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At least 19 recordsLinked to original sources

PubMed1992

Immediate HbA1c results. Performance of new HbA1c system in pediatric outpatient population.

OBJECTIVE: This study compared the performance of a new device that uses an IA to measure HbA1c in 9 min with a 1-microliter capillary blood sample with AC and CE methods in both nondiabetic and diabetic pediatric patients. RESEARCH DESIGN AND METHODS: Two hundred seven pediatric subjects (103 nondiabetic, 104 with insulin-dependent diabetes mellitus) had HbA1c measured with the IA method and compared with total GHb values determined by AC and HbA1 by the CE method with the same whole-blood capillary aliquot. Glucose values were also obtained from the same blood samples. RESULTS: Correlations and regression analyses show excellent correspondence between the three assays. The correlation between the AC and CE methods is 0.98 (P less than 0.001) with a slope of 1.615 +/- 0.0125 and intercept of 4.00 +/- 0.20. The correlation between the IA and AC methods is 0.99 (P less than 0.001) with a slope of 0.608 +/- 0.007 and intercept of 1.326 +/- 0.066. The correlation between the IA and CE methods is 0.97 (P less than 0.001), with a slope of 0.983 +/- 0.018 and intercept of 1.122 +/- 0.153. The average difference and average percentage difference between methods were also significant (P less than 0.001), reflecting the differences in GHb components measured. There was a significant correlation (P less than 0.001) between each method and glucose values (IA r = 0.72, AC r = 0.70, CE r = 0.73). Within-run precision for IA ranged from 1.7 to 3.5% and between-run precision 2.7 to 4.1%. CONCLUSIONS: Study results suggest that the IA method gives extremely accurate and reliable values over the clinical range of interest. The instrument is small, portable, easy to use, and provides information within 9 min for both physicians and patients.

Agglutination Tests↗

PubMed1990

[Measurement of HbA1c as a method to diagnose diabetes mellitus in nursing home residents].

Measurement of HbA1c is widely used to control diabetes mellitus (DM) and is one of the methods to diagnose DM. We adopted the measurement of HBA1c in the annual medical examination of residents at a nursing home for the elderly in order to obtain the normal serum level of HbA1c in the elderly and analyze the influence of aging on HbA1c. HbA1c and the body mass index (BMI) were measured in 968 elderly. HbA1c was distributed from 3.7 to 12.5%. Mean and SD, were 5.03 +/- 0.61% and there was no difference of the serum level of HbA1c between males and females. HbA1c was below 6.0% in 95% of all subjects. There was no correlation between age and HbA1c. To determine data trends, we divided the elderly into 4 age groups of 60 to 69 years, 70 to 79 years, 80 to 89 years and 90 or more. With advancing age, HbA1c gradually increased but there was no significant difference of HbA1c among the 3 groups which were younger than the group aged 90 or more. HbA1c was 5.51 +/- 1.06% in the group aged more than 90 years and there was a significant difference in the value of HbA1c between the group aged 90 or more and other groups. Inversely, BMI gradually decreased with age and there was also a significant difference of BMI between the group aged 90 or more and the other groups. These results suggest that there is a difference of metabolic condition between the group aged 90 or more and the other groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1995

The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial.

The Diabetes Control and Complications Trial (DCCT) demonstrated that a regimen of intensive therapy aimed at maintaining near-normal blood glucose values markedly reduces the risks of development or progression of retinopathy and other complications of insulin-dependent diabetes mellitus (IDDM) when compared with a conventional treatment regimen. This report presents an epidemiological assessment of the association between levels of glycemic exposure (HbA1c) before and during the DCCT with the risk of retinopathy progression within each treatment group. The initial level of HbA1c observed at eligibility screening as an index of pre-DCCT glycemia and the duration of IDDM on entry were the dominant baseline predictors of the risk of progression. The shorter the duration of IDDM on entry, the greater were the benefits of intensive therapy. In each treatment group, the mean HbA1c during the trial was the dominant predictor of retinopathy progression, and the risk gradients were similar in the two groups; a 10% lower HbA1c (e.g., 8 vs. 7.2%) is associated with a 43% lower risk in the intensive group and a 45% lower risk in the conventional group. These risk gradients applied over the observed range of HbA1c values and were unaffected by adjustment for other covariates. Over the range of HbA1c achieved by DCCT intensive therapy, there does not appear to be a level of glycemia below which the risks of retinopathy progression are eliminated. The change in risk over time, however, differed significantly between the treatment groups, the risk increasing with time in the study in the conventional group but remaining relatively constant in the intensive group. The risks were compounded by a multiplicative effect of the level of HbA1c with the duration of exposure (time in study). Total glycemic exposure was the dominant factor associated with the risk of retinopathy progression. When examined simultaneously within each treatment group, each of the components of pre-DCCT glycemic exposure (screening HbA1c value and IDDM duration) and glycemic exposure during the DCCT (mean HbA1c, time in study, and their interaction) were significantly associated with risk of retinopathy progression. Similar results also apply to other retinopathic, nephropathic, and neuropathic outcomes. The recommendation of the DCCT remains that intensive therapy with the goal of achieving near-normal glycemia should be implemented as early as possible in as many IDDM patients as is safely possible.

Biomarkers↗

PubMed1981

HbA1c and the diagnosis of diabetes mellitus.

To evaluate the usefulness of haemoglobin A1c (HBA1C) determinations in the diagnosis of diabetes mellitus, the outcome of a standard oral glucose tolerance test (OGTT) and HbA1c values were compared in 178 consecutive subjects referred for a diagnostic OGTT. The subjects were mainly in age groups in which non-symptomatic diabetes mellitus predominates. The prevalences of elevated fasting plasma glucose and abnormal OGTT were found to increase with increasing age. One third of the total series had impaired or diabetic OGTT. In the group with normal OGTT, 16% had fasting plasma glucose concentrations above the upper normal limit, but the range of HbA1c values did not differ from that of healthy controls. In the group with impaired OGTTs (n = 20), elevated HbA1c values were found only in subjects with elevated fasting plasma glucose and the highest two-hour OGTT values (n = 4). In the group with diabetic OGTT, 86-94% had HbA1c values above the upper normal limit, and HbA1c was elevated in all subjects with a fasting plasma glucose higher than 10.5 mmol/l or a 2-hour OGTT glucose value above 14.4 mmol/l. Using the results of the OGTT as the true diagnosis, HbA1c had a diagnostic specificity of 0.78 and sensitivity of 0.96. Only subjects with a substantially reduced glucose tolerance may be diagnosed by HbA1c determinations.

Adolescent↗

PubMed1994

[A comparison of 2 new rapid methods for determination of HbA1C concentration in patients with diabetes mellitus].

We have evaluated a new immunoturbidimetric assay (DCA 2000 HbA1c system, Bayer, Denmark) for determination of HbA1c. The aim of the study was to evaluate accuracy, precision and feasibility for the DCA 2000 method when employed in a diabetes centre by a technical assistant and at a general practitioner's by non lab staff. The results were compared with a high performance liquid chromatographic method (HPLC, AUTO A1C, Kyoto Daiichi Kagaku Co., Kyoto, Japan) which is the current laboratory method, and therefore used as reference. Assay time for the DCA 2000 method was nine minutes, while the HbA1c result was displayed within four minutes by HPLC. Blood samples were drawn after informed consent from 118 patients during a period of two months at the out-patient clinic of the Dept. of Paediatrics, Glostrup Hospital (n = 67) and at a general practitioner's (n = 51). Each sample was analyzed twice by each method on two consecutive days. In the HbA1c range from four to 14% (n = 67) the average within-assay precision (SD) for the HPLC method was 0.13%, whilst it was 0.23% for the DCA 2000 method (p < 0.001). The within-assay precision was low and acceptable, and for both methods it was independent of the current HbA1c concentration. For the DCA method precision was almost similar (p > 0.07) when carried out by a technical assistant (SD: 0.20%) and by non lab staff (SD: 0.25%). Interbatch variations for HbA1c results investigated with two different batches of reagents within a month were SD 0.30% (HbA1c range: 4.9-5.9%, n = 30) and SD 0.44% (HbA1c range: 10.5-12.1%, n = 30) for these two preparations.(ABSTRACT TRUNCATED AT 250 WORDS)

Chromatography, High Pressure Liquid↗

PubMed1979

Hemoglobin A1c (HbA1c) in children with long standing and newly diagnosed diabetes mellitus.

In 35 children with long-standing diabetes mellitus, a significant correlation was found between the hemoglobin A1c (HbA1c)--and the 24-hour urinary glucose excretion. By contrast, 11 newly diagnosed diabetic children had grossly elevated HbA1c-concentrations, but no correlations could be established between the levels of HbA1c and the duration of symptoms, blood glucose, glycosuria, ketonuria and the acid--base status. However, HbA1c and C-peptide were significantly correlated. The elevated HbA1c-concentrations decreased towards normal in all of these 11 children after 2--3 months following adequate therapy. The results suggest that the determination of HbA1c may serve as a valuable metabolic control index in children with long-standing diabetes mellitus, but adds little information in newly diagnosed patients. For the individual diabetic child during the early treatment period, HbA1c may be the index of choice for adequacy of metabolic control.

Acid-Base Equilibrium↗

PubMed1992

Association of HbA1c with prevalent cardiovascular disease in the original cohort of the Framingham Heart Study.

We studied the cross-sectional relationship between HbA1c and cardiovascular disease (CVD) in the survivors of the original cohort of the Framingham Heart Study (n = 1045). HbA1c was significantly related to prevalent CVD among women but not men. HbA1c was also related to hypertension and to the ratio of total to high-density lipoprotein cholesterol levels. In regression analyses that controlled for these and other potential risk factors, HbA1c remained significantly related to CVD among women. The relative odds of CVD increased 1.39-fold (95% confidence interval 1.06-1.83) for increases in HbA1c of 1% (e.g., for HbA1c from 5 to 6%). The relationship was not weakened when known diabetic subjects or subjects taking beta-blocker or thiazide medications were excluded from analysis. In contrast, there was no significant relationship between "casual" blood glucose and prevalent CVD. Our results reveal a strong, significant, independent association between hyperglycemia, measured by HbA1c, and CVD among older women.

Aged↗

PubMed1990

Immediate elimination of labile HbA1c with allosteric effectors of hemoglobin.

Our aim was to find a simple method of removing labile glycosylated hemoglobin (HbA1c) from blood samples before it is measured by cation-exchange chromatography. Labile HbA1c is formed by the binding of glucose to the NH2-terminal valine of the beta-chain of HbA. We sought a more competitive binder for the same site to dissociate labile HbA1c to glucose and HbA. Inorganic phosphates were found to have a strong allosteric effect and a great ability to eliminate labile HbA1c. We developed our method with 4 mM tetrapolyphosphate in the hemolyzing solution to eliminate labile HbA1c during the automatic processing (at pH 6 and heated for 2 min at 45 degrees C) of blood samples for HbA1c estimation. This may be useful when estimating HbA1c by the manual method.

Allosteric Regulation↗

PubMedDate not supplied

Metabolic control in 131 juvenile-onset diabetic patients as measured by HbA1c: relation to age, duration, C-peptide, insulin dose, and one or two insulin injections.

Glycosylated hemoglobin A (HbA1c), considered to reflect long-term metabolic control of diabetes, was analyzed in 131 patients, aged 2 5/12-19 6/12 yr, with juvenile-onset diabetes. Using stepwise multiple regression HbA1c, fasting blood glucose and plasma 3-hydroxybutyrate were analyzed as dependent variables versus independent variables such as age of the patients, duration of the disease, level of plasma immunoreactive C-peptide (IRCP), insulin dose, and number of insulin injections (one or two) per day. HbA1c was inversely related only to IRCP concentration. A low but significant, positive correlation was found between HbA1c and the duration of diabetes. Stepwise addition of the other independent variables did not further increase the fraction of explained variance. HbA1c was also correlated with a subjective rating score of the metabolic control performed by the treating physician. Fasting plasma glucose was significantly related to HbA1c but not to any of the independent variables. Fasting 3-hydroxybutyrate showed an inverse correlation to the age of the patient. The present study showed that in juvenile-onset diabetic patients, endogenous insulin secretion as reflected by IRCP was the factor best correlated with a low level of HbA1c. After the cessation of endogenous insulin secretion, there is a progressive deterioration of metabolic control and multiple injections of insulin rather than one or two per day may be needed to reach optimal control in the patients.

Adolescent↗

PubMed1993

Rapid desktop method for the measurement of glycated haemoglobin HbA1c.

A new desktop monoclonal antibody-based test system (Bayer Diagnostics DCA 2000) for quantitation of glycated haemoglobin HbA1c is described and evaluated. This method involves a monoclonal antibody to HbA1c which defines its specificity. It requires 9 minutes to complete, and shows good intra- and inter-run precisions (1.3%-3.7%), at 5 HbA1c levels tested--4.1%, 5.7%, 6.1%, 9.2% and 12.4%. Results from 81 blood samples obtained from diabetic patients (3.9%-13.2% HbA1c) showed excellent correlation with a laboratory-based ion-exchange HPLC technique (y = 1.03 [Lab] + 0.103%; Pearson coefficient, r = 0.99). The test can be performed either with a capillary fingerprick or venous blood sample. Only 1 microliter of blood volume is required. Comparison of HbA1c levels of 43 paired capillary and venous samples showed excellent correlation (y = 1.00 [venous] + 0.042%; r = 0.99). The HbA1c values obtained from a cohort of 37 healthy adults, mean (+/- SD) age 33 +/- 9.01 years, gave a value of 5.5 +/- 0.42%. The calculated 95% confidence limits are 4.7%-6.3%. This quick method provides 'stat' HbA1c results, which were hitherto not possible with the laboratory-based methods.

Adult↗

PubMed2026

Efficacy and Safety of iGlarLixi Versus IDegAsp by Baseline Age, Disease Duration and HbA1c in Chinese People With Type 2 Diabetes: Post Hoc Analyses of the Soli-D Study.

AIMS: To compare the efficacy and safety of insulin glargine 100 U/mL plus lixisenatide (iGlarLixi) with insulin degludec plus insulin aspart (IDegAsp) by baseline age, Type 2 diabetes (T2D) duration and glycated haemoglobin (HbA1c) in the Soli-D study. MATERIALS AND METHODS: In Soli-D, Chinese adults with T2D suboptimally controlled on oral antidiabetic drugs (OADs) were randomized to iGlarLixi or IDegAsp for 24 weeks. These post hoc analyses evaluated glycaemic efficacy, insulin dose, body weight and hypoglycaemia outcomes in subgroups defined by baseline age (< 65, ≥ 65 years), T2D duration (< 10, ≥ 10 years) and HbA1c (≥ 7% to ≤ 8% [≥ 53 to ≤ 64 mmol/mol], > 8% to ≤ 9% [> 64 to ≤ 75 mmol/mol], > 9% [> 75 mmol/mol]). RESULTS: Among 582 participants (iGlarLixi n = 291; IDegAsp n = 291), baseline age was < 65 years in 442 and ≥ 65 years in 140; T2D duration was < 10 years in 366 and ≥ 10 years in 216; and HbA1c was ≥ 7% to ≤ 8% in 205, > 8% to ≤ 9% in 209 and > 9% in 168. At Week 24, HbA1c reductions were greater with iGlarLixi versus IDegAsp, with no treatment-by-subgroup interactions for baseline age, T2D duration or HbA1c. Change in other glycaemic outcomes, insulin dose and body weight generally showed no interaction across subgroups. Total insulin daily doses during treatment and hypoglycaemia event rates were consistently lower with iGlarLixi versus IDegAsp in all subgroups. CONCLUSIONS: iGlarLixi provides improved glycaemic control at lower insulin doses with reduced risk of hypoglycaemia in Chinese adults with suboptimally controlled T2D on OADs, regardless of baseline age, disease duration or HbA1c.

Humans↗

PubMed1993

Evaluation of glycaemic control limits using the Ames DCA 2000 HbA1c analyser.

The Ames DCA 2000 is a benchtop analyser that measures HbA1c by an agglutination inhibition immunoassay using a monoclonal antibody. Laboratory and nursing staff measured HbA1c on-site in 78 patients with Type 1 diabetes at the outpatient clinic. Significant correlations were noted with both the Corning Glytrac total HbA1 assay (r = 0.89) and the Novoclone assay for HbA1c (r = 0.95). Mean within-assay CV was 1.6% and 3.0% at HbA1c of 5.4% and 13.0%, respectively, while between-assay CVs were 4.2% and 3.8%. These results are as good as our routine laboratory method based on the Corning HbA1 assay. Locally derived reference population data for HbA1c were produced and patients were assigned to categories of good, acceptable, and poor glycaemic control using conventional recommendations for Type 2 diabetes. There was poor agreement between the methods, with only 22% of patients achieving good/acceptable control using the DCA 2000, while 46% of patients had an HbA1 in this range. It appears that the convention for derivation of control limits for HbA1 does not hold for this HbA1c assay.

Antibodies, Monoclonal↗

PubMed1991

Comparison of 1,5-anhydroglucitol, HbA1c, and fructosamine for detection of diabetes mellitus.

To evaluate the use of serum 1,5-anhydroglucitol (AG) levels in screening for diabetes mellitus, we compared the sensitivity and specificity of HbA1c, fructosamine (FA), and AG in 1620 randomly selected subjects in 11 institutions throughout Japan. Most individuals were receiving diet and/or drug therapy for diabetes. Subjects were separated into four groups based on World Health Organization criteria: nondiabetic control subjects, subjects with impaired glucose tolerance (IGT), patients with diabetes, and patients with other disorders without IGT. The overlap of AG values between each group was less than that of HbA1c or FA values. AG levels were significantly correlated with fasting plasma glucose (r = -0.627), HbA1c (r = -0.629), and FA (r = -0.590) levels. If we took 14 micrograms/ml as the normal lower limit, AG level was highly specific (93.1%), and a decreased AG level indicated diabetes mellitus (84.2% sensitivity). According to the selectivity index (sensitivity value times specificity value), AG determinations were superior to both HbA1c and FA measurements for diabetes screening. When combinations of these tests were used, only AG and HbA1c together were slightly better than AG alone. Thus, together with other advantages of AG, e.g., its wide variance with relatively fair glycemic control and the negligible influence of the sampling conditions, AG level has more potential than HbA1c or FA level as a screening criterion for diabetes.

Biomarkers↗

PubMed1995

Kinetics of HbA1c, glycated albumin, and fructosamine and analysis of their weight functions against preceding plasma glucose level.

OBJECTIVE: To examine the kinetics of HbA1c, glycated albumin (GA), and fructosamine (FA) levels in response to plasma glucose change and their relationship with the preceding plasma glucose level. RESEARCH DESIGN AND METHODS: The time courses of HbA1c, GA, and FA after acute glycemic normalization were observed in nine patients with newly diagnosed non-insulin-dependent diabetes mellitus and compared with theoretical ones. Their weight functions against preceding plasma glucose level were analyzed assuming a stepwise plasma glucose change and compared with the theoretical prediction. RESULTS: The fasting plasma glucose level was acutely normalized after admission with a half-time of 6.3 +/- 2.4 days (mean +/- SD). The HbA1c level decreased linearly during the initial 2 months with a half-time of 34.6 +/- 10.1 days, followed by a gradual decrease thereafter. GA and FA levels decreased very rapidly during the initial 2-3 weeks with half-times of 17.1 +/- 2.8 and 12.2 +/- 4.8 days, respectively, followed by a gradual decrease thereafter. The time courses of HbA1c, GA, and FA agreed well with theoretically estimated decay curves. Experimental values of weight functions against the preceding plasma glucose level agreed well with the theoretical prediction. The weight functions for glycated proteins had maximum values on the days just before the measurement of glycated proteins and gradually decreased with an increasing time interval. The lengths of the periods over which the weight functions for HbA1c, GA, and FA extend back were estimated to be roughly 100, 40, and 30 days, respectively. CONCLUSIONS: The levels of HbA1c, GA, and FA do not reflect the simple mean but reflect the weighted mean of the preceding plasma glucose level over a considerably longer period than was previously speculated.

Adult↗

PubMed1993

Discrepancy in HbA1c measurements performed at different local laboratories and at a selected central reference laboratory.

As participants in a general practice intervention study, 66 patients had their HbA1c measured both at a local and at a selected central reference laboratory. A discrepancy in the results was observed, as 97% of the results measured locally were lower than the centrally determined results. Bias (as calculated from mean value of measured HbA1c) between local laboratories and the central laboratory was measured to -1.47% HbA1c. A bias of this magnitude gave "problems" both to the general practitioners, patients and laboratories. To reduce the "problems" a bias of 0.5% HbA1c is estimated to be acceptable. But, to avoid these "problems" totally, a bias of 0.25% HbA1c is estimated to be the highest allowed bias. For HbA1c, a control system for both control of method standardisation and for specificity is described.

Evaluation Studies as Topic↗

PubMed1990

Glycosylated haemoglobin (HbA1c) levels in normal pregnancy: sequential changes and relation to birth weight.

Twenty-five healthy pregnant females with the absence of family history of diabetes mellitus were investigated serially for glycosylated haemoglobin (HbA1c) as per cent haemoglobin A1 at the interval of 4 weeks. HbA1c values were also determined in 10 healthy non-pregnant females who were studied as control cases. As compared to non-pregnant females HbA1c values were found to be low at 14-16 weeks of pregnancy (4.9 +/- 0.25%). After 16 weeks the HbA1c levels showed an upward trend to reach maximum at 32-34 weeks (5.54 +/- 0.19%). After 34 weeks the levels fell again to reach the lowest by 40 weeks of gestation (4.8 +/- 0.203%). Statistically highly significant relationship (p less than 0.001) was found between the HbA1c values and birth weight, lower values were associated with low birth weight and with increasing HbA1c values birth weight was found to be correspondingly increased.

Birth Weight↗

PubMed1985

U.K. prospective diabetes study. II. Reduction in HbA1c with basal insulin supplement, sulfonylurea, or biguanide therapy in maturity-onset diabetes. A multicenter study.

Newly presenting maturity-onset diabetic subjects were put on diet and if, after 3-4 mo, their fasting plasma glucose continued greater than 6 mmol/L, they were randomized to three therapies: (1) continuing diet alone, (2) with additional sulfonylurea, or (3) with additional basal insulin supplement provided by ultralente insulin. Obese patients were also randomized to metformin therapy. The aim was to lower the fasting plasma glucose to less than 6 mmol/L and the degree to which this reduced the hemoglobin A1C (HbA1C) concentration was studied in 195 patients over 1 yr. Sulfonylurea and insulin similarly reduced (P less than 0.001) the fasting plasma glucose from 8.3 +/- 1.9 to 6.7 +/- 1.3 mmol/L (mean +/- 1 SD) and 8.6 +/- 2.2 to 6.8 +/- 1.4 mmol/L, respectively. This was accompanied by a significant reduction (P less than 0.001) of the HbA1C to the high normal range, from 9.1 +/- 2.1% to 7.8 +/- 1.2%, and from 9.1 +/- 1.9% to 8.1 +/- 1.3%, respectively, both values at 1 yr being significantly (P less than 0.05) lower than in patients randomized to diet alone. Patients randomized to diet alone had little change in fasting plasma glucose (8.6 +/- 1.8 to 9.3 +/- 2.3 mmol/L) or HbA1C (8.8 +/- 1.7% to 9.1 +/- 1.6%, respectively). Thus, the simple therapeutic aim of trying to reduce the fasting plasma glucose to less than 6 mmol/L is an effective means of reducing the HbA1C to a high-normal level. The HbA1C and fasting plasma glucose concentrations were similarly related for all three therapies (HbA1C [%] = 0.47 X fasting plasma glucose [mmol/L] + 4.7).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Fructosamine and HbA1c during monitoring of glucose levels in diabetes].

The authors compared the nycthemeral variations of fructosamine levels in nineteen patients with diabetes to fluctuations in their glucose levels. Thirty-five other patients with poorly controlled diabetes were given an optimal treatment then followed up for 2 months (mean glucose levels, fructosamine and HbA1c assays). Mean nycthemeral variations in fructosamine levels did not appear to be correlated with glucose levels. However, intraindividual nycthemeral variability was greater than the analytic variability. After correction for total protein levels this variability was smaller but remained significative. In this longitudinal study, fructosamine and HbA1c levels decreased when control of glucose levels improved. However, decreases were notably greater in HbA1c than in fructosamine compared at 15, 45 and 60 days of follow up. Inversely, fructosamine was correlated better with the mean glucose levels of the preceding 7 days than was HbA1c. When mean glucose levels were calculated for the 15, 30, 45 and 60 preceding days, the results favored HbA1c. The findings presented in this study show that HbA1c remains the best criteria for monitoring medium term glucose levels. However, further word is needed before this conclusion can be confirmed.

Biomarkers↗