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Rapid and slow rate of decrease in HbA1a + b and HbA1c during improved glycaemic control
Insights
Rapid improvements in blood glucose control lead to a biphasic decrease in glycosylated haemoglobins (HbA1a+b and HbA1c). The initial, faster decline may be influenced by labile HbA1, impacting long-term glycemic control assessments.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Clinical Chemistry
Background:
- Glycosylated haemoglobins (HbA1a+b and HbA1c) are key indicators of long-term glycemic control in diabetic patients.
- Rapid improvements in glycemic control can alter HbA1 levels, potentially affecting interpretation.
Purpose of the Study:
- To investigate the kinetics of glycosylated haemoglobin changes following rapid glycemic control improvement.
- To determine if the decrease in HbA1a+b and HbA1c occurs in a single or multiple phases.
Main Methods:
- Column chromatography was used to measure HbA1a+b and HbA1c levels.
- Nine diabetic patients with rapidly improved glycemic control were monitored for at least 3 weeks.
Main Results:
- A biphasic decrease in both HbA1a+b and HbA1c was observed within the first few days of improved control.
- The initial decrease in HbA1a+b and HbA1c was faster than the subsequent decline.
- Individual patient data showed a correlation between the initial rate of decrease in glycosylated haemoglobins and blood glucose.
Conclusions:
- Glycosylated haemoglobins (HbA1a+b and HbA1c) exhibit a biphasic reduction pattern during rapid glycemic control improvement.
- A labile HbA1 fraction likely contributes to the rapid initial decrease, potentially influencing HbA1's utility as a long-term glycemic control marker.
Abstract:
The change in glycosylated haemoglobins was studied with a column chromatographic method when glycaemic control was rapidly improved in nine diabetic patients. The patients were followed for 3 weeks or more. There was a decrease in HbA1a+b and HbA1c within the first few days of improved control and this decrease was faster than later on. The initial decrease of HbA1a+b was faster than that of HbA1c. In individual patients the initial decrease in glycosylated haemoglobins correlated with the initial rate of decrease in blood glucose. It is concluded that HbA1a+b and HbA1c decrease biphasically during improved glycaemic control. The rapid initial decrease may be due to labile HbA1 and it is large enough to influence the value of HbA1 as an indicator of long-term glycaemic control in some patients.