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Clinical Importance Of Glycosylated Hemoglobin

(HbA1c) In Diabetes Mellitus Patients

Article · January 2008

Source: DOAJ

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 Online Journal Pharmainfo.net 2008 March 21 1

“Clinical importance of Glycosylated

hemoglobin (HbA1c) in diabetes mellitus
patients”.

P. V. Ingle

The HbA1c test (hemoglobin A1c, glycosylated hemoglobin A1c,

glycohemoglobin A1c, or A1c test) is a lab test, which reveals average
blood glucose over a period of two to three months.

Specifically, it measures the number of glucose molecules attached to hemoglobin, a

substance in red blood cells 1. People who do not have diabetes generally have an HbA 1c level

of less than 6 %. This means that less than 6 % of their hemoglobin molecules have glucose

permanently attached 2.

Based on the results of studies such as the Diabetes Control and Complications Trial (DCCT),

which showed that tight blood glucose control could reduce the risk of diabetic eye, kidney and

nerve disease, the American Diabetes Association (ADA) recommends that people with

diabetes try to keep their HbA1c level below 7% 3.

Underlying Principle:

In the normal 120-day life span of the red blood cell glucose molecules join hemoglobin,

forming glycosylated hemoglobin. In individuals with poorly controlled diabetes, increases in

the quantities of this glycosylated hemoglobin are noted. Once a hemoglobin molecule is

glycosylated, it remains that way. A buildup of glycosylated hemoglobin within the red cell

reflects the average level of glucose to which the cell has been exposed during its life cycle.

Measuring glycosylated haemoglobin assesses the effectiveness of therapy by monitoring long-

term serum glucose regulation4.

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The HbA1c level is proportional to average blood glucose concentration over the previous four

weeks to three months (some researches state that the major proportion of its value is related

to a rather short term period of two to four weeks). Hemoglobin is the oxygen-carrying

pigment that gives blood its red color and also the predominant protein in red blood cells.

About 90% of hemoglobin is hemoglobin A. (The "A" stands for adult type.) Although one

chemical component accounts for 92% of hemoglobin A, approximately 8% of hemoglobin A is

made up of minor components that are chemically slightly different. These minor components

include hemoglobin A1c, A1b, A1a1, and A1a2. Hemoglobin A1c (HbA1c) is a minor component

of hemoglobin to which glucose is bound. HbA 1c also is referred to as glycosylated or

glucosylated hemoglobin 5.

HbA1c levels depend on the blood glucose concentration. That is, the higher the glucose

concentration in blood, the higher the level of HbA1c; and not influenced by daily fluctuations

in the blood glucose concentration but reflect the average glucose levels over the prior six to

eight weeks. Therefore, HbA1c is a useful indicator of how well the blood glucose level has

been controlled in the recent past and may be used to monitor the effects of diet, exercise and

drug therapy on blood glucose in diabetic patients 6.

Healthy HbA1c levels 7:

However target HbA1c levels may vary from person to person. A general range for HbA1c

levels is:

• Less than or equal to 7% is a very healthy HbA1c level

• Between 7% and 8% is a fair HbA1c level and needs work to improve

• Between 8% and 10% indicates your blood glucose levels are too high

• Above 10% indicates your blood glucose levels are extremely high

Importance 2:

Patient’s daily blood glucose tests provide only a snapshot of glycemic control at the moment

you test. The HbA1c test, on the other hand, gives the big picture by showing how patient

blood glucose control has been over the previous couple of months. HbA 1c tests are helpful to

physician because they give an immediate indication of patient blood glucose control. It is

certainly easier than ploughing through the last three month’s.

Over a longer period of time, consecutive HbA1c tests may provide an overall trend in your

diabetes control. If HbA1c is progressively raising each time patient visit the clinic then it may

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suggest that your treatment plan needs modifying; if you have Type 2 diabetes. Finally, HbA1c

tests are often used in setting and achieving treatment goals.

A major study, the UKPDS Study 8

published in 2000, managed to quantify many of the

benefits of reducing a high HbA1c level by just 1%.

• A 16% decrease in risk of heart failure

• A 14% decrease in risk of fatal or nonfatal myocardial infarction (heart attack)

• A 12% decrease in risk of fatal or nonfatal stroke

• A 21% decrease in risk of diabetes-related death

• A 14% decrease in risk of death from all causes

• A 43% decrease in risk of amputation

A 37% decrease in risk of small blood vessel disease (e.g. retinal blood vessel disease causing

vision loss).

Diabetic patients who are on oral antihyperglycemic agents should check their HbA 1c once a

month. If it is high, patient should change diet and or doctor should change medication of the

patient. When the HbA1c is normal, everything is deemed right. The postprandial blood glucose

level monitoring was declared a new target for optimizing treatment of diabetes mellitus. But

HbA1c determination is the best method of monitoring of long term glucose control 9.

References:

1. http://www.geocities.com/diabeteschart/hba/test.html

2. http://www.diabetes-insight.info/Iwd/management/clinic/DI-HbA1c.asp

3. Diabetes Control and Complications Trial (DCCT),

http://diabetes.niddk.nih.gov/dm/pubs/control

4. http://en.wikipedia.org/wiki/Hemogliobin_A1c# underlying_principle

5. http://www.faqs/diabetes/faq/part2/section_9.html

6. http://www.answers.com/htale

7. http://www.labtestonline.org

8. United Kingdom Prospective Diabetes Study (UKPDS), URL:http://www.dtu.ox.ac.uk

9. http://www.drmirkin.com/diabetes/8698.html. Europen Heart Journal Supplements

2000;2;D36-D38.

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About Authors:

P. V. Ingle
Lecturer, Department of Clinical Pharmacy, R. C. Patel College of
Pharmacy, Shirpur -425405, Dist: Dhule (M.S.), India.
Email- prabhu4ever2000@rediffmail.com; Phone- +91 9421472242;
Fax – 02563- 251808

V. G. Kuchake
R. C. Patel College of Pharmacy, Shirpur, Dist – Dhule, (MS).

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S. J. Surana
R. C. Patel College of Pharmacy, Shirpur, Dist – Dhule, (MS).

G. S. Talele
Jalgaon Zillha Medicine Dealers Society’s College of Pharmacy,
Mamurabad, (MS).

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