A mistaken diagnosis of type 2 diabetes due to hemoglobin N-Baltimore.
ABSTRACT Glycohemoglobin (HbA1c) estimation is the gold standard for assessing long-term glycemic control in diabetic patients. Some hemoglobin variants interfere with HbA1c assay, thus, limiting its utility. Over 150,000 diabetic patients are estimated to have hemoglobin variants in the United States; but this number may be up to 30% in some parts of the world. Although, most of the hemoglobinopathies are clinically silent, some of them cause biochemical aberrations, which could interfere with HbA1c assay. However, hemoglobin N-Baltimore has not been reported to give false HbA1c estimation. We present a woman with mistaken diagnosis of diabetes due to hemoglobin N-Baltimore that produced a spuriously elevated HbA1c level.
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ABSTRACT: The importance of hemoglobin A1c (HbA1c) as an indicator of mean glycemia and risks for complications in patients with diabetes mellitus was established by the results of long-term clinical trials, most notably the Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS), published in 1993 and 1998 respectively. However, clinical application of recommended HbA1c targets that were based on these studies was difficult due to lack of comparability of HbA1c results among assay methods and laboratories. Thus, the National Glycohemoglobin Standardization Program (NGSP) was initiated in 1996 with the goal of standardizing HbA1c results to those of the DCCT/UKPDS. HbA1c standardization efforts have been highly successful; however, a number of issues have emerged on the "long and winding road" to better HbA1c, including the development of a higher-order HbA1c reference method by the International Federation of Clinical Chemistry (IFCC), recommendations to use HbA1c to diagnose as well as monitor diabetes, and point-of-care (POC) HbA1c testing. Here, we review the past, present and future of HbA1c standardization and describe the current status of HbA1c testing, including limitations that healthcare providers need to be aware of when interpreting HbA1c results.Clinica chimica acta; international journal of clinical chemistry 01/2013; 418. DOI:10.1016/j.cca.2012.12.026 · 2.76 Impact Factor
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