Chapter-035 The HbA1c Assay: A Critical Appraisal

BOOK TITLE: ESI Manual of Clinical Endocrinology

1. Baruah Manash P
2. Bhattacharya Bhaskar
Publishing Year
Author Affiliations
1. Excelcare Hospital, Guwahati, Assam, India, Excel Center, Guwahati, Assam, India, Specialization—Clinical Endocrinology, Excelcare Hospitals (P) Ltd., Guwahati, Assam, India, Excel Center (A Unit of Excelcare Hospitals), Guwahati, Assam, India, Excel Care Hospital, Guwahati, Assam, India
2. Clinical Diagnostic and Laboratory Services, Specialization—Medical Biochemistry, Suraksha Diagnostic (P) Ltd., Kolkata, West Bengal, India
Chapter keywords
Hemoglobin, glycated hemoglobin, A1C-Derived Average Glucose, glycemic control, National glycohemoglobin standardization program, proficiency testing


HbA (adult) and HbF (fetal) are chromatographically differentiable hemoglobin (Hb) fractions. HbA1a, HbA1b and HbA1c are three minor components of HbA. HbA1c concentration is a function of hyperglycemia, and establishes a link between diabetes and the molecule. When hemoglobin molecule is glycated, it remains that way and individuals with poorly controlled diabetes, the quantities of glycated hemoglobins are much higher than in healthy people. A1c assay is used to target glycemic control and has become a major role in the clinical management of diabetes. The two studies namely the Diabetes Control and Complications Trial (DCCT), UK Prospective Diabetes Study (UKPDS), conducted in patient with type 1 and 2 diabetes respectively established the fact that levels of HbA1c are a measure of the risk for the development of diabetes complications. Evidence-based scientific data has proven the worth of HbA1c in clinical diabetology. This chapter discusses in detail about the National glycohemoglobin standardization program and analytical considerations.

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