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Clinical Chemistry, Vol 40, 683-687, Copyright © 1994 by American Association for Clinical Chemistry
RJ Benjamin and DB Sacks
Department of Pathology, Brigham and Women's Hospital, Boston, MA.
On the basis of the results of the Diabetes Control and Complications Trial (DCCT), the American Diabetes Association (ADA) now recommends tight control of blood glucose to near-normal concentrations as the primary goal for most eligible insulin-dependent diabetic patients. In the DCCT, intensive therapeutic intervention was based on frequent self- monitoring of blood glucose and monthly measurements of glycohemoglobin. The importance of glycohemoglobin assessments serves to highlight the present inadequacies in laboratory measurements of this analyte, which hinders wide implementation of the ADA recommendations. Clinical interventions aimed at achieving the DCCT's published therapeutic goals may place patients at a significantly increased risk for life-threatening hypoglycemia, if the therapy is based on nonstandardized laboratory results. Clinical laboratories will now be under increasing pressure to provide reproducible, standardized measurements of glycohemoglobin, a goal that recent research has shown to be realistic, if widespread interlaboratory calibration is adopted. Finally, recent advances in measuring glycated serum proteins appear to warrant reevaluation of such assays during future intensive therapy trials, as potentially important tools for fine-tuning tight blood glucose control.
The following articles in journals at HighWire Press have cited this article:
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  A H Berg and D B Sacks Haemoglobin A1c analysis in the management of patients with diabetes: from chaos to harmony J. Clin. Pathol., September 1, 2008; 61(9): 983 - 987. [Abstract] [Full Text] [PDF]
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 D. E. Goldstein, R. R. Little, R. A. Lorenz, J. I. Malone, D. Nathan, C. M. Peterson, and D. B. Sacks Tests of Glycemia in Diabetes Diabetes Care, July 1, 2004; 27(7): 1761 - 1773. [Full Text] [PDF]
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 M. E. RYAN, O. CARNU, and A. KAMER The influence of diabetes on the periodontal tissues J Am Dent Assoc, October 1, 2003; 134(suppl_1): 34S - 40S. [Abstract] [Full Text] [PDF]
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 A. P.F. Turner, B. Chen, and S. A. Piletsky In Vitro Diagnostics in Diabetes: Meeting the Challenge Clin. Chem., September 1, 1999; 45(9): 1596 - 1601. [Abstract] [Full Text] [PDF]
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D. B. Sacks Implications of the Revised Criteria for Diagnosis and Classification of Diabetes Mellitus Clin. Chem., December 1, 1997; 43(12): 2230 - 2232. [Full Text] [PDF]
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E. Gerlo and F. Gorus Calibration of ion-exchange HPLC measurements of glycohemoglobin: effect on interassay precision Clin. Chem., December 1, 1997; 43(12): 2353 - 2357. [Abstract] [Full Text] [PDF]
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U. Kobold, J.-O. Jeppsson, T. Dulffer, A. Finke, W. Hoelzel, and K. Miedema Candidate reference methods for hemoglobin A1c based on peptide mapping Clin. Chem., October 1, 1997; 43(10): 1944 - 1951. [Abstract] [Full Text] [PDF]
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N. B. Roberts, B. N. Green, and M. Morris Potential of electrospray mass spectrometry for quantifying glycohemoglobin Clin. Chem., May 1, 1997; 43(5): 771 - 778. [Abstract] [Full Text] [PDF]
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 M K Hassan, R H Neary, and J H Scarpello Derive reference range locally BMJ, December 3, 1994; 309(6967): 1511b - 1512. [Full Text]
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