Glycated protein update: implications of recent studies, including the diabetes control and complications trial

On the basis of the results of the Diabetes Control and Complications Trial (DCCT), the American Diabetes Association (ADA) now recommends tight control of blood glucose to near-normal concentrations as the primary goal for most eligible insulin-dependent diabetic patients. In the DCCT, intensive therapeutic intervention was based on frequent self-monitoring of blood glucose and monthly measurements of glycohemoglobin. The importance of glycohemoglobin assessments serves to highlight the present inadequacies in laboratory measurements of this analyte, which hinders wide implementation of the ADA recommendations. Clinical interventions aimed at achieving the DCCT's published therapeutic goals may place patients at a significantly increased risk for life-threatening hypoglycemia, if the therapy is based on nonstandardized laboratory results. Clinical laboratories will now be under increasing pressure to provide reproducible, standardized measurements of glycohemoglobin, a goal that recent research has shown to be realistic, if widespread interlaboratory calibration is adopted. Finally, recent advances in measuring glycated serum proteins appear to warrant reevaluation of such assays during future intensive therapy trials, as potentially important tools for fine-tuning tight blood glucose control.