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Consensus statement on HbA1c measurement issued
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The American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and Laboratory Medicine and the International Diabetes Federation issued a consensus statement on the worldwide standardization of the HbA1c measurement.
“Anchored in the knowledge that elevated HbA1c values increase the likelihood of the microvascular complications of diabetes, clinicians have used HbA1c test results to guide treatment decisions, and the assay has become the cornerstone for the assessment of diabetes care,” the consensus committee wrote in Diabetes Care. The consensus statement was also presented at the 43rd Annual Meeting of the EASD held recently in Amsterdam.
Researchers have initiated an international study to document the relationship between HbA1c and average blood glucose. The study aims to provide a more accurate conversion algorithm using frequent capillary measurements and continuous glucose monitoring.
More standardization
The IFCC developed a new reference method that measures the concentration of only one molecular species of glycated HbA1c, according to the committee. The IFCC also suggested that test results be reported in scientifically correct units, such as mmoL/moL.
“The impact of both changes proposed by the IFCC would be to significantly change the numeric results provided to clinicians,” the consensus committee wrote.
“The IFCC, which is made up of clinical chemists, correctly pointed out that in the world of measurement, a percentage is not a measure,” Richard Kahn, PhD, chief scientific and medical officer of the ADA, told Endocrine Today. “Pending the successful outcome of the international study, major diabetes organizations might be more proactive in having others use the estimated average glucose as the term of choice.”
“The advent of a new reference method to standardize the HbA1c results, along with the anticipated documentation that the assay does indeed indicate average blood glucose, has led to a variety of proposed changes in the reporting of HbA1c test results worldwide,” the committee wrote. “Clinicians will have the opportunity to convey the concept of chronic glycemia in terms and units most suitable to patients under their care.”
The ADA, EASD, IDF and IFCC approved five recommendations:
- HbA1c test results should be standardized worldwide, including the reference system and results reporting.
- The new IFCC reference system is the only valid foundation to implement standardization of the HbA1c measurement.
- Using the IFCC-NGSP (National Glycohemoglobin Standardization Program) master equation, HbA1c results should be reported worldwide in IFCC units (mmol/mol) and derived NGSP units.
- An HbA1c-derived average glucose value calculated from the HbA1c result will be reported as an interpretation of the HbA1c results if the average plasma glucose study fulfills its specified criteria.
- Clinical guideline glycemic goals should be expressed as IFCC units, derived NGSP units and HbA1c-derived average glucose. – by Christen Haigh
For more information:
- Consensus Committee – International Federation of Clinical Chemistry, American Diabetes Association, European Association for the Study of Diabetes, International Diabetes Federation. Consensus statement on the worldwide standardization of the hemoglobin A1c measurement. Diabetes Care. 2007;30:2399-2400.