Problem of using hemoglobin A1C measurement in endemic area of hemoglobinopathy

Area of Science:

• Clinical Chemistry
• Endocrinology
• Hematology

Background:

• Diabetes mellitus (DM) is a prevalent metabolic disorder requiring consistent glycemic control monitoring.
• Glycohemoglobin (GHb), specifically Hemoglobin A1C (HbA1C), is a standard biomarker for assessing long-term glycemic control in diabetic patients.
• HbA1C reflects average blood glucose levels over 2-3 months, formed by non-enzymatic glycation of hemoglobin.

Purpose of the Study:

• To address the challenges and limitations of using Hemoglobin A1C (HbA1C) for monitoring diabetes in populations with a high prevalence of hemoglobin variants (hemoglobinopathy).
• To highlight potential inaccuracies in HbA1C measurements due to patient- and laboratory-related factors in endemic regions.

Main Methods:

• Review of existing literature on HbA1C measurement methodologies.
• Analysis of factors affecting HbA1C accuracy, including hemoglobin variants and derivatives.
• Discussion of diagnostic implications in endemic areas of hemoglobinopathy.

Main Results:

• Hemoglobin variants and derivatives can interfere with standard HbA1C assays, leading to inaccurate glycemic control assessments.
• Patient- and laboratory-specific factors further complicate reliable HbA1C measurement in affected populations.
• The prevalence of hemoglobinopathy in certain regions poses a significant challenge to the routine use of HbA1C.

Conclusions:

• Standard HbA1C measurement may not be reliable for glycemic control assessment in diabetic patients residing in areas endemic for hemoglobinopathy.
• Alternative or complementary methods for glycemic monitoring may be necessary in these specific patient populations.
• Further research is needed to develop and validate accurate glycemic assessment tools for individuals with hemoglobin variants.