" glycated hemoglobin
When to perform the exam?
The dosage of glycated hemoglobin should be performed at the time of diagnosis of diabetes and every 3-4 months to verify the degree of metabolic control. In well-compensated patients, its determination is accepted every 6 months, while in the case of severe decompensation, a new control can be justified even after only one month.
Is the test reliable?
If performed in accordance with international standards, the HPLC measurement of glycated hemoglobin is very reliable. Rather, what under certain circumstances may be poorly reliable is its clinical significance.
Factors affecting glycated Hb levels
Com "it is logical, to expect, the values of glycated hemoglobin are altered in all conditions in which the number and survival of erythrocytes are modified (chronic anemia, haemolytic anemia, leukemia, recent haemorrhage or transfusions, removal of the spleen), but also in other conditions (malaria, uremia, severe hyperbilirubinemia, severe hypertriglyceridemia, severe leukocytosis, alcoholism).
The presence of hemoglobin variants can cause both positive and negative interference, depending on the methods used.
Beyond these conditions, the values of glycated hemoglobin have some limits even in the diabetic patient. For what has been said, in fact, this parameter provides an indicative picture of the average blood glucose values of the last period, but it does not provide any information about the fluctuations undergone by the blood sugar itself. Ironically, a person who spends half the day in a state of hyperglycemia. and the remaining half in hypoglycemic conditions could therefore have normal glycated hemoglobin values. For this reason, the evaluation of HbA1c levels must be accompanied by data collected through self-monitoring of blood glucose, useful for evaluating acute fluctuations of glycemic levels; therefore, the collaboration of the patient becomes fundamental, who must take care to monitor their glycemic levels on different days and at different times, especially in the early morning, two hours after meals, in the evening and, at least sometimes, at night This aspect cannot absolutely be neglected, since we know that regardless of the risk related to the levels of e glycated moglobin (mainly affecting eyes, kidneys and nerves), changes in blood sugar are related to vascular risk (macrovascular complications of diabetes).
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