Editorials

Standardisation of glycated haemoglobin

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7476.1196 (Published 18 November 2004) Cite this as: BMJ 2004;329:1196
  1. Philip Home ([email protected]), professor of diabetes medicine,
  2. Jean-Claude Mbanya, associate professor of medicine,
  3. Ed Horton, professor of medicine
  1. School of Medical Sciences, Diabetes, Newcastle upon Tyne, NE2 4HH
  2. Endocrine Unit, Department of Internal Medicine, University of Yaoundé I, BP 8046, Yaoundé 8, Cameroon
  3. Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, USA

    Is a scientific advance, but it could worsen overall blood glucose control

    The detection of sugars in the urine of people with diabetes usually is attributed to Matthew Dobson. However, first attempts at quantification of urine sugars seem to have been made by Francis Home, an Edinburgh physician. Estimation of urine sugar as a measure of severity of diabetes had two major problems that, until recently, were shared with its contemporary equivalent, estimation of glycated haemoglobin. Firstly, both are surrogate measures of the average concentration of plasma glucose that is responsible for the microvascular and arterial damage that manifests itself in later years. Secondly, both also included in their measurement non-specific (nonglucose) substances when using available assays. Very recently, the glycated haemoglobin assay has been standardised by the scientific community to remove this non-specificity, but switching to this more accurate method for everyday reporting of results could lead to confusion and worsening of the control of diabetes.

    Urine glucose remains of value only where the cost of self monitored blood glucose control is out of reach, but glycated haemoglobin (as HbA1c) has become central to …

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