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In vitro determination of hemoglobin A1c for diabetes diagnosis and management: technology update

Authors English E, Milosevich E, John WG

Received 21 March 2014

Accepted for publication 14 April 2014

Published 16 July 2014 Volume 2014:6 Pages 21—31

DOI https://doi.org/10.2147/PLMI.S48403

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Emma English,1 Elise T Milosevich,1 W Garry John2

1School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom; 2Department of Clinical Biochemistry, Norfolk and Norwich University Hospital, Norwich, United Kingdom

Abstract: It is fascinating to consider the analytical improvements that have occurred since glycated hemoglobin was first used in routine clinical laboratories for diabetes monitoring around 1977; at that time methods displayed poor precision, there were no calibrators or material with assayed values for quality control purposes. This review outlines the major improvements in hemoglobin A1c (HbA1c) measurement that have occurred since its introduction, and reflects on the increased importance of this hemoglobin fraction in the monitoring of glycemic control. The use of HbA1c as a diagnostic tool is discussed in addition to its use in monitoring the patient with diabetes; the biochemistry of HbA1c formation is described, and how these changes to the hemoglobin molecule have been used to develop methods to measure this fraction. Standardization of HbA1c is described in detail; the development of the IFCC Reference Measurement Procedure for HbA1c has enabled global standardization to be achieved which has allowed global targets to be set for glycemic control and diagnosis. The importance of factors that may interfere in the measurement of HbA1c are highlighted.

Keywords: glycated hemoglobin, HbA1c, IFCC

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