The long and winding road to optimal HbA1c measurement.
The long and winding road to optimal HbA1c measurement.
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DOI：
10.1016/j.cca.2012.12.026
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发表时间：
2013-03-15
期刊：
影响因子：
--
通讯作者：
Rohlfing CL
中科院分区：
文献类型：
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作者：
Little RR;Rohlfing CL
长期临床试验的结果证实了糖化血红蛋白（HbA1c）作为糖尿病患者平均血糖和并发症风险指标的重要性，其中最著名的是分别于1993年和1998年发表的糖尿病控制和并发症试验（DCCT）和英国前瞻性糖尿病研究（UKPDS）。然而，由于不同检测方法和实验室之间的HbA1c结果缺乏可比性，基于这些研究推荐的HbA1c靶点的临床应用很困难。因此，国家糖蛋白标准化计划（NGSP）于1996年启动，目标是将HbA1c结果标准化到DCCT/UKPDS的结果。糖化血红蛋白标准化工作非常成功；然而，在改善HbA1c的“漫长而曲折的道路”上出现了许多问题，包括国际临床化学联合会（IFCC）开发的高级别HbA1c参考方法，使用HbA1c诊断和监测糖尿病的建议，以及即时（POC） HbA1c检测。在这里，我们回顾了HbA1c标准化的过去、现在和未来，并描述了HbA1c检测的现状，包括医疗保健提供者在解释HbA1c结果时需要注意的局限性。
The importance of hemoglobin A1c (HbA1c) as an indicator of mean glycemia and risks for complications in patients with diabetes mellitus was established by the results of long-term clinical trials, most notably the Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS), published in 1993 and 1998 respectively. However, clinical application of recommended HbA1c targets that were based on these studies was difficult due to lack of comparability of HbA1c results among assay methods and laboratories. Thus, the National Glycohemoglobin Standardization Program (NGSP) was initiated in 1996 with the goal of standardizing HbA1c results to those of the DCCT/UKPDS. HbA1c standardization efforts have been highly successful; however, a number of issues have emerged on the “long and winding road” to better HbA1c, including the development of a higher-order HbA1c reference method by the International Federation of Clinical Chemistry (IFCC), recommendations to use HbA1c to diagnose as well as monitor diabetes, and point-of-care (POC) HbA1c testing. Here, we review the past, present and future of HbA1c standardization and describe the current status of HbA1c testing, including limitations that healthcare providers need to be aware of when interpreting HbA1c results.