[What you always wanted to know about HbA1c]

Irreversible, nonenzymatic glycation of the haemoglobin A beta chain leads to the formation of haemoglobin A1c (HbA1c), a stable minor haemoglobin component with enhanced electrophoretic mobility. The rate of formation of HbA1c is directly proportional to the ambient glucose concentration. HbA1c is commonly used to assess long-term blood glucose control in patients with diabetes mellitus, because the HbA1c value has been shown to predict the risk for the development of many of the chronic complications in diabetes. There are currently four principal glycohaemoglobin assay techniques (ion-exchange chromatography, electrophoresis, affinity chromatography and immunoassays) and over 20 methods that measure different glycated products. The ranges indicating good and poor glycaemic control can vary markedly between different assays. At the moment values differ between methodologies and even between different laboratories using the same methodology. Optimal use of HbA1c testing requires standardisation. There is progress towards international standardisation and improved precision of HbA1c which will lead to all assays reporting results in a standardised way. Clinicians ordering HbA1c testing for their patients should be aware of the type of assay method used, the reference interval, potential assay interferences (e.g. haemoglobinopathies, chronic alcohol ingestion, carbamylation products in uraemia) and assay performance. And they should know that a variety of factors have been shown to directly influence HbA1c values, e.g. iron deficiency anaemia, chronic renal failure and shortened red blood cell life span.