Resumen

LITTLE, Randie R.; ROHLFING, Curt L.  y  SACKS, David B.. Status of Hemoglobin A_1c measurement and goals for improvement: from chaos to order for improving diabetes care. Acta bioquím. clín. latinoam. [online]. 2011, vol.45, n.2, pp.349-361. ISSN 0325-2957.

BACKGROUND: The Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS) established the importance of hemoglobin A_1c (Hb A_1c) as a predictor of outcome in patients with diabetes mellitus. In 1994, the American Diabetes Association began recommending specific Hb A_1c targets, but lack of comparability among assays limited the ability of clinicians to use these targets. The National Glycohemoglobin Standardization Program(NGSP) was implemented in 1996 to standardize Hb A_1c results to those of the DCCT/UKPDS. CONTENT: The NGSP certifies manufacturers of Hb A_1c methods as traceable to the DCCT. The certification criteria have been tightened over time and the NGSP has worked with the College of American Pathologists in tightening proficiency-testing requirements. As a result, variability of Hb A_1c results among clinical laboratories has been considerably reduced. The IFCC has developed a reference system for Hb A_1c that facilitates metrological traceability to a higher order. The NGSP maintains traceability to the IFCC network via ongoing sample comparisons. There has been controversy over whether to report Hb A_1c results in IFCC or NGSP units, or as estimated average glucose. Individual countries are making this decision. SUMMARY: Variability among Hb A_1c results has been greatly reduced. Not all countries will report Hb A_1c in the same units, but there are established equations that enable conversion between different units. Hb A_1c is now recommended for diagnosing diabetes, further accentuating the need for optimal assay performance. The NGSPwill continue efforts to improve Hb A_1c testing to ensure that clinical needs are met.

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