Haemoglobin A1c or Glycated Albumin for Diagnosis and Monitoring Diabetes: An African Perspective

Area of Science:

• Endocrinology
• Clinical Chemistry
• Public Health

Background:

• Diabetes mellitus (DM) is a global epidemic, with sub-Saharan Africa experiencing significant increases.
• Poorly controlled diabetes is prevalent among diagnosed individuals in the region.
• Existing diagnostic and monitoring methods for DM in Africa face limitations.

Purpose of the Study:

• To review the limitations of glycated haemoglobin (HbA1c) for diabetes monitoring in Africa.
• To assess the utility of glycated albumin and fructosamine in African patients.
• To highlight alternative biomarkers for diabetes management in specific African contexts.

Main Methods:

• Literature review focusing on glycated haemoglobin (HbA1c), glycated albumin, and fructosamine.
• Analysis of factors affecting HbA1c accuracy in African populations.
• Discussion of enzymatic measurement methods for glycated albumin.

Main Results:

• Conditions common in Africa, such as sickle cell anemia, chronic kidney disease, and HIV infection, compromise HbA1c accuracy.
• Glycated albumin reflects short-term glycaemia and is less affected by these interfering conditions.
• Fructosamine also offers an alternative for monitoring glycaemic control.

Conclusions:

• Standard HbA1c monitoring may be unreliable for diabetes management in many African patients.
• Glycated albumin and fructosamine present viable alternatives for assessing glycaemic control in this population.
• Further research and implementation of these alternative markers are crucial for improving diabetes care in Africa.