 |
 |
But surely the reason given for using HbA1c for the diagnosis of diabetes is that you can avoid fasting the patient and therefore use it opportunistically. And in any case just because we use some tests badly is no excuse for not learning our lessons and introducing another test which is not effective. (For the English buffs that's two sentences beginning with a conjunction) The current evidence, particularly the narrow intra-individual variation makes HbA1c unsuitable as a diagnostic tool. Mike Addison Date sent: Fri, 31 Oct 2003 10:17:31 +0000 Send reply to: Mohammad Al-Jubouri <[log in to unmask]> From: Mohammad Al-Jubouri <[log in to unmask]> Subject: Re: HbA1c in diagnosis of diabetes (was: 5.6 mmol/L is new cutoff for IFG) To: [log in to unmask] Dear Robin 1. I agree that HbA1c can not be used solely for diagnosis of diabetes. However, it can be a useful adjunct to a fasting glucose. 2. A lot of the biochemical tests have the same inherent problems that HbA1c has. This has not prevented their usage for diagnostic purpose. We use them with the full knowledge of their limitations and in conjuction with other tests. 3. DCCT aligned HbA1c using HPLC methods are performing better than many other tests on the EQAS. Therefore the analytical and standardisation problems have now largely been resolved. 4. There are several studies that have used HbA1c to detect uknown diabetic patients in conjunction with plasma glucose. Therefore the debate goes on! Best wishes Mohammad --- Robin Marks <[log in to unmask]> wrote: > Hello everybody ! > To quote from the article in the November 2003 issue > of Diabetes Care posted > by Mohammed: > > "... > A1C for the diagnosis of diabetes still has > disadvantages. > 1) A profusion of assay methods has led to different > nondiabetic reference > ranges because different glycated hemoglobin > fractions have been measured > (30).... > 2) A chemical preparation to create uniform > calibration standards has only > recently been established (30). This preparation > however has not yet been > widely adopted. > 3) A1C values may be affected by other conditions > (e.g., hemoglobinopathy, > pregnancy, uremia, blood transfusion, and hemolytic > anemia), and depending > on the laboratory method used, this may confound the > diagnosis of diabetes." > > > In summary 'HbA1c measurement cannot be used for the > diagnosis of diabetes > because of analytical or standardisation problems in > the assay'. > > Do we agree ? > > Dr Robin Marks > Consultant Chemical Pathologist > Calderdale Royal Hospital > Halifax > HX3 0PW > UK > > > -----Original Message----- > > From: Mohammad Al-Jubouri > [mailto:[log in to unmask]] > > Sent: 28 October 2003 12:03 > > To: [log in to unmask] > > Subject: Re: 5.6 mmol/L is new cutoff for IFG > > > > > > Hi Louise > > > > I have attached the relevant article which is > freely > > available. > > > > Mohammad > > > > > > --- "Tilbrook Louise (RQ8) Mid Essex Hospital" > > <[log in to unmask]> wrote: > Thank you > for > > this information. Do you have the > > > original journal reference > > > to hand? > > > > > > Thanks again > > > > > > Louise Tilbrook > > > > > > Louise Tilbrook > > > Principal Clinical Scientist > > > Department of Clinical Biochemistry > > > Mid Essex Hospital Services NHS Trust > > > Broomfield Hospital > > > Chelmsford > > > Essex > > > CM1 7ET > > > > > > Phone 01245 514013 > > > Fax 01245 514077 > > > > > > > > > > > > -----Original Message----- > > > From: Mohammad Al-Jubouri > > > [mailto:[log in to unmask]] > > > Sent: 28 October 2003 11:26 > > > To: [log in to unmask] > > > Subject: 5.6 mmol/L is new cutoff for IFG > > > > > > > > > An international expert committee on the > diagnosis > > > and > > > classification of diabetes mellitus has > published > > > revised guidelines, which incorporate new data > since > > > the last report of 1997, in the November issue > of > > > Diabetes Care. Decreasing the cutoff for > impaired > > > fasting glucose from 110 mg/dL to 100 mg/dL > could > > > increase diagnoses of prediabetes by > approximately > > > 20%. > > > The other diagnostic thresholds remained the > same. > > > > > > Mohammad > > > > > > > > > ===== > > > Dr. M A Al-Jubouri > > > Consultant Chemical Pathologist > > > > > > > > > ______________________________________________________________ > > __________ > > > Want to chat instantly with your online friends? > > > Get the FREE Yahoo! > > > Messenger http://mail.messenger.yahoo.co.uk > > > > > > ------ACB discussion List Information-------- > > > This is an open discussion list for the academic > and > > > clinical > > > community working in clinical biochemistry. > > > Please note, archived messages are public and > can be > > > viewed > > > via the internet. Views expressed are those of > the > > > individual and > > > they are responsible for all message content. > > > > > > ACB Web Site > > > http://www.acb.org.uk > > > List Archives > > > > > > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html > > > List Instructions (How to leave etc.) > > > http://www.jiscmail.ac.uk/ > > > > > > > ===== > > Dr. M A Al-Jubouri > > Consultant Chemical Pathologist > > > > > ______________________________________________________________ > > __________ > > Want to chat instantly with your online friends? > Get the FREE Yahoo! > > Messenger http://mail.messenger.yahoo.co.uk > > > > ------ACB discussion List Information-------- > > This is an open discussion list for the academic > and clinical > > community working in clinical biochemistry. > > Please note, archived messages are public and can > be viewed > > via the internet. Views expressed are those of the > individual and > > they are responsible for all message content. > > > > ACB Web Site > > http://www.acb.org.uk > > List Archives > > > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html > > List Instructions (How to leave etc.) > > http://www.jiscmail.ac.uk/ > > > > ------ACB discussion List Information-------- > This is an open discussion list for the academic and > clinical > community working in clinical biochemistry. > Please note, archived messages are public and can be > viewed > via the internet. Views expressed are those of the > individual and > they are responsible for all message content. > > ACB Web Site > http://www.acb.org.uk > List Archives > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html > List Instructions (How to leave etc.) > http://www.jiscmail.ac.uk/ ===== Dr. M A Al-Jubouri Consultant Chemical Pathologist ______________________________________________________________________ __ Want to chat instantly with your online friends? Get the FREE Yahoo! Messenger http://mail.messenger.yahoo.co.uk ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/Dr G.Michael Addison Royal Manchester Children's Hospital Pendlebury Manchester M27 4HA United Kingdom Tel 0161-727-2250(AM)or 0161-220-5342(PM) FAX 0161-727-2249 Email [log in to unmask] ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/