Glycemic Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Glycemic and links to relevant pages within the course.
Learn more about laboratory continuing education for medical technologists to earn CE credit for AMT, ASCP, NCA, and state license renewal and recertification. Or get information about laboratory safety and compliance courses that deliver cost-effective OSHA safety training and continuing education to your laboratory's employees.
|Hemoglobin A1C and Diabetes Diagnosis|
The addition of hemoglobin A1C (HbA1C) measurement to the diagnosis of diabetes is a significant change. HbA1C assay is currently the standard biomarker for glycemic management. Mainly due to lack of standardization, HbA1C measurement had not been a component for diagnosis of diabetes. HbA1C assays are now highly standardized and recommended usage expanded. The 2010 ADA Clinical Practice Recommendations specifically states that the HbA1C measurement be a National Glycohemoglobin Standardization Program (NGSP) method and traceable to the Diabetes Control and Complications Trial (DCCT) reference assay. Note that point-of-care HbA1C methods do not currently meet this standardization criteria for diagnostic use.
|Type 2 Diabetes Continued|
Often with change in environmental factors (diet changes, weight loss, and exercise), a type 2 diabetic can regain acceptable glycemic control. If not, oral hypoglycemic medication is required. An absolute insulin deficiency may develop late in the disease and insulin would then be required.Type 2 diabetes accounts for the majority of those with diabetes, probably 80-90%. Ordinarily insulin resistance and deficiency develop in adult years. Due to poor diet and decreased physical activity, many young adults and school-age children are currently diagnosed with type 2 diabetes in US.Type 2 diabetes was formerly Type II Non-Insulin Dependent Diabetes Mellitus (NIDDM) and referred to as adult-onset diabetes. Again the ADA recommends discontinued use of these designations.
Hemoglobin A comprises the majority of normal adult hemoglobin (Hb) and includes the minor hemoglobins, Hb A1a, Hb A1b, and Hb A1c. Sometimes these three are referred to as Hb A1 but A1C is the major fraction and composes 80% of Hb A1. Following synthesis of Hb A, a nonenzymatic reaction adds glucose to the N-terminal valine on either beta chain forming glycated Hb. The pre-A1C molecule is a labile Schiff base and this reaction is reversible. As the red blood cells circulate, an irreversible Amadori rearrangement of the pre-A1C base occurs forming a stable ketoamine, A1C. Over the life span of the red blood cells (120 days) this process continues and the concentration of A1C is proportional to the concentration of the blood glucose. The concentration of A1C then relates to an individual's average glucose over time and can be used as an index relating to the extent of carbohydrate control during a 2 - 3 month period. There is also a direct relationship between the concentration of HbA1C and risk of complications in diabetic patients. Therefore, the ADA has recommended using HbA1C measurements to monitor glycemic control.
|Monitoring Diabetic Glycemic Control|
A HbA1C that is <7.0% indicates glycemic control for most adults with diabetes.Providers might recommend even lower HbA1c goals than the general goal of <7.0% for some patients ( if this can be achieved without significant hypoglycemia or other adverse effects). This includes patients who have a short duration of diabetes (i.e., gestational diabetes), long life expectancy, and no significant cardiovascular disease.Less stringent HbA1c goals than the general goal of <7.0% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, and those individuals with longstanding diabetes who are not able to consistently achieve the general goal of <7.0%.