Glycosylated Hemoglobin Assay Research Articles

Effect of Scaling and Root Planing in Conjunction with Antimicrobial Therapy on Glycated Hemoglobin Levels in Type 2 Diabetes Mellitus Patients.

Scaling and root planing with systemic doxycycline had an effect on blood glucose levels in type 2 diabetes patients, according to the results of a glycosylated hemoglobin assay. The trial was conducted to determine whether periodontal therapy affected blood sugar regulation as a result of this finding. A total of 60 people with type 2 diabetes (diabetes mellitus not caused by insulin deficiency) were split into three groups. Group I (control group) consists of patients who are only taking an oral anti-diabetic medication. Patients on an oral anti-diabetic drug plus scaling and root planing make up group II. Patients on an oral anti-diabetic drug, scaling, root planing, and doxycycline constitute Group III. The patients were re-evaluated for glycated hemoglobin levels and periodontal status using the clinical parameters of gingival index by Loe and Silness and clinical attachment level at baseline, 30th, 60th, and 90th day. Compared with group II, the findings showed a statistically significant decrease in glycated hemoglobin values (p =0.001) and improvements in clinical attachment level (p =0.022, 0.05) and gingival index (p = 0.009.,01) in group III. In the control group (group I), no such finding was made. The average gingival index, however, increased statistically significantly (p = 0.032, 0.05). Various studies have been showing the benefits of non-surgical periodontal therapy as a benefit for improving the overall glycemic status of the patient. Non-surgical mechanical periodontal therapy combined with systemic administration of antimicrobials such as doxycycline enhances the metabolic status of type 2 diabetes mellitus patients better than non-surgical mechanical periodontal therapy alone.

Evaluation and Validation of Utility of BD Glucose Vacutainer for Glycosylated Hemoglobin Assay for Timely Therapeutic Management of Diabetes Mellitus

Evaluation and Validation of Utility of BD Glucose Vacutainer for Glycosylated Hemoglobin Assay for Timely Therapeutic Management of Diabetes Mellitus

A research report on the prescription rights of Chinese nurses

Abstract Objective To explore the feasibility of the nurse's prescription right in China, to develop the requirements for the qualification of the applicant for the prescription right of nurse, and to determine the content of certain prescriptions in the specific circumstances. Methods Literature review on the relevant articles/material with the contents of the nurse's right of prescription home and abroad. Semi-structured depth interview method was used to interview 18 experts on whether the nurses can participate in the graded nursing decision and whether nurses with certain ability can make the decision. Using the self-made questionnaire “Nurses involved in graded nursing decision-recognition questionnaire”, 553 nurses completed questionnaires on willingness to nurse decision-making grading. Using the analytic hierarchy process, the 23 experts' judgment on the main body of the graded nursing was rated. Using semi-structured depth interview method, 17 experts were interviewed on the graded nursing quality assessment and training outline. The form of expert personal judgment and the “grading nursing qualification experts predict questionnaire” were used as a preliminary designing tool, 32 experts were asked to predict the graded nursing quality. The relatively important factors that might promote implementation of right of Chinese nurse prescribing weights setting were obtained by analytic hierarchy process. Using Delphi method, 2 rounds of consultation to 291 experts/times were performed, and determined its content on the fields of graded nursing decision, nurses' job description, decision making nurse in graded nursing work process and related management system, decision-making main body of clinical nursing, nurse authority of prescription application qualification, clinical nurses, diabetes specialist nurses, tumor specialist nurses, nurses in emergency department, community nurses in certain circumstances writing prescription, and nursing undergraduate added with nurse authority of prescription related courses. Results The physician is not considered to be the best decision-making main body of clinical nursing work and graded nursing, nurses can participate in the work of decision-making. The qualification of hierarchical decision-making nurse and nurse prescribing applicants have been determined. The hierarchical nursing decision-making nurses' position description and training outline have been compiled. Experts suggest that clinical nurses with certain qualifications should be given the rights of some prescription form (independent prescription, prescription, prescription protocol extension) to prescribe specific drugs in high fever, hypoglycemia, hypertension, anaphylactic shock and other 11 specific circumstances. The nurses of the diabetes should be given the right of prescribing sulfonylureas, biguanides, glucosidase inhibitor, and protamine zinc insulin, and the right to write the prescription and consultation for part of medical equipment, health education, and four routine tests, which contains blood sugar monitoring, urine glucose monitoring, glycosylated hemoglobin assay, and oral glucose tolerance test. Tumor specialist nurses should be given the right to write the prescription of 7 specific circumstances including blood routine tests, electrocardiogram, blood biochemistry and other 9 laboratory tests, constipation, phlebitis, and cancer pain, and the right of 5 tumor emergency prescription including chemotherapy drug allergy, hemorrhagic shock, acute upper gastrointestinal bleeding. Nurses in emergency department with certain qualification should be given the right to prescribe specific drugs in 15 circumstances which include cardiac arrest, ventricular fibrillation, and acute cardiogenic chest pain. Community nurses with certain qualification should be given the right to write the prescriptions on 14 contents including disinfection and cleaning, sterile infusion type, and wound care products. Experts suggest that nursing undergraduate education in China should be added with 2 courses which are prescription rights related laws and regulations and nursing intervention, and that pharmacology course should be supplemented with related course in order to adapt to the implementation of nurse prescribing rights. Conclusions China's nurses with certain qualification or after special training have the ability to accept and should be given the right of prescriptions in certain circumstance within the scope of their work.

Validation and modification of dried blood spot-based glycosylated hemoglobin assay for the longitudinal aging study in India.

This study aims to validate a modified dried blood spot (DBS)-based glycosylated hemoglobin (HbA1c) assay protocol, after a pretest in India showed poor correlation between the original DBS-based protocol and venous results. The original protocol was tested on different chemistry analyzers and then simplified at the University of Washington (UW). A second pretest was conducted in India to validate the modified assay protocol, using 44 quality control specimens. Data from UW indicated that, using the original protocol, the correlation coefficients between DBS and venous results were above 0.98 on both Bio-Rad and Olympus chemistry analyzers. The protocol worked equally well on filter paper, with or without pre-treatment, and when the recommended amount of blood spot material, or less, was used. A second pretest of the modified protocol confirmed that DBS-based levels from both Olympus and Roche chemistry analyzers were well correlated with DBS results from UW (correlation coefficients were above 0.96), as well as with venous values (correlation coefficients were above 0.94). The DBS-based HbA1c values are highly correlated with venous results. The pre-treatment of filter paper does not appear to be necessary. The poor results from the first pretest are probably due to factors unrelated to the protocol, such as problems with the chemistry analyzer or assay reagents.

A Case Report on Escitalopram-Induced Hyperglycaemia in a Diabetic Patient

The incidence of depression in diabetic patients is quite high; moreover, it has been suggested that the presence of depression itself may increase the risk of diabetes mellitus. Hence, it follows that the simultaneous use of antidiabetic and antidepressant drugs is common. Some clinical evidence indicates that selective serotonin re-uptake inhibitors (SSRIs) could be very useful in treating overweight patients, both with and without diabetes. However, recent deregulation of glucidic metabolism was tested in diabetic subjects treated with antidepressants. Several cases of hyperglycaemia and hypoglycaemia associated with other SSRIs have been published, whereas only one case of escitalopram inducing hyperglycaemia has been noted. The exact mechanism of glucose control impairment in patients taking SSRIs--escitalopram in particular--still remains unclear. We describe a diabetic 83-year-old woman with good glycaemic control (as evinced by glycaemic and glycosylated haemoglobin assay--HbA1c--values) before escitalopram initiation in response to therapy with glibenclamide. Escitalopram resulted in a significantly increased glycaemia values 5 days following administration. Glycaemia values returned to normality only after suspension of escitalopram, despite antidiabetic dosage increase. We report this case to draw attention to escitalopram as a possible cause of glycaemic control loss.

Moderate Deterioration in Glucose Tolerance during High-Dose Growth Hormone Therapy in Glucocorticoid-Treated Patients with Juvenile Idiopathic Arthritis

Objectives: To describe glucose metabolism changes during growth hormone (GH) treatment in juvenile idiopathic arthritis (JIA). Study Design: Observational study in 58 children on glucocorticoid therapy (GC) for JIA, of whom 28 received late GH therapy (7.3 ± 3.4 years into GC), 15 early GH therapy (1.2 ± 0.1 years into GC), and 15 no GH therapy. The GH dose was 0.46 mg/kg/week. Oral glucose tolerance testing with insulin and glycosylated hemoglobin assays were performed yearly. Nonparametric tests were used to compare groups after 3 years and regression analyses to estimate factors predicting glucose AUC and HOMA-IR at baseline and after 3 years. Results: GH combined with GC was associated with an increase in mean fasting insulinemia. Late GH therapy patients exhibited significant increases over time in mean fasting glycemia (p = 0.01), mean 2-hour postglucose load glycemia (p < 0.05), mean AUC for glucose (p < 0.05), and mean HOMA-IR (p < 0.05). Impaired glucose tolerance was found in 16/43 GH-treated patients (37%) and transient diabetes in 2 (5%) patients. Conclusions: GH treatment in JIA children decreased insulin sensitivity but had only modest effects on glucose tolerance. Close monitoring by oral glucose tolerance testing is crucial before and during GH treatment, particularly during puberty and relapses.

OTC Product: BioSafe Diabetes Risk Assessment

Category:Fasting plasma glucose and glycosylated hemoglobin assay. Manufacturer:BioSafe Laboratories, Inc. Use:Assessing diabetes risk. Availability: Kit includes lab form, alcohol pad, sterile gauze, lancets (two), blood sample return bag with desiccant, test card, bandage, instructions, postage- paid return mail envelope, Health Insurance Portability and Accountability Act disclosure. Discussion:A total of 6 million Americans have undiagnosed diabetes, while 54 million have prediabetes.1 Early detection and treatment reduces medical costs, morbidity, and mortality.2–6 Increasing costs with decreasing access drives the market for point-of-care (POC) testing.78 Laboratory charges average $65 (Quest Diagnostics, oral communication, June 2008) for glycosylated hemoglobin (A1C; results 72 hours) and $34 (LabCorp, oral communication, June 2008) for fasting plasma glucose (FPG; results 48 hours) testing. Common POC devices include Cholestech GDX ($1,200; FPG results 5 minutes), DCA Vantage Analyzer ($3,700; A1C results 6 minutes), AlcNow ($120; A1C results 5 minutes), and the Diabetes Risk Assessment Kit ($29; FPG results 3 minutes, A1C results 1–2 weeks). Only the BioSafe product assesses FPG and A1C but is not certified by the National Gly- cohemoglobin Standardization Program (sensitivity 95.8%, specificity 93.8%, accuracy 95.1 %) .9 The American Diabetes Association recommends screenings only at a health care setting via FPG or 2-hour oral glucose tolerance test in overweight, asymptomatic adults with risk factors or those 45 years or older.10

A comparison of three methods of measuring plasma glycosylated hemoglobin

Background: The current clinical dilemma of diabetes mellitus is prevention of micro- and macrovascular complications. These complications are directly linked to the degree of hyperglycaemia in diabetics. For long-term control of the glycaemic state, measurement of glycohaemoglobin in blood is essential, and glycohaemoglobin harmonization is encouraged for significant inter-laboratory variability. Objectives: To evaluate the performance of plasma glycosylated hemoglobin (HbA1c) assay on Primus PDQ and Bio-Rad D10 analyzers with respect to imprecision against the HbA1c goal, recovery and correlation to the HbA1c test on Cobas Integra 800 automated analyzer. Methods: PDQ employs high performance liquid chromotography (HPLC) boronate affinity chromatography. D10 uses HPLC cation-exchange chromatography. Cobas Integra 800 uses an immunoturbidimetric method. Imprecision studies were performed using patient samples and commercial control sera. Each sample was assayed 20 times and run every morning and afternoon for 5 consecutive days to evaluate between-run data. Recovery was assessed using a patient’s sample with low HbA1c level, admixed with another sample containing high HbA1c level. Comparison was made using 60 patient samples on PDQ and D10 using Cobas Integra 800 as the reference system. Ten venous samples from each group of patients with thalassaemia and uraemia were assayed for HbA1c on Cobas Integra 800, PDQ and D10. Results: The within-run coefficients of variation (CVs) on patient samples were 0.5 % and 0.6 % for PDQ and 1.1% and 1.3 % for D10. The between-run CVs were 1.0 % and 0.8 % for PDQ and 0.3 % and 1.2 % for D10. PDQ yielded CVs of 1.1 % and 0.7 % for level 1 (normal) and level 2(abnormal) controls respectively while D10 demonstrated CVs of 0.5 % for each level of controls. The between-run CVs for normal and abnormal controls were 1.7 % and 0.8 % respectively for PDQ, and 1.0 % and 0.7 % respectively for D10. Mean recovery for PDQ and D10 were 99.7 % and 101.7 % respectively. Both PDQ and D10 correlated well with Cobas Integra 800 [Cobas800]. HbA1c method by PDQ correlated well with that by D10. Conclusion: Both the HPLC systems demonstrated acceptable data, good recovery and are comparable with our current operating system (Cobas Integra 800). Both these systems appear to be satisfactory analytical alternatives to the Cobas Integra 800.

Characterization of Patients Presenting for Treatment to a University Refractory Periodontal Diseases Unit: Three Case Reports

Of the many forms of periodontal disease, refractory periodontal diseases are the least characterized. They are defined as the continued degeneration of the periodontium despite adequate management. This has led to the suggestion that there may be a systemic component that is a contributing factor to the development of this condition. The objectives of this report were to follow the progression of clinical changes associated with periodontal disease over a number of years in this unique population and review various hematologic and microbiologic factors that may be contributing to the disease progression. Three subjects were profiled. They were referred to the Refractory Periodontal Disease Unit at the University of Toronto by periodontists or general practitioners in the Southern Ontario region. Complete medical and dental histories were obtained along with baseline clinical measurements. Periodontal examinations were facilitated with the use of a computer-assisted periodontal probe. A microbiologic analysis using immunofluorescence techniques was able to detect Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, and Actinobacillus actinomycetemcomitans and spirochetes. A hematologic analysis, including a complete blood count (CBC), immune profile, and glycosylated hemoglobin assay, was also performed. The clinical presentation revealed that patients receiving adequate maintenance therapy and with good to excellent oral hygiene demonstrated sites with continual loss of attachment. Few periodontal pathogens were detected. However, the most significant finding appeared to be the report elevated levels of CD8+ cells within this group of patients compared to normal laboratory ranges. This report is an attempt at characterizing a unique population within the periodontal realm. The long-term monitoring of these patients allowed for an assessment of factors that may be involved in the continued decline of the periodontal health of these patients. Based on the immune profile, it is possible that a hyperresponsive state may be the primary feature of this population. Future assessments, including full-mouth interleukin (IL)-1 and matrix metalloproteinase (MMP)-8 levels, may assist in characterizing this population further, with the goal of producing markers that will assist clinicians in predicting treatment outcome.

Can the method of glycosylated haemoglobin assay affect results of such long-term studies?

Can the method of glycosylated haemoglobin assay affect results of such long-term studies?

Glycosylated haemoglobin assay of canine blood samples.

A method for assaying canine glycosylated haemoglobin was evaluated. The method is a turbidimetric inhibition immunoassay and the final reaction is bichromatically measured using a multichannel automatic analyser. Within-run coefficients of variation (2.07 to 4.46 per cent) were permissible, but between-run coefficients of variation (2.10 to 8.25 per cent) were slightly more elevated. The detection limit of this assay is 0.052 per cent. A sample dilution of 10 microliters of sample and 500 microliters of haemolysing reagent is recommended for routine analysis of canine blood samples. A normal reference interval of 1.39 +/- 0.70 per cent was obtained from the glycosylated haemoglobin analysis in 82 healthy dogs and no statistically significant differences in relation to age or gender were observed. Some changes in glycosylated haemoglobin concentrations were noted throughout the ovarian cycle, although differences between dogs were evident. Since this assay specifically measures the glycosylated haemoglobin content in canine blood samples, it could be very useful for monitoring diabetic dogs.

Modeling the effect of diabetes education on glycemic control.

The objective of this study was to identify the mechanisms by which diabetes education improves glycemic control. Study participants were 82 adult patients from a comprehensive outpatient diabetes education program who completed a research protocol at the outset of the program and again 6 to 12 months later. The research protocol included a glycosylated hemoglobin assay and self-reported frequency of two insulin administration events (shot skipping and dosage adjustment), self-monitoring of blood glucose (SMBG), and exercise. Those who did not improve any aspect of self-care reduced their mean glycohemoglobin from 9.7 to 9.0. Those who improved exercise or SMBG (but not both) reduced their glycohemoglobin from 10.9 to 9.6. Those who improved both exercise and SMBG and those who improved insulin administration had the largest improvement in glycemic control, from 12.5 to 9.6. These findings suggest that if diabetes education can help patients improve self-care behavior, it can bring about dramatic improvements in glycemic control. Improved insulin administration is the single most powerful way to improve glycemia, but improving other aspects of self-care also can produce substantial gains.

Comparison of reliability of plasma fructosamine and glycosylated hemoglobin assays for assessing glycemic control in diabetic patients on hemodialysis

To search for a reliable marker of medium-term integrated blood glucose level in diabetics on maintenance hemodialysis (HD), plasma fructosamine and glycosylated hemoglobin (Hb) levels were determined every week and blood glucose levels were determined four times every day over 3 weeks. The mean values of fructosamine (mol/L per 40 g of albumin) and of glycosylated Hb over the study period correlated ( r = .746, P < .001) for combined materials of diabetic and nondiabetic subjects. However, plasma fructosamine values at the end of the study period did not correlate with the overall mean blood glucose values during the preceding 8 to 21 days ( r = .372, NS). In contrast, glycosylated Hb values correlated closely with the same mean blood glucose values ( r = .703, P < .001). Fructosamine values significantly decreased during a HD, irrespective of the increases in albumin and total protein. In conclusion, glycosylated Hb was a reliable marker of long-term integrated blood glucose even in diabetics on HD. However, fructosamine was not a reliable marker of medium-term integrated blood glucose in these patients.

Self-Care Predictors of Metabolic Control in NIDDM Patients

The objective of this study was to evaluate whether the relationship between self-care behavior and metabolic control is comparable in patients with non-insulin-dependent diabetes mellitus (NIDDM) on insulin and not on insulin. We studied 84 NIDDM patients hospitalized for an elective admission in Washington University's Model Demonstration Unit. At admission, patients reported the frequency of exercise, blood glucose monitoring, and meal skipping for the previous 2 wk. Metabolic control over the previous 8-12 wk was determined from glycosylated hemoglobin assays. In cross-sectional analysis controlling for patient sociodemographic and health characteristics, glycosylated hemoglobin levels were positively related to meal skipping (P = 0.0008) and negatively related to the frequency of blood glucose monitoring (P = 0.0025). Self-care behaviors explained 26% of the variance in glycosylated hemoglobin levels in NIDDM patients. Multivariate modeling demonstrated no significant interaction effects between insulin treatment and self-care on metabolic control. In conclusion, these findings support the clinical significance of self-care activities for metabolic control in NIDDM patients, particularly meal skipping and blood glucose monitoring.

Glycosylated haemoglobin measurement on blood samples taken by patients: an additional aid to assessing diabetic control.

200 patients attending a diabetic outpatient clinic were each asked to post to the hospital, prior to their three-monthly routine clinic visit, a finger-prick capillary blood sample for glycosylated haemoglobin assay (HbA1). Patients took their own blood into UNISTEP bottles, which automatically measure a 53 microliters aliquot and mix it with 150 microliters of diluent suitable for transport to the laboratory. During 1 year 883 (84%) of 1046 bottles sent out were returned of which 776 (87%) were suitable for analysis. The availability of the result at the time of the patients' clinic visit aided assessment of diabetic control and was associated with a mean reduction of the HbA1 by 0.8% (p less than 0.001) over a twelve-month period. This simple system facilitates remote monitoring of HbA1 levels, is suitable for both hospital and general practice use and may allow a reduction in the number of patient visits.

Differential effects of social support and social network on physiological and social outcomes in men and women with Type II diabetes mellitus.

Patients with non-insulin-dependent diabetes mellitus (NIDDM) were advised to comply with a complex behavioral regimen of diet and exercise. The relationship between social support satisfaction and social support network size was evaluated using the Social Support Questionnaire for 32 men and 44 women with a confirmed diagnosis of NIDDM. Control of diabetes, as measured by the glycosylated hemoglobin assay, was significantly correlated with social support satisfaction for women but negatively correlated with social support satisfaction for men. Social support network size differentially predicted success in a program for men and women. For women, network size was significantly correlated with failure to attend sessions and with failure to complete a diary. For these women, network size was not significantly correlated with weight loss, which was the goal of the program. For men, network size was correlated with increases in weight, cholesterol, and triglycerides over an 18-month period. We conclude that social support network size and satisfaction have different functions for men and women faced with a serious chronic illness. Network size adversely affects success in a program, whereas social support satisfaction has some benefits for women. The direction of the influence of social network may be determined by the similarity or dissimilarity of network norms to the desired behavior.

Differential effects of social support and social network on physiological and social outcomes in men and women with type II diabetes mellitus.

Patients with non-insulin-dependent diabetes mellitus (NIDDM) were advised to comply with a complex behavioral regimen of diet and exercise. The relationship between social support satisfaction and social support network size was evaluated using the Social Support Questionnaire for 32 men and 44 women with a confirmed diagnosis of NIDDM. Control of diabetes, as measured by the glycosylated hemoglobin assay, was significantly correlated with social support satisfaction for women but negatively correlated with social support satisfaction for men. Social support network size differentially predicted success in a program for men and women. For women, network size was significantly correlated with failure to attend sessions and with failure to complete a diary. For these women, network size was not significantly correlated with weight loss, which was the goal of the program. For men, network size was correlated with increases in weight, cholesterol, and triglycerides over an 18-month period. We conclude that social support network size and satisfaction have different functions for men and women faced with a serious chronic illness. Network size adversely affects success in a program, whereas social support satisfaction has some benefits for women. The direction of the influence of social network may be determined by the similarity or dissimilarity of network norms to the desired behavior.

Nonenzymatically Glycosylated Proteins

Nonenzymatic glycosylation takes place in all proteins with a free-reacting lysine or valine in the presence of glucose. The formation of glycosylated plasma albumin, hemoglobin (Hb A1c), and skin collagen provides a diagnostic index of short- to long-term time-concentration of glucose in vivo. A wide range of assay methods are available, with affinity chromatographic, isoelectric focusing, and spectrophotometric methods providing the best accuracy and versatility. Glycosylated hemoglobin assays indicate glucose pressure over the previous 2 to 3 months and are of diagnostic value in general diabetic control, while glycosylated plasma albumin determinations are preferable in acute episodes in the life of a diabetic (e.g., pregnancy, infection, stress, trauma, surgery), since they provide an overview of changing blood glucose values of the previous 2 to 4 weeks. Glycosylated collagen estimations reflect tissue aging and are relevant in healing processes. Glycosylation alters the biologic activity of proteins, and these may relate to the manifold complications concomitant on the lifelong elevation of blood and tissue glucose in the diabetic (C6a). Assays for glycosylated hemoglobin have been routinely performed in clinical chemistry laboratories for a decade, and convenient determination for other nonenzymatically glycosylated proteins is proceeding apace.

Glycosylated hemoglobin assays in the management and diagnosis of diabetes mellitus. Health and Public Policy Committee, American College of Physicians.

Glycosylated hemoglobin assays in the management and diagnosis of diabetes mellitus. Health and Public Policy Committee, American College of Physicians.

The clinical information value of the glycosylated hemoglobin assay.

We evaluated the clinical information value of the glycosylated hemoglobin assay by comparing it with practitioners' estimates of glucose control over the preceding 10 weeks in 216 patients with diabetes. Twenty-four per cent of the practitioners' estimates, which were based on historical and laboratory data collected during a routine office visit, differed by more than +/- 75 mg per deciliter from the actual mean blood glucose levels calculated with the glycosylated hemoglobin assay. One third of the mean blood glucose concentration fell outside the confidence intervals physicians used to bound their estimates. When examined individually or in the aggregate, historical information, such as polyuria, nocturia, or home urine testing for glucose, and laboratory information, such as fasting or random blood glucose levels, were weak predictors of the actual mean concentration of blood glucose. We conclude that the glycosylated hemoglobin assay provides information about the degree of long-term glucose control that is not otherwise obtainable in the usual clinical setting.