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      Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients

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          Abstract

          Diabetes is a global endemic with rapidly increasing prevalence in both developing and developed countries. The American Diabetes Association has recommended glycated hemoglobin (HbA1c) as a possible substitute to fasting blood glucose for diagnosis of diabetes. HbA1c is an important indicator of long-term glycemic control with the ability to reflect the cumulative glycemic history of the preceding two to three months. HbA1c not only provides a reliable measure of chronic hyperglycemia but also correlates well with the risk of long-term diabetes complications. Elevated HbA1c has also been regarded as an independent risk factor for coronary heart disease and stroke in subjects with or without diabetes. The valuable information provided by a single HbA1c test has rendered it as a reliable biomarker for the diagnosis and prognosis of diabetes. This review highlights the role of HbA1c in diagnosis and prognosis of diabetes patients.

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          Dyslipidemia in type 2 diabetes mellitus.

          Arshag D Mooradian (2009)
          Dyslipidemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. The characteristic features of diabetic dyslipidemia are a high plasma triglyceride concentration, low HDL cholesterol concentration and increased concentration of small dense LDL-cholesterol particles. The lipid changes associated with diabetes mellitus are attributed to increased free fatty acid flux secondary to insulin resistance. The availability of multiple lipid-lowering drugs and supplements provides new opportunities for patients to achieve target lipid levels. However, the variety of therapeutic options poses a challenge in the prioritization of drug therapy. The prevalence of hypercholesterolemia is not increased in patients with diabetes mellitus, but mortality from coronary heart disease increases exponentially as a function of serum cholesterol levels, and lowering of cholesterol with statins reduces diabetic patients' relative cardiovascular risk. Although drug therapy for dyslipidemia must be individualized, most people with diabetes mellitus are candidates for statin therapy, and often need treatment with multiple agents to achieve therapeutic goals.
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            Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?

            Iciar Martín-Timón (2014)
            Diabetes mellitus is a chronic condition that occurs when the body cannot produce enough or effectively use of insulin. Compared with individuals without diabetes, patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is it associated with an augmented prevalence of well-known risk factors such as hypertension, dyslipidaemia and obesity in these patients. However the improved cardiovascular disease in type 2 diabetes mellitus patients can not be attributed solely to the higher prevalence of traditional risk factors. Therefore other non-traditional risk factors may be important in people with type 2 diabetes mellitus. Cardiovascular disease is increased in type 2 diabetes mellitus subjects due to a complex combination of various traditional and non-traditional risk factors that have an important role to play in the beginning and the evolution of atherosclerosis over its long natural history from endothelial function to clinical events. Many of these risk factors could be common history for both diabetes mellitus and cardiovascular disease, reinforcing the postulate that both disorders come independently from "common soil". The objective of this review is to highlight the weight of traditional and non-traditional risk factors for cardiovascular disease in the setting of type 2 diabetes mellitus and discuss their position in the pathogenesis of the excess cardiovascular disease mortality and morbidity in these patients.
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              Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of european prospective investigation of cancer and nutrition (EPIC-Norfolk).

              Ailsa A. Welch, R. Luben, Jeremy Day … (2001)
              To examine the value of glycated haemoglobin (HbA(1c)) concentration, a marker of blood glucose concentration, as a predictor of death from cardiovascular and all causes in men. Prospective population study. Norfolk cohort of European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk). 4662 men aged 45-79 years who had had glycated haemoglobin measured at the baseline survey in 1995-7 who were followed up to December 1999. Mortality from all causes, cardiovascular disease, ischaemic heart disease, and other causes. Men with known diabetes had increased mortality from all causes, cardiovascular disease, and ischaemic disease (relative risks 2.2, 3.3, and 4.2, respectively, P /=7%, or history of myocardial infarction or stroke were excluded. 18% of the population excess mortality risk associated with a HbA(1c) concentration >/=5% occurred in men with diabetes, but 82% occurred in men with concentrations of 5%-6.9% (the majority of the population). Glycated haemoglobin concentration seems to explain most of the excess mortality risk of diabetes in men and to be a continuous risk factor through the whole population distribution. Preventive efforts need to consider not just those with established diabetes but whether it is possible to reduce the population distribution of HbA(1c) through behavioural means.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Biomark Insights
                Journal ID (iso-abbrev): Biomark Insights
                Journal ID (publisher-id): Biomarker Insights
                Title: Biomarker Insights
                Publisher: Libertas Academica
                ISSN (Electronic): 1177-2719
                Publication date Collection: 2016
                Publication date (Electronic): 03 July 2016
                Volume: 11
                Pages: 95-104
                Affiliations
                [1 ]Department of Internal Medicine, Division of Pulmonary Medicine, The Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University College of Medicine, Columbus, OH, USA.
                [2 ]Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia.
                [3 ]Division of Endocrinology, Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
                [4 ]Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
                [5 ]Drug Discovery and Development Research Group, College of Pharmacy and Nutrition, University of Saskatchewan, Canada.
                Author notes
                Article
                Publisher ID: bmi-11-2016-095
                DOI: 10.4137/BMI.S38440
                PMC ID: 4933534
                PubMed ID: 27398023
                SO-VID: 73581fe7-9d28-42cf-a667-5ca0caf89d76
                Copyright © © 2016 the author(s), publisher and licensee Libertas Academica Ltd.
                License:

                This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.

                History
                Date received : 05 February 2016
                Date revision received : 09 June 2016
                Date accepted : 09 June 2016
                Categories
                Subject: Review

                ScienceOpen disciplines: Clinical chemistry
                Keywords: diabetes,hba1c,diagnosis,prognosis,blood test
                Data availability:
                ScienceOpen disciplines: Clinical chemistry
                Keywords: diabetes, hba1c, diagnosis, prognosis, blood test

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