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Labile glycated hemoglobin: an underestimated laboratory marker of short term glycemia

Joris R Delanghe1, Stijn Lambrecht1, Tom Fiers1

  • 1Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium.

Clinical Chemistry and Laboratory Medicine
|January 18, 2022
PubMed

Insights

Labile hemoglobin A1c (l-HbA1c) offers a faster indicator for glycemic changes than standard HbA1c. This labile fraction, alongside red blood cell distribution width (RDW), aids in monitoring diabetes management.

Area of Science:

  • Clinical Chemistry
  • Endocrinology
  • Hematology

Background:

  • Diabetes mellitus poses a significant public health challenge.
  • Hemoglobin A1c (HbA1c) is crucial for diabetes management but has limitations due to red blood cell (RBC) lifespan variations and slow response to glucose changes.
  • A labile HbA1c (l-HbA1c) fraction exhibits faster kinetics and can be measured alongside HbA1c.

Purpose of the Study:

  • To explore the utility of the l-HbA1c fraction for monitoring glycemia.
  • To assess the correlation of l-HbA1c with glycemic control and HbA1c.
  • To investigate the relationship between l-HbA1c, HbA1c, and red blood cell distribution width (RDW).

Main Methods:

  • Simultaneous assay of l-HbA1c and HbA1c fractions using a Tosoh G8 analyzer.
  • Comparison of l-HbA1c results with serum glucose and HbA1c.
  • Determination of RDW using a Sysmex SN analyzer to assess erythrocyte lifespan.

Main Results:

  • l-HbA1c demonstrated good measurement precision (CVs 2.2-2.3%).
  • l-HbA1c showed strong correlations with glycemia (r=0.80) and HbA1c (r=0.73).
  • Glycemia and HbA1c were the primary determinants of l-HbA1c in a multiple regression model (r²=0.752); RDW showed a weaker correlation.

Conclusions:

  • l-HbA1c serves as an additional marker for detecting rapid glycemic fluctuations missed by standard HbA1c and blood glucose monitoring.
  • RDW can indicate atypical RBC lifespan, potentially enhancing the interpretation of l-HbA1c fraction results.
Abstract

Keywords:
diabetes mellitusglucoseglycated hemoglobinlabile HbA1c fractionred cell distribution width (RDW)

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