RBC or hemolysate is prepared and this is stable for 4 to 7 days at 4 °C.
3. A blood sample can be drawn at any time.

Normal

Source 1

• HbA1 c (% of total Hb) = 4.0 to 5.2
• Hb A₁  (%  of  total Hb) ₌ 5.0 to  7.5

Source 2

1. Non Diabetic adult = 2.2 to 4.8 %.
2. Non Diabetic child = 1.8 to 4.0 % .
   1. Prediabetic              = 5.7 to 6.4 %
   2. Diabetics                  = >6.5 %
   3. Diabetic HbA1c = > 8.1 % = corresponds with glucose >200 mg/dl.

Diabetic Control And HbA1c

1. Good diabetic control = 2.5 to 5.9 %.
2. Fair diabetic control = 6 to 8 %.
3. Poor diabetic control = > 8 %.
   • (Values may vary according to the lab)

The following table gives a recommendation for the treatment:

HbA1c And Estimated Blood Glucose Level:

Formula = mg/dL /18 = mmol/L

                    mmol/L  x 18 = mg/dL

Increased Level Is Seen In:

1. Newly diagnosed diabetic patient.
2. Uncontrolled diabetic patient.
3. Nondiabetic hyperglycemia is seen in:
   1. Cushing’s syndrome.
   2. Acromegaly.
   3. Corticosteroids therapy.
   4. Pheochromocytoma.
   5. Acute stress.
   6. Glucagonoma.
4. Patient with splenectomy.
5. Alcohol toxicity.
6. Iron deficiency anemia.
7. Lead toxicity.

Decreased HbA1c Level Is Seen In:

1. Hemolytic anemia.
2. Chronic blood loss.
3. Chronic renal failure.
4. Pregnancy.

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