Among the scientific community, HbA 1c has traditionally served as an indicator of glycemic control over the preceding 2- to 3- month period. It is notable, however, that HbA 1c has been associated with controversies and confusion among patients and physicians alike. 4 These targets vary from one organization to another, ranging roughly between 6.0% and 7.0%. Control of hyperglycemia, as monitored by glycated hemoglobin (HbA 1c), has been recommended by various international diabetes organizations which recommend HbA 1c management targets. These micro-and macrovascular complications continue to claim more lives and to further exhaust national budgets. It follows that there is a critical need to develop effective methods to improve early detection and treatment of diabetes and pre-diabetes, in an effort to avert the well-known complications of diabetes. 1, 3 Recent studies 2 have shown pre-diabetes which eventually progresses to diabetes in up to 70% of cases, to be a risk factor for cardiovascular disease. 2 The prevalence of pre-diabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT), is also increasing globally. 2 Epidemiological data have shown that diabetes prevalence skyrocketed in recent years for example, in the US, a 61% increase in the prevalence of diabetes between 19 has been reported. The “worldwide explosion in the prevalence of type 2 diabetes mellitus 1” has turned diabetes into a global epidemic. Very recently, the first of such recommendations has been proposed by an expert panel, as announced by the US Endocrine Society. Given the recent literature supporting HbA 1c diagnostic abilities, and given the shortcomings of the current guidelines, it is possible that a diagnostic role for HbA 1c may be considered in future practice guidelines, globally. While recent developments in HbA 1c methodologies are acknowledged, it is not yet known which changes will be implemented, and how soon. These diagnostic methods have shortcomings warranting a potential diagnostic role for HbA 1c. In diabetes screening and diagnosis, the current diagnostic guidelines use measurement of plasma glucose either fasting or after glucose load. These include lower reference ranges (by about 1.5–2 points) and measurement units expressed in percentage (%), as mg/dL (mmol/L) or mmol/mol (or a combination of these units). Implementation of changes in HbA 1c results and units of measurements have been suggested for the purpose of test standardization. The objective of this review is to summarize the recent developments and to review a potential diagnostic role for HbA 1c. Although HbA 1c is currently undergoing a reassessment, and major developments have been underway in recent years, HbA 1c is not recommended at present for diabetes screening or diagnosis. Hemoglobin A 1c (HbA 1c) has been used for decades to monitor the control of glycemia in diabetes.
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