Laboratory assessment of the diabetes scenario with respect to HbA1c and microalbuminuria

Background: Glycated haemoglobin (HbA1c) has proved to be a good indicator of long term glycaemic control and reflects the mean glucose value (MGV). A linear relationship with HbA1c, microalbuminuria and the incidence of diabetic nephropathy is known to exist. Aim: To analyze the prescribing patterns of clinicians, the correlation of the plasma glucose values to HbA1c and the prevalence of microalbuminuria in a laboratory set up. Settings and Design: Retrospective, data collection of one year from Medical records, conducted at KMC hospital, Ambdekar circle, Mangalore. Materials and Methods: A data survey was conducted for a period of 12 months at he clinical biochemistry lab of our institution to note the number of requisitions for Fasting Plasma Glucose (FPG), Post Prandial Plasma Glucose (PPPG), Random Plasma Glucose (RPG), Glycated Haemoglobin (HbA1c) and Urinary microalbumin (UmA). Mean Glucose Value (MGV) was calculated from the HbA1c values. Statistical analysis: All findings were expressed as summations and percentiles. The SPSS package was used for descriptive statistics. Pearson's correlation coefficient was employed for correlational analysis. Results: There were about 15,000 requests each for FPG and PPPG, 7,058 for RPG, 2,884 for HbA1c and only 515 for microalbuminuria. RPG showed a better correlateon than FPG with HbA1c (r = 0.472 vs 0.699). The patients with HbA1c and Um Arequisitions were categorized, based on their MGV values. The prevalence of UmA was found to be around 32% in all the groups, except in the group with MGV between 251-300 mg/dL, in which it was 62.06 %. Conclusion: The number of requests for FPG and PPPG were to the same. The HbA1c requests comprised of 7.8% of the plasma glucose requests, thus indicating a probable underutilization of the same. In patients with infrequent HbA1c estimations, RPG was a better predictor of HbA1c levels. MGV resulted in a meaningful translation of the HbA1c values to the patients. Considering the high prevalence of UmA and the relatively lesser number of requisitions for the same, it would be desirable to screen the diabetes patients more rigorously.