Diabetes Specific Intervention: HBA1C Diagnostic Tool

Diabetes Specific Intervention: HbA1c Diagnostic Tool
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Introduction
Diabetes is a condition that is characterized by abnormal metabolism which in most cases is described as hyperglycemia. There are two types of diabetes type 1 and type 2. Historically, diagnosis of diabetes involves measurement glucose level in the blood. Type 1 diabetes has adequate characteristic clinical presentation at the start which helps the clinician to easily diagnose the condition. Usually, the condition presents as comparatively acute and extreme blood glucose concentration elevation. In most cases, the onset of type 1 diabetes is accompanied by various symptoms hence precise blood glucose levels are not essential in diagnosing it in most clinical setups. In contrast, the onset of diabetes type 2 (diabetes mellitus) is more gradual where the levels of glucose rise slowly with time. As such, its diagnosis requires specific glucose values so that it can be distinguished from non-pathological glucose levels in non-diabetic population. Virtually all diagnostic and classification criteria for diabetes rely on the quantification of glucose levels in plasma or blood or serum in timed samples. This paper is aimed at discussing Glycated hemoglobin (HbA1c) tool used in monitoring glycemic control in patients presenting with diabetes mellitus.
HbA1c is considered as the golden standard that provides glycemic level measures that are accurate and precise and which correlate with the threat of diabetic’s complications (Incani et al, 2015). HbA1c is a glycoprotein that is formed when blood glucose react with hemoglobin. HbA1c titers are usually higher in patients who have had a prolonged period of hyperglycemia (Degeling & Rock, 2012). Various international diabetes societies as well as the World Health Organization have endorsed the use of this test. The American Diabetes Association and the International Expert Committee proposed diagnostic criteria based on HbA1c for both pre-diabetes and diabetes in 2010. The diagnostic criterion for diabetes mellitus is HbA1c ≥ 6.5% (≥48mmol/mol) while that of pre-diabetes is between 5.7-6.4% (39-46mmol/mol) (Incani et al, 2015).
There are significant differences between glucose based tests and HbA1c test for diagnosing pre-diabetes and diabetes. In a study involving participants from Dutch population in diagnosis of diabetes, HbA1c indicated 24% sensitivity and 99% specificity. The above level of specificity and sensitivity were replicated in a variety of other studies. All these study results suggested poor uniformity between fast plasma glucose (FPG), 2 Hour plasma glucose (2hPG) and HbA1c. In addition, the degree of diagnostic uniformity of HbA1c criterion with that of fasting and 2h glucose based criterion for diagnosing pre-diabetes was questionable and it is assumed that it might be different across various ethnic groups and various populations. This assumption is supported by the fact that HbA1c glycoprotein shows variations within and between populations (Degeling & Rock, 2012). This suggests that the diagnostic performance HbA1c test is dependent ...