Complication and mortality rates further increase with concomitant smoking, obesity, hypertension, increased cholesterol and triglyceride, proteinuria, and poor glucose control. Early diagnosis together with good glucose monitoring and control are crucial to reduce the burden of diabetes.
The confirmation of diagnosis of diabetes long relied on determination of blood/plasma glucose. Also for monitoring of treatment, blood glucose measurement was the only available tool. However, glucose levels fluctuate considerably depending on food intake and other factors, being lowest in the morning before breakfast and then often increasing after meals, depending both on the diet and the individual glucose regulation with higher levels and greater variations in diabetes. To diagnose earlier stages of diabetes, at least two plasma/blood glucose tests on different days are required. These measurements require fasting before sampling. Moreover fasting values do not reflect what happens after meals. An oral glucose tolerance test (OGTT) is therefore sometimes also required. Values are then determined 2 hours after an oral dose of 75 g of glucose, a time-consuming test. Although these methods are useful, alternatives, reflecting the mean glucose levels during a longer period, have been sought to simplify diagnosis and monitoring.
As various sugars bind to some degree to proteins in different tissues forming more or less stable adducts that can be analysed, methods based on such adducts have been developed. These reflect the glucose levels for a longer or shorter previous period of time and. One of the proteins to which glucose binds is haemoglobin. This protein has very special properties that make the fraction of haemoglobin bound to glucose a very useful marker of impaired glucose turnover that reflects the mean blood glucose level during the preceding 12 weeks or so (the lifetime of a red blood cell or erythrocyte.
The fraction of hemoglobin that is bound to glucose - HbA1c - now serves as a powerful tool for assessing long-term glycaemic control. HbA1c also correlates well with the risk of development of complications related to diabetes, which is a very important aspect. In the future HbA1c is likely to become a useful tool also for the diagnosis and evaluation of all forms of diabetes mellitus and patients at risk of developing diabetes, making it possible to detect diabetes earlier.
At the point of care, our Afinion Analyser System, developed by Axis-Shield and based on a patented test method makes it possible to easily and rapidly determine HbA1c at the physician's office in the presence of the patient. This system will simplify monitoring of any type of diabetes facilitating treatment management, and prevention of late complications. It may also increase the patient's motivation to comply with treatment and lifestyle changes to optimise prognosis. The option of a NycoCard test for the same parameter is also available.
In the laboratory, our proprietary immunoassay technology for measurement of HbA1c is utilised in the Abbott AxSYM and ARCHITECT systems.
Other complications of diabetes include kidney damage and Axis-Shield also offers ways to detect early evidence of this at the point of care, under microalbuminuria.
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As a general marker of overall health status, few tests carry greater predictive weight than Homocysteine. The amount of Homocysteine in your blood is one of the best independent indicators of how healthy you are.