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David Plaut: Off the Cuff

Another Blood Glucose Marker?

Published March 20, 2014 3:24 PM by David Plaut

It is well known that both HbA1c is an excellent marker to assess 2-3 month blood glucose levels and that measuring the blood glucose is good for the past few hours.  This is certainly true for most people.  But ... there are situations where another marker may be of use. 

For example, in patients where hemoglobin A does not represent most of the hemoglobin in the blood stream (e.g. in newborns where HbF still contributes significant levels or patients with HbS or other hemoglobinopathies in which the hemoglobin does not bind glucose). Another group of patients consists of diabetic who are being treated for diabetic kidney disease and undergoing iron or erythropoietin treatment. 

It has been found that another marker can be of value in these patients. Glycated albumin, fructosamine and 1,5 anhydroglucitol, the first two of which are readily available have been proposed for these patients. GA is especially helpful in patients with chronic kidney disease (CKD) stages 4 and 5.

In pregnancy, HbA1c is reduced due to iron deficiency but GA remains normal throughout in non-diabetic women. The consequences of uncontrolled gestational diabetes are severe to both maternal and fetal well-being. An ideal laboratory test to monitor gestational diabetes should accurately reflect short-term glucose changes. Glycated albumin, by virtue of its short half-life of 14-19 days, lends itself to monitor and control gestational diabetes.
posted by David Plaut
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