Long term glycaemic control in DM with
(Glycated haemoglobin) (2296-H17th)Measurement of glycated haemoglobin is the standard method for assessing long term glycaemic controlWhen plasma glucose is consistently elevated there is an increase in non enzymatic glycation of haemoglobin small amount of HbA are non enzymaticaly glycated to form HbAjcThis alteration reflects the glycemic history over previous 2-3 months (since erythrocytes have an average life span of 120 days)* HbAlc assay performed by the high performance liquid chromatography (HPLC)HbAir measurement becomes unreliable in condition like- Haemoglobinopathies- Hemolytic anemia- Uremia* An alternative indicator of glycemic control when HbAjc is inaccurate is glycated albumin*** Nomal values 4-6% of the total hemoglobin* When HPLC the HbAlc approximate the following mean plasma glucose value* HbAlc 6% is 7.5 mmol/L (135mg ldl)7% is 9.5 mmol.L (170 mg/dl)8% is 11.5 mmol/L (205 mg/dL)(al% rise in HbA1c translates into 2.0 mmol/dL (35mg/dL) increase the mean glucose)GLUCOSE TOLERANCE TEST* Most valuable in investigating a case of "symptomless" glycosuria such as renal glycosuria and lag type glycosuria* Helpful in recognizing milder case of DM and "early DM"Decrease Glucose toleranceIncreased glucose tolerance* DM* In hyper activity of anterior pituitary and adrenal cortex* Hyperthyroidism* Hypopitutarism* Hyperinsulinism* Hypothyroidism* Adrenal cortical hypofunction (such as Addison's disease)* If there is decreased absorption like sprue, celiac disease* Fructosamine assay (albumin) generally reflects the status of glycemic control for only the preceding 2 weeks* Important for - hemoglobinopathies or hemolytic states or when a narrower time frame is required such as for ascertaining glycemic control at the time of conception in a diabetic women who has recently become pregnant (CMDT)
Total protein
Glycated haemoglobin
Total haemoglobin
Glucose tolerance test
Endocrinology