Table of Content - Volume 6 Issue 3 - June 2017
A study of level of glycosylated hemoglobin in patients of diabetes mellitus at tertiary health care centre
Dilip Pandurang Patil
Assistant Professor, Department of Medicine, Krishna institute of Medical sciences " Deemed To Be University" Karad Dist_ Satara-415539, Maharashtra, INDIA. Email: patilhospitalkarad@gmail.com
Abstract Background: The glycosylated haemoglobin (HbA1c) test has been the most widely accepted, reliable biomarker for evaluating long term glycaemic control in patients with diabetes mellitus (DM). Aims and Objectives: To Study level of glycosylated hemoglobin in patients of diabetes mellitus at tertiary health care centre. Methodology: This prospective study was undertaken at Krishna Hospital and Medial research Centre, Karad. One hundred patients of Diabetes Mellitus admitted to hospital during an eighteen month period from 1st July 1977 to 31st December 1998 were included in the study. The glycosylated hemoglobin was estimated by kit available in our hospital. We considered HbA1C (%) less than 8 –Good, 8.1-9.0-Fair, 9.1-11-Poor, >11-Bad. Result: In our study we have seen that The majority of the patients were in the age group of 51-60 were 34%, 61-70 were 27%, followed by 41-50 were 18%, 31-40 were 7%, 71-80% were 6%, 21-30 were 4%, >80 and <20 were 2%. The IDDM patients were 28% and NIDDM were 72%. The majority of the patients were with HbA1C% >11 (Bad) were 41%, 9.1-11.0 (Poor)-19%, 8.1-9.0 (Fair)-16%, <8 (Good)-24%. Conclusion: It can be concluded from our study that the majority of the patients were in the age group of 51-60, the majority of the patents were NIDDM and majority were associated with > 11 HbA1C%. Key Wrds: Glycosylated hemoglobin (HbA1C), IDDM (Insulin Dependant Diabetes Mellitus), NIDDM (Non-insulin Dependant Diabetes Mellitus).
INTRODUCTION The glycosylated haemoglobin (HbA1c) test has been the most widely accepted, reliable biomarker for evaluating long term glycaemic control in patients with diabetes mellitus (DM). Despite HbA1c being the most important indicator used by clinicians to manage diabetes, studies show that HbA1c results is either poorly recalled or understood among diabetic patients1,2 despite recommendations that patients should know their target and actual HbA1c values.3 There were however, studies which showed a high percentage of patients with HbA1c understanding including knowing their target HbA1c goals4,5 and those who were able to recall their last HbA1c results correctly.6 Those with better HbA1c understanding had achieved better glycaemic control with significantly lower HbA1c values.2,5
MATERIAL AND METHODS This prospective study was undertaken at Krishna Hospital and Medial research Centre, Karad. One hundered patients of Diabetes Mellitus admitted to hospital during an eighteen month period from 1st July 1977 to 31st December 1998 were included in the study. The national diabetes data group of the national Institute of health in 1979 revised the criteria for the diagnosis of Diabetes Mellitus (39) was used for the diagnosis of diabetic patients. The glycosylated hemoglobin was estimated by kit available in our hospital. We considered HbA1C (%) less than 8 –Good, 8.1-9.0-Fair, 9.1-11-Poor, >11-Bad. The patients with hemolytic anemia, pregnancy, acute or chronic blood lost and those with abnormal hemoglobin’s as their HbA1C concentrations may not be accurately estimated.
RESULT
Table 1: Age wise distribution of patients of diabetes mellitus
The majority of the patients were in the age group of 51-60 were 34%, 61-70 were 27%, followed by 41-50 were 18%, 31-40 were 7%, 71-80% were 6%, 21-30 were 4%, >80 and <20 were 2%.
Table 2: Pathological classification of Diabetes Mellitus
The IDDM patients were 28% and NIDDM were 72%
Table 3: Distribution of the patients as per the Glycosylated Hemoglobin Levels
The majority of the patients were with HbA1C% >11 (Bad) were 41%, 9.1-11.0 (Poor)-19%, 8.1-9.0 (Fair)-16%, <8 (Good)-24%.
DISCUSSION Type 2 diabetes mellitus is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.7 The World Health Organization definition of diabetes mellitus (both type 1 and type 2) is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either 8: fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dl) or with a glucose tolerance test, two hours after the oral dose a plasma glucose ≥ 11.1 mmol/L (200 mg/dL). A random blood sugar of greater than 11.1 mmol/L (200 mg/dL) in association with typical symptoms 9 or a glycated haemoglobin (HbA1C) of greater than 6.5% is another method of diagnosing diabetes 10. In 2009 an International Expert Committee that included representatives of the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) recommended that a threshold of ≥6.5% HbA1C should be used to diagnose diabetes. This recommendation was adopted by the American Diabetes Association in 2010.11 Positive tests have to repeated unless the person presents with typical symptoms and blood sugars >11.1 mmol/L (>200 mg/dL).12 According to WHO regional office for south-east Asia, the percentage of diabetic in urban areas will increase from 54% in 1995 to 73% by the year 2025.The risk of complications are also on a rise, so it is important to intervene at right time to decrease the associated morbidity.13 According to WHO, the estimation of fasting blood glucose is the highly effective method for diagnosing diabetes mellitus. Measurements of fasting blood glucose levels provide a short-term picture of control. When plasma glucose is consistently elevated, there is an increase in non-enzymatic glycosylation of haemoglobin, and this alteration reflects glycaemic control of the past 2-3 months as red blood cells have a lifespan of 120 days. Thus, glycosylated haemoglobin levels are used to diagnose diabetes mellitus.14 In our study we have seen that The majority of the patients were in the age group of 51-60 were 34%, 61-70 were 27%, followed by 41-50 were 18%, 31-40 were 7%, 71-80% were 6%, 21-30 were 4%, >80 and <20 were 2%. The IDDM patients were 28% and NIDDM were 72%. The majority of the patients were with HbA1C% >11 (Bad) were 41%, 9.1-11.0 (Poor)-19%, 8.1-9.0 (Fair)-16%, <8 (Good)-24%.
CONCLUSION It can be concluded from our study that the majority of the patients were in the age group of 51-60, the majority of the patents were NIDDM and majority were associated with > 11 HbA1C%.
REFERENCES
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