1. Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin deficiency) 2. Type 2 diabetes (due to a progressive insulin secretory defect on the background of insulin resistance) 3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes) 4. Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drugor chemical-induced diabetes (such as in the treatment of HIV/AIDS or after organ transplantation)

Classification and diagnosis of diabetes

KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease

http://pic1.cmt.com.cn/newspic/files/dm-guidelines-ccp.pdf

American association of clinical endocrinologists and american college of endocrinology - clinical practice guidelines for developing a diabetes mellitus comprehensive care plan - 2015.

Background: Glycohemoglobin (gHb), measured as hemoglobin (Hb) A1c or as total gHb, provides a common means for assessing long-term glycemic control in individuals with diabetes mellitus. Genetic variants and chemically modified derivatives of Hb can profoundly affect the accuracy of these measurements, although effects vary considerably among commercially available methods. The prevalence of genetic variants such as HbS, HbC, and HbE, and chemically modified derivatives such as carbamyl-Hb among patient populations undergoing testing is not insignificant. Clinical laboratories and sites responsible for point-of-care testing of gHb need to be aware of the interferences produced in assays by these Hbs.

Approach: We conducted a review of the literature describing the effects of variant Hbs on gHb assay methods commonly used in clinical laboratories.

Content: This review summarizes the documented effects of both common and uncommon Hb variants and derivatives on the measurement of gHb. Where known, we discuss mechanisms of interference on specific assays and methodologies. We specifically address effects of commonly encountered Hbs, such as carbamyl-Hb, HbS, HbC, HbE, and HbF, on assays that use cation-exchange chromatography, immunoassays, or boronate affinity methods for measuring gHb.

Summary: A variety of patient- and laboratory-related factors can adversely affect the measurement of gHb in patients harboring Hb variants or derivatives. Identification of the variant or derivative Hb before or during testing may allow accurate measurement of gHb by the selection of a method unaffected by the given variant or derivative. However, laboratories should make available alternative, non-Hb-based methods for assessing long-term glycemic control in individuals with HbCC, HbSS, or HbSC disease, or with other underlying disorders where the concentration of gHb does not accurately reflect long-term glycemic control.

/pdf/effects-of-hemoglobin-variants-and-chemically-modified-31f6k684bx.pdf

Effects of Hemoglobin Variants and Chemically Modified Derivatives on Assays for Glycohemoglobin

The implantation process involves complex and synchronized molecular and cellular events between the uterus and the implanting embryo. These events are regulated by paracrine and autocrine factors. Trophoblast invasion and migration through the uterine wall is mediated by molecular and cellular interactions, controlled by the trophoblast and the maternal microenvironment. This review is focused on the molecular constituents of the human trophoblast, their actions and interactions, including interrelations with the uterine endometrium.

/pdf/human-trophoblast-function-during-the-implantation-process-34arq9ws6x.pdf

Human trophoblast function during the implantation process

A 66-year-old Caucasian female was referred for specialist follow-up of her treatment-refractory type 2 diabetes. The diagnosis was made based on two consecutive HbA1c results >6.5% (48 mmol/mol) in accordance with the Canadian Diabetes Association and the American Diabetes Association guidelines (1,2). Fasting glucose was normal and hyperglycemic symptoms were absent at diagnosis. The patient’s hematological indices were normal and she was unaware of any family history of hemoglobinopathy. Her glycemic control proved difficult to manage, with persistently elevated HbA1c (10.8–11.2% [95–99 mmol/mol]) despite treatment with metformin and, eventually, insulin glargine. Further, with treatment, the patient began to experience symptoms of episodic hypoglycemia.

A fasting glucose of 84.6 mg/dL (4.8 mmol/L) obtained at the same time as an HbA1c of 11.2% (99 mmol/mol) triggered suspicion of interference. As all of the HbA …

/pdf/erroneous-diabetes-diagnosis-a-case-of-hba1c-interference-84mibtk7ky.pdf

Trefor Higgins

Papers

Erroneous Diabetes Diagnosis: A Case of HbA1c Interference

Improved resolution of serum bisalbumin on electrophoresis and investigation of bisalbumin in urine.

A case of beta thalassemia major detected using HPLC in a child of Chinese ancestry.

Analytical evaluation of the Siemens' fructosamine and the Exocell Glycaben assays

A high-throughput test for diabetes care: An evaluation of the next generation Roche Cobas c 513 hemoglobin A1C assay.