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HbA1c : interpretation and common errors

By Pratyush kumar


HbA1c measures glycation of hemoglobin and considered equivalent to mean blood glucose over period of 8 to 12 weeks.
It depends on :
  1. Red cell turnover
  2. HbA1c in reticulocytes
  3. Rate of glycation which depends on age of RBCs

Any factor which cause reduced life span of RBCs  may give erroneously low hba1c and vice versa .


Conditions causing high HbA1c
  1. Iron deficiency anemia
  2. Pernicious anemia
  3. Drugs - statins,Aspirin in high doses
  4. Hyperbilirubinemia
  5. Renal failure
  6. Few Hemoglobinopathies
  7. Splenectomy

Conditions causing low HbA1c
  1. Hemolytic anemia
  2. Renal failure
  3. Hemoglobinopathies
  4. Splenomegaly
  5. Drugs - hydroxyurea, Administration of iron and b12, Vitamin c & e ~ antioxidants, TMP-SMX, antiretroviral
  6. Alcoholism
  7. Chronic liver disease
  8. Hypertriglyceridemia

Alternatives for glycated hemoglobin HbA1c are
glycated albumin, fructosamine, or serum albumin-adjusted fructosamine.

Studies done on HbA1c
  1. NHANES Study
  2. DETECT 2
  3. ADAG STUDY
  4. DCCT
  5. UKPDS

The A1C test should be performed using a method that is certified by the NGSP (www.ngsp.org)

Criteria for Diabetes
A1C ≥6.5%(48mmol/mol).The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.*
Criteria for Pre Diabetes (ADA 2017)
A1C=  5.7 - 6.4% (39 - 47 mmol/mol)


Reference

  1. American Diabetes Association Standards of Medical Care in Diabetes 2017
  2. Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes  Mellitus    Abbreviated Report of a WHO Consultation - 2011

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A2 milk, desi cows and Jallikattu - Need to unlearn what's wrong been taught over years.

By Pratyush kumar

Recent debate on the ban of Jallikattu which will decimate India’s indigenous cattle breed (https://thewire.in/19157/banning-jallikattu-will-decimate-indias-indigenous-cattle-breeds/) brought my attention over another ongoing debate in West on a1 vs a2 milk which I feel everyone should know.
Milk contains lots of water, carbohydrates, proteins and fat. Debate is on its protein part which are caseins and whey proteins. Among caseins it's a1 and a2 variant which has brought so much of debate.
A2 is by default in our desi cows and a1 is supposed to be mutant type prevalent in European cows.
A1 and a2 proteins differs by an amino acid, In a1 at 69th position histidine is there whereas in a2 proline is there.
This difference leads to a major change when these proteins are digested in our body. A1 protein because of histidine which form a weaker bond with BCM7, on digestion it gets released which gets absorbed in our body. BCM7 has been found to be associated with type 1 diabetes mellitus, autism, ischaemic heart disease and schizophrenia.
BCM7 is a bioactive peptide beta caseomorphine 7 which leads to harmful effects on immune and nervous system. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475924/)
By default most of our desi cows used to give a2 milk and imported cattles give a1 milk. But now with imported and crossbreed jersey and Holstein Friesian cattles from abroad to increase milk production, We lost our own desi breed in race of quality over quantity of milk.
Those imported cows give a1 milk.
Now since it's been crossbred with our desi cows it's difficult to identify cows giving a2 milk. Although there are genetic tests available in few countries to correctly identify but it's not available everywhere.
It's easy to  identify our desi cows producing a2 milk by the hump on back and flaps of akin beneath it's neck which are absent in exotic cows.

Although it needs more research to substantiate the claims made so far and prove harmful effects of BCM 7, but at present it's better to switch over to our own desi cows for milk.

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