Sepulchre E, Lutteri L, Cavalier E, Guerci B, Radermecker R P
Rev Med Liege. 2014 Sep;69(9):497-503.
Determining the level of glycated haemoglobin, in particular its major fraction called HbA(1c), is an attractive tool in the management of diabetic patients. In fact, it provides a global evaluation of the glycemic control's level through the past 8-12 weeks. However, this tool must be used with caution. First of all, it does not allow to examine the glycemic kinetics since it represents a glycemic average. Secondly, it does not allow to appreciate the glycemic evolution through the full day. This dosage needs then sometimes to be complemented by fingersticks blood glucose testing. Last but not least, caution is advised in interpreting the results because a number of physiological, pathological and technical factors might interfere with HbA(1c) measurement. It is therefore important that physicians keep a critical view of the values obtained. The paper reviews the different methods used to determine the level of glycated haemoglobin and their limitations. It also emphasizes the medical situations in which over- and under-estimation of the real HbA(1c) value could occur. It does not address the specific issue of the new expression values of HbA(1c) in mmol/mol instead of %. Moreover, the medical situations in which over- and underestimation of the real HbA(1c) value could occur will be described.
测定糖化血红蛋白水平，尤其是其主要组分糖化血红蛋白A1c（HbA1c），是糖尿病患者管理中的一项实用手段。事实上，它能对过去8至12周的血糖控制水平进行全面评估。然而，使用这一手段时必须谨慎。首先，由于它反映的是血糖平均值，所以无法检测血糖动力学。其次，它无法反映全天的血糖变化情况。因此，有时需要通过指尖血糖检测来补充这一检测方法。最后，在解读结果时也需谨慎，因为许多生理、病理和技术因素可能会干扰HbA1c的测量。所以，医生对所获数值保持批判性观点很重要。本文回顾了用于测定糖化血红蛋白水平的不同方法及其局限性。还强调了可能出现HbA1c真实值高估或低估的医学情况。本文未涉及以mmol/mol而非%表示的HbA1c新表达值的具体问题。此外，还将描述可能出现HbA1c真实值高估和低估的医学情况。
