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News: David B. Sacks for the ADA/EASD/IDF Working Group of the HbA1c Assay Global Harmonization of Hemoglobin A1c Clin Chem 2005; 51: 681-683 [Full text] [PDF]

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An opinion on a news item

Trefor N Higgins   (4 May 2005)

An opinion on a news item 4 May 2005
Trefor N Higgins, Co Director of Clinical Chemistry Dynacare Kasper Medical Laboratories Send letter to journal: Re: An opinion on a news item trefor.higgins{at}dkml.com Trefor N Higgins	The article entitled Global harmonization of Hemoglobin A1c by Dr Sacks in Clinical Chemistry 2005; 51: 681-83 raises some concerns. Firstly there is a change in abbreviation of the measured parameter from the traditional Hb A1c, as used in a paper by Roberts et al (Effects of Hemoglobin C and S traits on Glycohemoglobin measurements by Eleven methods Clinical Chemistry 2005; 51: 776-8) in the same issue of Clinical Chemistry, to HbA1c. Although this abbreviation (HbA1c) is considerably easier to type is there global acceptance of this new abbreviation? Secondly there is a proposal to change the report from Hb A1c to mean blood glucose. If, in countries using traditional units for reporting of plasma glucose results, the decision is made to report the MBG in mmol/L there could be confusion in the patient’s mind when he /she is told his/her measured blood glucose (MBG ?) is 120 (mg/dl) but their mean blood glucose (MBG) is only 6.7 (mmol/L). If some countries report in mmol/L and others in mg/dL there will be confusion in patient’s minds. Our experience with the reporting of cholesterol in Canada illustrates the confusion in patient’s minds in reporting laboratory results using different units. Patients phone to ask why, on the Internet, they find that a cholesterol value below 200 (mg/dL) is acceptable or even good but their physician is telling them that their cholesterol is very high at 7.0 (mmol/L). Units have little meaning to the general public only the number. Dr Sacks comments that a major stumbling block in using the IFCC HbA1c values is that they “do not convey to patients that a change of 0.5% has major impact on health care”. In countries using SI units the change in mean blood glucose values (MBG) required to make a major impact will be of a similar magnitude to that using IFCC HbA1c values. There is therefore little to be gained by using this new unit.