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Órgano oficial de difusión de la Federación Mexicana de Patología Clínica, AC y de la Asociación Latinoamericana de Patología Clínica/Medicina de Laboratorio

2012, Number 2

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Rev Mex Patol Clin Med Lab 2012; 59 (2)

Detection, diagnosis and monitoring of diabetes mellitus on the basis of a nine field table: BFG, HBa1c, QAG

Terrés-Speziale AM

Language: Spanish
References: 25
Page: 69-79
PDF size: 170.13 Kb.


ABSTRACT

Background: It’s been half a century since the discovery and confirmation of HBa1 as a diabetic component in the subfractions of hemoglobin. Major improvements have occurred in diagnostic systems since 1977 when HBa1 was introduced in clinical laboratories. It took more than thirty years until HBa1c% was certified by the National Glycohemoglobin Standardization Program until 2010 when the American Diabetes Association accepted HBa1c% as the method of choice for the diagnosis of diabetes mellitus as long as certified methods are used in order to meet NGSP requirements. Objective: To review the importance of glycation of proteins and specifically of HBa1c% in the pathophysiology of chronic degenerative diseases associated with diabetes mellitus in addition to its applicability and usefulness in the diagnosis and management in accordance with the recommendations of the American Diabetes Association 2010 using a table contingency of 3 x 3. Material and methods: This paper is a review which collects the information available in the literature in order to establish analytical, specific, measurable, achievable, challenging goals for three fundamental tests for the detection, diagnosis and control of diabetes mellitus including 1) HBa1c%, 2) Basal Fasting Glucose: BFG mg/dL and 3) QAG Quarterly Average Glucose mg/dL. Results: HBa1c% › 6.5% in combination with BFG › 126 mg/dL has a sensitivity of 47% and a specificity of 98% for diabetes mellitus diagnosis. To improve diagnostic sensitivity detection of diabetes mellitus should be performed in all patients who have a GBA › 100 mg/dL even when the diabetic syndrome: Polyuria, polydipsia, polyphagia, and weight loss is absent. Discussion: NGSP certification of analytical systems for diabetes mellitus diagnosis of HBa1c% has allowed basic applicability in order to recommend the use of this test in clinical grounds. The implementation of the new diagnostic criteria of the American Diabetes Association 2010 are relatively simple, especially when compared with tests of glucose tolerance in terms of reliability and applicability. It will be worth monitoring and evaluating the impact on patients and the health systems to assess the cost/benefit in the short, medium and long term.


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