Glycohemoglobin: a primary predictor of the development or reversal of complications of diabetes mellitus. Clinical Chemistry

Background: Diabetes mellitus is a major health prob-lem worldwide with long-term micro- and macrovascu-lar complications responsible for a majority of its mor-bidity and mortality. The development and progression of these complications relate strongly to glycemic con-trol. Methods: We reviewed the literature extensively for studies that relate glycemic control to the development and progression of diabetic complications. We discuss the problems of standardizing glycohemoglobin mea-surements for monitoring diabetic therapy and also consider recently developed electrospray ionization mass spectrometry methods that have been considered as candidate reference methods for estimation of glyco-hemoglobin. Results: Several clinical trials and studies have clearly shown that improved glycemic control is strongly asso-ciated with decreased development and/or progression of complications in both type 1 and type 2 diabetes mellitus. Irrespective of the methods used for estimat-ing glycohemoglobin, these results underline the impor-tance of glycohemoglobin for guiding therapy of diabe-tes mellitus. Recently developed candidate reference methods promise to yield greatly improved standardiza-tion for the measurement of glycohemoglobin. Conclusions: Glycohemoglobin measurement remains the optimal indicator of glycemic control in diabetic patients, but translation of findings from clinical trials to clinical practice worldwide demands consistent val-ues across all assays. To ensure that the important prognostic information still applies to all diabetic pa-tients with the application of the reference method(s), the hemoglobin A1c values reported in the major clinical trials will have to be translated into statistically and computationally compatible values based on the new reference system(s)