Database of diseases - Diabetes

show all

Glycated hemoglobin (HbA1c) - diabetic alignment index

THE BEST METHOD OF GLUCOSE LEVEL IN BLOOD

Glycated Hemoglobin (HbA1c) - the best indicator for diabetes control

Hemoglobin in red blood cells relatively easily attaches a glucose molecule from the blood. The higher the level of glucose in the blood and the longer it lasts, the more glucose gets attached and more is called. glycated hemoglobin, marked with the symbol - HbA1c. Because the red blood cell lives on average about 120 days - the level of glycated hemoglobin accurately reflects the average level of sugar in the blood at this time. Therefore, this index has become an assessment of the effectiveness of diabetes treatment in longer sections of time.

Glucometer - the most popular blood glucose meter

In everyday practice, the most common measure of diabetes control is the concentration of glucose in the blood, tested using a special electronic device - a glucometer. The blood glucose concentration is called the medical term - the level of glycaemia.
(In addition, the other indicator is the presence of sugar in urine, the so-called glucosuria).

What are the pros and cons of measuring the meter?

An unquestionable advantage of glucose meter glucometer measurement is the speed and ease of measurements. They can be performed at home by the patient themselves, eg with the help of these increasingly popular and cheap electronic devices. The disadvantage of this measure of glycemia - as an indicator of therapeutic control - is that it only determines the metabolic state of the body (temporary glycaemia). Similarly, glucosuria (the presence of sugar in the urine) depends not only on the degree of hyperglycemia, but also on the individually variable renal threshold for glucose.

# # Banner

We recognize the symptoms of diabetes by measuring the level of glucose in the blood (called glucose) - a glucometer

1. When you double your fasting glucose level is above 126 mg / dl (7.0 mmol / l)
2. When the plasma concentration in an accidental measurement is greater (or equal) 200 mg / 100 ml (11.1 mmol / l) and there are typical symptoms of diabetes.

What are the causes of glycemic variability?

The main causes of glycemic variability in diabetic patients are the effect of meals of different size and quality, variable physical activity, the variety of drugs and individual responses to them, current health status, etc.

How can one determine the correctness of diabetes treatment in longer periods of time?

Serial, frequent blood glucose measurements, so-called daily glycemic profiles. They enable the assessment of diabetic compensation over longer time intervals, but are burdensome for the patient and therefore rarely used.

What improved glycemic assessment has modern science suggested to people with diabetes in recent years?

At the end of the 1970s, a new indicator of long-term diabetes control, namely glycated hemoglobin, was introduced in the United States and then in Western Europe. The term is abbreviated as HbA1c.

INTERPRETATION OF MEASUREMENT OF GLYMATED HEMOGLOBINE

The reliability of the glycemic index - the level of glycated hemoglobin - HbA1c

The basis of the new indicator was the discovery that glucose has the ability to permanently combine with blood proteins, and especially with hemoglobin. It is important to know that blood cells circulating in the blood (erythrocytes) contain a protein - hemoglobin, which transports oxygen from the lungs to the organs and tissues. It turned out that red blood cells of healthy adults contain 4-6 percent of hemoglobin compound with glucose, so-called glycated hemoglobin. The process of combining hemoglobin with glucose is called glycation. It runs slowly and is almost irreversible. It lasts throughout the life of the red blood cell, an average of 120 days.

.
What then means a specific level of glycated hemoglobinHbA1c- resulted from the measurement?

The rate of formation of glycated hemoglobin (HbA1c) is determined by the concentration of glucose in the blood and the duration of hyperglycaemia (the period of "blood" hyperemia). This hemoglobin is formed in the blood in a quantity proportional to the average glucose concentration in the last 2 months preceding the test. How important this index is, let us testify to the fact that people with poorly compensated diabetes usually have glycosylated hemoglobin levels 2-3 times higher than in healthy people.

What level of glycated hemoglobin in the blood can be considered optimal and what is unfavorable?

1. A value below 7% of glycated hemoglobin (HbA1c) indicates a good leveling of diabetes
2. Values in the range of 7-8% indicate a worse alignment of diabetes, but they can still be accepted.
3. Values higher than 8% of the glycated hemoglobin level in blood mean that changes in the treatment of diabetes should be urgently required.

Why is the optimal level of this indicator a reliable assessment of the quality of diabetes treatment?

According to the research, in people who, thanks to the correct treatment of diabetes, achieved glycosylated hemoglobin below 6% - the risk of diabetic complications in the form of adverse sight changes (retinopathy), kidneys (nephropathy) and also in the arteries of the heart, brain and lower limbs decreased as much as 67%! That is why we say that this is an indicator of long-term compensation for diabetes, and its systematic determination, 3-4 times a year, is a good way to evaluate the effectiveness of treatment.

Is the correct level of glycated hemoglobin sufficient to guarantee a good leveling of diabetes, eg in short periods of time, and especially avoiding hypoglycaemia?

Unfortunately, no, because the reduction or increase in glycated hemoglobin is slow in the blood over many days rather than hours. This indicator does not show health-threatening, though short-lived, hypoglycaemic events (hypoglycaemia). Most importantly, in patients with type 1 diabetes (requiring injections of insulin) - especially those who care about the minimum level of glycated hemoglobin, eg below 6%, three times more cases of hypoglycaemia are observed than in others. These people were also easier to gain weight.

DIABETES TREATMENT FOR THE DIABETES AND GLISHED HEMOGLOBIN AS A METHOD OF GLYCEMY

How to determine the goal of good diabetes control?

For many people, the goal may be to minimize the level of glycated hemoglobin - it provides very good health benefits, but under an important condition. Only medically well-trained patients, as well as very careful glucose control, can afford to set such an ambitious goal. This means people who are able to prevent hypoglycaemia relatively independently by modifying the dose of drugs (it applies mainly to people with type I diabetes, requiring insulin injections). As well as those people who properly control the sugar and calories content in the diet and skillfully applying physical effort (applies to all patients). It is worth taking into account that the latest generation of hypoglycemic agents, such as glimepiride, provide easier control of the level of glycated hemoglobin without undesirable increase in insulin levels. Therefore, taking into account all these premises, every patient should realistically assess their self-control capabilities and in consultation with the doctor determine the values to which the HbA1c index may aspire. Whether to minimize the level of glycated hemoglobin or to less stringent indicators, but with a lower risk of hypoglycaemia (hypoglycaemia).

.
What can be advised to those who do not feel strong to minimize the level of glycated hemoglobin?

It is very beneficial for health to achieve HbA1c content within 7-7,5%. It is already easier and, from the perspective of long-term health protection, highly profitable.

What else should we know about the role of the indicator?

An unquestionable advantage of this indicator is also the fact that the blood sample required for the determination can be collected at any time of the day, because the current meals and activities performed on a given day do not have a significant impact on its value. Determination of glycated hemoglobin is performed in the majority of voivodship diabetology clinics, as well as in many municipal clinics.

Are there other similar indicators along with glycated hemoglobin based on the combination of glucose and blood proteins?

In addition to hemoglobin, albumin also binds glucose. The binding of glucose is proportional to the size and duration of hyperglycaemia. The degree of albumin glycation is evaluated by determining the concentration of the so-calledfructosamine. It is also a good indicator of long-term diabetes compensation, but applies to a shorter period, as the two weeks preceding the study. This is due to the fact that the albumin half-life is much shorter than that of hemoglobin. The determination of the glycemic index, which is fructosamine, is a complementary test in comparison to the measurement of glycated hemoglobin (HbA1c). Due to the shorter period needed for changes in its concentration, the determination of fructosamine concentration should be performed frequently, eg once a month, especially since it is a simple, fast and low cost method.