Untitled Quiz

Limitations of 1,5-AG

• Low levels of 1,5-AG indicate hyperglycemia in the preceding 24 hours.
• It is not reliable in patients with renal disease and gestational diabetes mellitus (GDM).

Monitoring of Glycemic Control

• Long-term monitoring methods include:
  • HbA1c
  • Glycated Albumin
  • Fructosamine
  • Advanced Glycation End-products (AGE)
  • C-peptide
  • Insulin

Glycated Haemoglobin (HbA1c)

• Non-enzymatic glucose attachment to hemoglobin signifies average glycemic control over 90-120 days.
• Gold standard for monitoring diabetes mellitus (DM), sensitive to changes in the last month.
• No fasting required for testing.
• Decreasing HbA1c levels correlates with reduced risk for microvascular disease (37%), myocardial infarction (14%), and death (21%).
• Should be measured 2-4 times per year in DM patients.

Limitations of HbA1c

• Results may be skewed by erythrocyte turnover, hemoglobinopathies, chronic kidney disease (CKD), or alcoholism.
• It does not measure glycemic variability or hypoglycemia.
• Levels increase with age, and there are racial disparities in results.
• Less reliable in rapidly evolving Type 1 diabetes mellitus (T1DM).

HbA1c and Plasma Glucose Relationship

• Strong relationship exists between HbA1c and plasma glucose:
  • Average Plasma Glucose (mg/dL) = (HbA1c x 35.6) - 77.3
  • Average Plasma Glucose (mmol/L) = (HbA1c x 1.98) - 4.29

Glycated Albumin and Fructosamine

• Glycated Albumin and fructosamine measure glycemic state over 2-3 weeks, useful when HbA1c is unreliable.
• Fructosamine indicates recent glycemic control changes.
• Glycated albumin is advantageous for DM patients with CKD.

Clinical Utility and Limitations of Glycated Albumin and Fructosamine

• Useful in monitoring poorly controlled DM and predicting complications.
• Limitations include underestimation in obesity and effects of systemic illness on serum proteins.

C-peptide

• C-peptide indicates insulin production, reflecting residual beta-cell function.
• Helps assess insulin replacement adequacy and dosage adjustments.
• Higher C-peptide levels correlate with lower complication rates in T1DM and better control in T2DM.
• Distinguishes DM types: low in T1DM, high or normal in early T2DM.

Detection and Management of Diabetic Complications

• Acute Complications:
  • Diabetic Ketoacidosis (DKA)
  • Hyperglycemic Hyperosmolar State (HHS)
  • Hypoglycemia
  • Lactic acidosis
• Chronic Complications:
  • Microvascular: nephropathy, neuropathy, retinopathy
  • Macrovascular: coronary heart disease, peripheral vascular disease, cerebrovascular disease

Monitoring Acute Complications

• Key tests for diagnosis include glucose, lactate, creatine kinase, electrolytes, and ketone levels.
• Blood urea nitrogen (BUN) and creatinine levels monitor risk for acute kidney injury during DKA and HHS.
• Liver enzymes (AST, ALT) track potential liver dysfunction associated with DKA and HHS.

Monitoring Chronic Complications

• Urine Albumin and ACR should target <30 mg/g for early nephropathy detection.
• Serum creatinine and estimated glomerular filtration rate (eGFR) help assess kidney function.
• Serum cystatin-C is more sensitive for renal impairment assessment in diabetics.
• Monitor lipid profiles annually due to cardiovascular risk association.
• Regular HbA1c testing helps identify risk for chronic complications related to DM.