[Glycated hemoglobin (HbA1c) as a standard diagnostic criterium for diabetes?]. / Czy hemoglobina glikowana (HbA1c) stanie sie standardem w diagnostyce cukrzycy?

Glycated hemoglobin HbA1c is considered the gold standard for assessing the compensation and treatment of diabetes. After the success of the DCCT and UKPDS studies, which showed that HbA1c is an independent indicator of risk for the development of chronic vascular complications of diabetes, this parameter was used for routine monitoring of metabolic control. In 2010, the American Diabetes Association introduced HbA1c determined by HPLC or HPLC-standardized methods for the diagnosis of diabetes as a parameter more accurate and more stable than the determination of fasting plasma glucose or oral glucose tolerance test. HbA1c measurements can be performed by different analytical methods including HPLC, affinity chromatography, electrophoresis and immunoenzymatic and immunoturbidometric methods. Due to differences in the results of HbA1c determined by laboratories using various methods, it is extremely important to standardize methods for the results given by the HPLC method compared to the methods used in the DCCT and UKPDS studies. The problem is even greater as the large discrepancies are observed between the frequency of carbohydrate disorders diagnosed on the basis of determination of HbA1c and glucose, which raise important questions concerning the widespread introduction of HbA1c for the diagnosis of diabetes.

[Aspects of the standardization of glycated hemoglobin (HbA1c) measurement]. / Aspekty standaryzacji oznaczania hemoglobiny glikowanej (HbA1c).

Glycated hemoglobin (HbA1c) is considered the gold standard for monitoring and the treatment of diabetes. After the success of the DCCT and UKPDS studies, which showed that HbA1c is an independent indicator for risk of developing chronic complications of diabetes, intensive work began on the standardization of this parameter. Currently, the process of standardization of HbA1c determination is being pursued by two independent international organizations: NGSP and IFCC. At present most HbA1c determinations carried out worldwide are done via a test which is performed using uniform and standardized methods, which have been certified by the NGSP. At the same time, the IFCC has created a new, more consistent and specific method of standardization, but this method is not used routinely. According to the IFCC standard, HbA1c values are significantly lower compared to the results obtained by NGSP. Moreover, the IFCC has introduced a new alternative unit of HbA1c mmol/mol. Discrepancies between the programs of the two organizations, their advantages and disadvantages, have led to the consensus on global standardization of HbA1c determinations. This paper presents aspects of the standardization of HbA1c determination methods, which takes into account the obtained values and recommended range of values for each group of diabetic patients, as well as the statement of the largest diabetological organization.

Level of knowledge concerning diet in type 2 diabetic patients and nurses.

Introduction: Among patients with diabetes, there are many myths concerning food products which are believed to lower or not influence the blood glucose (BG) level. The aim of this study was to assess the knowledge of patients with diabetes and hospital nurses concerning popular food products and their impact on BG levels. Materials and methods: The study group consisted of 250 patients with diabetes (DM), members of the Polish Diabetes Association; the other group consisted of 123 healthy nurses (N) from 3 hospitals in Szczecin, Poland. Participants were asked to complete a questionnaire on products common in diabetic diet (grapefruit, honey, coffee substitute, diabetic chocolate, milk soup, pork neck) and their influence on BG levels. Results: The highest percentage of wrong answers was given for pork (DM 71%; N 83%, NS) and grapefruit (DM 51%; N 77%, p < 0.01), while the most correct answers were for honey (DM 69%; N 80%; p < 0.05) and milk soup (DM 64%; N 67%, NS). Negative correlation was found between the number of correct answers and the age of patients (r(s) = −0,14; p < 0.01;) and no correlation between the number of correct answers and the duration of diabetes mellitus (NS). Patients treated with insulin provided correct answers significantly more frequently than patients on oral medication only (44% vs 34.8%; p < 0.01). Conclusions: 1. The level of knowledge concerning products commonly used in diabetic diet among patients with diabetes and hospital nurses is low. 2. Both groups, patients and hospital nurses, need education about diabetic diet.

False diagnosis of type 1 diabetes mellitus and its complications in Wolfram syndrome--is it the reason for the low number of reported cases of this abnormality?

Wolfram syndrome (WS), also known as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness), is a rare autosomal recessive syndrome (1/770,000 in the United Kingdom), characterised by juvenile onset of diabetes mellitus, optic nerve atrophy, diabetes insipidus, sensorineural deafness, renal tract and neurological abnormalities, and primary gonadal atrophy. WS is caused mainly by biallelic mutations in the WFS1 gene, which encodes wolframin. Wide tissue distribution of wolframin and many mutations in the wolframin gene resulting in Wolfram syndrome may contribute to different phenotypes and the unusual combinations of clinical features. We describe a female patient with Wolfram syndrome diagnosed at the age of 25, with a previous false diagnosis of type 1 diabetes mellitus and misdiagnosed diabetic complications. The patient was found to be a compound heterozygote for two novel mutations in exon 8 of WFS1 gene: a 2-bp deletion AT at nt 1539 leading to a frameshift (Y513fs) and a single-base substitution 1174C > T resulting in a stop codon (Q392X). A detailed analysis of the patient's medical history and a review of the literature suggest that many cases of Wolfram syndrome may remain undiagnosed due to misdiagnosis as type 1 diabetes mellitus and incorrect interpretation of clinical symptoms of neurodegenerative abnormalities, especially in their early stages.