2醣化血红素hba1c.ppt

為什麼要談這個主題：HbA1c 台灣現況(健保局資料) 全民中有4.0 % 被歸類為糖尿病，但醫療支出佔11.5 % 每位糖尿病患的平均給付金額為其他疾病的3.3倍 調降1/3的嚴重個案比例，可減少20 %的總支出 NIH Guidelines for A1C Test 1.Specific measurement of HbA1c. 2.Narrow non-diabetic range (4.0%-6.0%). 3.Highly precise measurement (2% CV) 4.Removal of interferences. 5.Hemoglobin variant detected when present. 6.NGSP certified method and calibrator. 7.Within ± 0.5% HbA1c bias from the reference value. Does HbA1c cam be used for Diabetes Screening HbA1c cutoff Sensitivity Specificity 5.6% * 83.4% 84.4% 6.1% * 63.2% 97.4% *(1SD and 2SD above normal mean) Normal population : 5.1 +/- 0.5 % Diabetes Care 23:187-91, 2000 ADA Endorses HbA1c for Diabetes Diagnosis (2010 Feb.) 監測 １）自我血糖監測 (self-monitoring of blood glucose, SMBG)理想情形是維持飯前血糖在70-140，飯後≦140 mg/dl。但應依 病童 的年紀和處理低血糖的能力酌情調整。 ２）醣化血紅素 (HbA1c) 反映最近２個月來血糖的平均值。目標值: 7.0 或6.5 % ３）尿酮：必須為陰性。 4）血脂：total Cholesterol, Triglyceride, LDL-Chol要保持 正常。 5）微尿白蛋白(microalbuminuria)：發病5-6年後，必須 開始測定，期能早期檢出腎病變。 6) AGEs (Advanced Glycosylation End Products ）最終糖化蛋白(AGEs）是引起糖尿病併發症的元兇 Monitoring Diabetes Self Monitoring Blood glucose test (SMBG) Hemoglobin A1c (HbA1c) testing Complete separation of Hb Kaoshiung QA Activity in HbA1c test in Taiwan 1.使用NGSP/IFCC認證過的檢測方法 2.Tracible to DCCT /IFCC value 的校正 3. CV 3% and Bias 0.5 A1C% 4. 鑑別變異型Hb/G-6-P.D.等干擾因素 Conclusion 1. Reference range of HbA1c is 4.0 ~6.0 % 2.HbA1c 6.5% is a New Diagnostic Criteria for Diabetes 3.Achieve A1C 7.0% or 6.5% as goal of good glycemic control. 4.“Translation” of HbA1c into eAG in laboratory report. 5.Real time report of HbA1c have good outcome 6.Traceability to NGSP unit(%) in Taiwan * * 糖尿病的臨床影響 糖尿病的併發症包括: 心血管疾病(CVD), 腎病變(Nephropathy), 視網膜病變(Retinopathy)及神經病變(neuropathy), 其中糖尿病腎病變是造成末期腎病(ESRD)最主要的原因。 Slide source: * The overall results of the ADAG study are shown here.