Introduction The world health organisation(WHO) refers to the science of protecting and improving the health of familiesand communities through advancement of analysis and treatment. Therefore, it isapprehensive with international public health. (Who.int, 2017).
Red blood cells also known as erythrocytesare small biconcave disc shaped cells in the bloodstream that are coated withoxygen carrying pigment called haemoglobin. (Bellad et al, 2016)In hyperglycaemic state, the excess glucose in the bloodstream binds to haemoglobinforming a molecule called ‘glycated haemoglobin’ (HbA1c). The greater theamount of glucose present in the bloodstream, the more HbA1c will be present inclinical serum of that patient.
(Ang et al, 2015).Whatis diabetes?Diabetes is achronic health disorder; it causes a state of hyperglycemia; high amount ofglucose in the circulation. Both type of diabetes cause a hyperglycemic stateleading to many complications (Mealey et al, 2007). Insulin is an anabolic hormoneproduced by beta cells in the islets of Langerhans in the pancreas. (Fu et al, 2013).
The hormoneworks to regulate circulating glucose levels and keep them under referencerange. When we ingest a meal, carbohydrates from the diet are absorbed into thecirculation and a state of hyperglycemia develops. (Coll et al, 2007) The betacells in the pancreas then release insulin, which works to cause glucose absorptioninto hepatic and muscle cells and reduce the circulating glucose levels.
(Saltiel et al 2001). Insulin is commonly defined as akey, which unlocks the doors to the cells, allowing glucose to pass in(Whettem, 2014). Type 1 diabetes is an autoimmune/idiopathic disorder where thebeta cells attacks and destroy the insulin-producing cells, which then causesabsolute insulin deficiency. About 10 percent people with diabetes have type 1 (Hadjiyianni et al 2010). Mainly children andyoung people develop type 1 diabetes however; there is a chance that elderlypeople can develop it as well (Tuomi, 2005).Type 2 diabetes is when the bodydoes not make enough insulin, or when the body becomes resistant to insulin.This results in a buildup of glucose in the blood. About 80-90%, people have withdiabetes have type 2.
(Watkins et al, 2003).Type 2 diabetes is mainly common insouth Asian, African and Afro-Caribbean origin also; people who have familyhistory will also have a chance to develop type 2 diabetes. Type 2 diabetes canbe delayed or prevented through a healthy lifestyle. (Olokoba et al, 2012)The common symptoms of diabetes are increased thirst,increased hunger, dry mouth, frequent urination or urine infections,unexplained weight loss the main symptoms includes excessive fatigue, blurredvison and headaches are the common sign of diabetes. Cuts and woundstake longer to heal. These are the main signs and symptoms of diabetes. (Clark et al, 2007)Oral andinjectable diabetes medications work in numerous ways to stimulate theproduction of insulin and the absorption of insulin, into the cells to reducethe output of glucose from the liver.
(Moller et al,2001) Also to slow the absorption ofcarbohydrates, and even to spill extra glucose out of the kidneys. At a certainpoint in the progression of diabetes, insulin or insulin in combination withthe other oral diabetes medications is necessary to control blood glucoselevels. (Skamagas et al, 2008). Hemoglobin is a protein that is initiatewithin red blood cells, its function to carries oxygen throughout the body,when hemoglobin combines with glucose in the blood it come to be glycated, alsoknown as HbA1c. (Florkwoski, 2013) The Haemoglobin (HbA1c) are distributed in twocategories, and they remain divided in the method based on the chargedifferences and methods based on the structural differences Ion-exchangechromatography and electrophoresis come under the first category moreover whileimmunoassay, enzymatic assay and affinity chromatography come under secondcategory therefore the routine of Haemoglobin (HbA1c) (Sherwani et al, 2016). Disscusion The overall aim for this report is to discuss if HbA1c is an effectivetechnique in the diagnosis of Diabetes Mellitus.
Furthermore, mentioning thelimitations of HbA1c as a potential diagnostic tool and whether there are anypossible limitations in specific scenarios (Barman et al, 2012). HbA1c is an analytical tool that is used tocheck on the belongings of exercise or precise diet on diabetes and reliant onthe results. (Peters etal 1996). Glycatedhaemoglobin (HbA1c) was initially recognised as an ‘abnormal’ molecule indiabetic individuals. (Hinzmann etal 2012). However, it was not accurate until properexperiments and trails were prepared and tested.
Recently there has been significantattention drawn in the use of HbA1c as an analytical tests for diabetes as wellas the screening test for individuals who are at high risk of diabetes (Akande, 2016) HbA1c isacknowledged as the haemoglobin in the blood that is bonded to glucosemolecules. Advanced red blood cells are anucleate cells because they lack anucleus and additional membrane bound organelles. This allows the maximumamount of haemoglobin to fully coat the erythrocyte (Anon, 2017). Haemoglobin is a pigment responsible for thered colour of blood. Approximately 90% of the haemoglobin is adult (A) type andfurthermore about 8% of this A type haemoglobin is prepared from moleculescalled A1a1, A2a2, A1b, A1C. When glucose levels are not controlled and thereis an increase in glucose levels, the glucose molecule begin to bind tohaemoglobin A1C, resulting in glycated haemoglobin (HbA1c).
(IMAGAWA et al, 1984) Therefore, the levels of HbA1c in the blood indicate theaverage quantity of glucose, with an increase in HbA1c levels indicating anincrease in glucose levels in the blood. (Rohlfing etal, 2012). This allows us to monitor the glucose levelsand see if they are high or have been high recently. Red blood cells have alifespan of 120 days (8-12weeks) henceforth; the HbA1c is a beneficialindicator to evaluate how well the diabetes is controlled of an induvial in thelast 8-12 weeks. (Diabeticretinopathy, 2005) Figure 1: Summary of Diagnostic Criteria for DiabetesMellitus (Fitriani,2018) As mentioned earlier the haemoglobin containsthe range of molecules. Nevertheless, to distinguish A1c from additionalhaemoglobin molecules there is an electrical charge existent on the A1cmolecules (to which the glucose binds). (Koval et al, 2011) In addition,there is a difference in size.
There is a special method called the high-pressureliquid chromatography (HPLC) this takes advantage of these differences betweenA1c and other haemoglobin molecules; to divide A1c. (Weykamp etal, 2009). In order toperform the HbA1c test, a blood sample is taken from a specific individual. Dueto HbA1c levels being unaffected by temporary changes in glucose levels, (likeright after consuming a meal), HbA1c levels can be used. (Alferness et al 2009),correspondingly fasting for the blood test is not essential. Firstly, when thetest is performed, the blood is taken out of the individuals arm in the surgeryand after this; it is sent off to the laboratory. (Hirst etal, 2014) The results ofthe test indicates the stability of the patients’ blood glucose concentration,which then allows for the planning of a particular treatment plan according tothe patient. However, theHbA1c is a suitable test, it is not necessary to require any specificpreparation e.
g. fasting, this can take in a suited place like hospitalsclinics/surgery, and laboratories.by analysing the HbA1c this shows how thehigh blood glucose has been on average over the last 8-12 weeks.
(Renard 2005) Whilst HbA1c tests are usuallyreliable, there are some limitations to the accuracy of the test, since thisparticular test does not reveal the blood glucose levels. (Linden,2006) The average normal levels of the HbA1c in a non-diabetic individual areabout 36mmol/l (5.5%). In a diabetic 48mmol/l, (6.5%) it is consideredconventional. Typically, a level of 6.
5% indicates that the individual hasdiabetes. (Sacks et al., 2002). The purpose of the HAb1c to keepHbA1c levels of diabetics under 7% to avoid the possibility of complicationswhich include eye problems, nerve damage, kidney disease and heart disease.(Bennett et al, 2007).These are just the approximates due to the levelof HbA1c in every diabetic contrasts as to the factors for example beginunderweight and overweight. The usual set target is <59 mmol/mol (7.
5%) areat the possibility of developing severe hypercalcemia. (Miller et al,2015). People with forms of anaemia may not have appropriate haemoglobin forthe test to be precise and may need to have a fructosamine test instead. (Radin, 2013) Also beingpregnant or having and rare form of haemoglobin (known as a haemoglobinvariant) can also return an inaccurate HbA1c, while readings can also beaffected by short term issues for example illness as they can cause a temporaryrise in blood glucose. (Thevarajah et al, 2010) Because of the way, the HbA1c test measuresblood sugars, if you higher blood sugar levels in the weeks leading up to yourHbA1c test will have a greater on your test result than your glucose levels 2to 3 months before the test. (Jia et al, 2016) HbA1c mmol/mol % Normal Below 42 mmol/mol Below 6.
0% Prediabetes 42 to 47 mmol/mol 6.0% to 6.4% Diabetes 48 mmol/mol or over 6.5% or over Figure 2: This diagram shows how HbA1c can indicate people with prediabetes ordiabetes.(Diabetes.co.uk, 2018) Conclusion Although this test is a convenient test, yet it’snot a perfect diagnostic test. This due to the fact when some people who arediagnosed as having diabetes based on this specific test they will actually nothave diabetes (false positive) and on the other hand, those who are notdiagnosed might be under risk of having diabetes (false negative) (Who.
int, 2017). Henceforth regardless, off WHOapproving the use OF HbA1c as a diagnostic check, this test is not a 100%reliable. This is because this test cannot used to monitor routine glucoseconcentration or even detect the everyday presence or absence of hypoglycaemiaor hypercalcemia.
(Chua et al2014) Other limitations of HbA1cas a diagnostic contrivance is that it can be affected by conditions thateffect haemoglobin, such as anaemia and also supplements such as vitamin C andE, similarly high cholesterol levels.(Ahmad et al 2013). Moreover,kidney disease and liver disease may also affect the result of an HbA1c test.
This may explain why it will detect some patients as having diabetes when they actuallydo not and vice versa. This specific test is organised at least once a year andis recommended in addition to home blood glucose monitoring. (Kuo et al, 2016)