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Department of Clinical ChemistryBatch (25)

By:

Smaher AL-sayed Haroon

Supervisor: Ustaz. Abubakr Hassan


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Is a disease characterized by persistent hyperglycemia

(high blood sugar level) resulting either from inadequate

secretion of hormone insulin or inadequate response of

target cell to insulin or combination of these factors, that

because insulin is a principle hormone that regulates

uptake of glucose into most cells.

And also It has been defined by WHO as fasting

venues plasma glucose concentration greater than 140

Mg /dL

Definition:


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Type 1

Known as insulin dependent diabetes (IDDM)

childhood diabetes or juvenile onset diabetes. Itmost commonly diagnosed in child but can occurs

in adult it characterized by beta.cell destruction

which usually leads to an absolute deficiency of

insulin, there for insulin therapy is essential for

survival.


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known as non insulin dependent diabetes

(NIDDM).

It is due to combination of defective insulinsecretion and defective responsiveness to insulin

which lead to elevated level of insulin in the blood.

Onset is most usual during adult life.Although no genetic marker have been foundThere is a familial tendency

Type 2:


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.It divides to:

1-immediate complication or acute metabolic

complication

A-diabetic keto acidosis (DKA)

B-non- ketotic hyper osmoler coma

C-hypoglycemia

2-micro & macro vascular disease


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1- Urine glucose test:

If it is positive a confirmatory blood test is

needed.

2- Blood tests:

* Random blood glucose test( RBS).

* Fasting blood glucose test.

* Glucose tolerance test

* Glycated HbA1c test.


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Adult Hb is composed of one major component Hb

A & several sub fractions.

G.Hb is a generic term for Hb bound irreversibly to

glucose , often the term is used to mean total G.Hb

HbA1a,HbA1b,HbA1c & possibly HbA1d and HbA1e

which are sub fractions of G.HbA, and sometimes to

Hb A1c which is major sub fraction .


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G.Hb is formed by posttranslational, non-enzymatic,

substrate- concentration dependent irreversible

process of combination of aldehyde group of glucose

with the amino-terminal valine of the beta chain of Hb

, there is two steps for the reaction between Hb &

blood glucose. The 1st step consist of the formation of

reversible aldimine form of Hb to glucose linkage .

The 2nd step the labile aldimine form is converted

slowly to the stable & irreversible ketoamine form

throught an amadori rearrangement.


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The level of G.Hb in the blood is directly related to

the average of blood glucose level over the life span

of the red blood cells (RBCs), since the half life of

RBCs is about 120 days.A single determination of G.Hb reflect the

average of blood glucose level during preceding 8-12

weeks .The test is therefore a very good monitor forlong term (2-3months) blood glucose control in

patient with diabetes mellitus.


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Many diabetic patients dont pay

enough attention to their blood glucose

and this may be due to illiteracy and

economical status.


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General objective:To follow up patients to know whether

their blood glucose has been well controlledwithin the previous 3 months.

Specific objectives:1) Measurement of glycated HbA1c.2) Measurement of random blood glucose.


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Area of study:This study have been done in Jabeer abo-aleezs

diabetic center in Khartoum city.Duration of study:

In the period from July to October 2006.Sample size:

52 known diabetic patients (32 male and 20female) were chosen for this study.

3 ml of blood were taken from each patient, 1 ml

were kept in EDTA container for measurement ofHBA1c level, and 2 ml into fluoride oxalate containerfor measurement of random blood glucose.

Method: for estimation the blood glucose:

Enzymatic, colorimetric method. GOD-PAP method(GOD) the resultant hydrogen peroxide (H2O2) isoxidatively coupled with amino phenazone and phenol inthe presence of peroxidase (POD) to yield a redQuinonamine dye, the concentration of dye which read at

520 nm is directly proportional to the concentration ofglucose.


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Whole blood is mixed with a lysing reagent containing adetergent and borate ions. The hemolysate is then mixed for

5 minutes with a weakly binding cation exchange resin.

During this time, HbA1c binds to the resin. A special resinseparator is used to remove the resin from the supernatant

fluid which contains the HbA1c.

The glycomhemoglobin percentage of total hemoglobin is

determined by measuring the absorbance of theglycomhemoglobin of the total hemoglobin fraction at 415nm , 405 nm in comparison with a standardglycohemoglobin .

Reaction principle:

Method: for estimation of glycohemoglobin HbA1c

Fast ion-Exchange Resin Separation Method


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Table.1:Number of frequency and percentage of male, femalepatients and control

10072total

27.820control

27.820femalepatient

44.432male patient

percentfrequenc

0

5

10

15

2025

30

35

40

45

50

male patient female

patient

control

frequenc

percent

Fig.1:frequency and percentage of male, female patients and control


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Table.2:Number of frequency and percentage ofweight distribution of all samples.

10072Total

20.81576-100

69.45051-75

9.7743-50

percentfrequency

0

10

20

30

40

50

60

70

80

frequenc percent

43-50

51-75

76-100

Fig.2:frequency and percentage of weight

.distribution of all sample


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Table.3:Number of frequency and percentage of the durationof disease

10052Total

3.8231-40

7.7421-30

28.81520--11

59.63110--1

percentfrequency

0

10

20

30

40

50

60

70

1--10 11--20 21-30 31-40

frequency

percent

Fig.3:Frequency and percentage of the duration of disease


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.Table.4:Frequencies of good and bad controls in both sexes

)30.8%( 16)30%( 6)31.3%( 10Good control

)69.2%( 36)70%( 14)68.8%( 22Bad control

TotalFemaleMale

The groups of the patient

Good ControlBad Control

Percent

80.0

60.0

40.0

20.0

0.0

The sex of the patie

Male patient

Female p atient

30.0

70.0

31.3

68.8

Fig.4:Frequencies of good and bad controls in both sexes

Also the result showed that the males control their bloodglucose better than the females do. 68% of the males have badlycontrolled blood glucose whereas 70% of the females have badly

controlled blood glucose.


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Table.5:Relationship between age and HBA1c level.

22270-79

22760-69

21250-59

214.840-49

206.830-39

22420-29

Mean of HBa1cAge

195

200

205

210

215

220

225

230

20-29 30-39 40-49 50-59 60-69 70-79

Age

Me

anofHB1c

Mean of HBa1c

Fig.5:Relationship between age and HBA1c level.

The results showed that age had no effect on the level of HBA1c.

bl l i hi b i h d


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Table.6:Relationship between weight andHBA1c level

237.880-89

228.870-79

204.260-69

211.249-59

Mean of HBA1cWeight

180

190

200

210

220

230

240

250

49-59 60-69 70-79 80-89

weight

meanofHBA1c

mean of HBA1c

Fig.6:Relationship between weight and HBA1c level

From the results it is seen that an important factor affecting the level of

HBA1c is the weight of the patient. The greater the weight of the patientthe higher the level of the HBA1c.

bl l i hi b d i f di d


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Table.7:Relationship between duration of disease andHBA1c level

27740--28

26427--21

217.620--17

21016--11

21010--6

2065--1

Mean of HBA1cDuration

206210 210

217.6

264

277

0

50

100

150

200

250

300

1--5 6--10 11--16 17--20 21--27 28--40

Duration

MeanofHB1c

Mean of HBA1c

Fig.7:Relationship between duration of disease and HBA1c level

The duration of disease has an effect on the level of HBA1cand the control of blood glucose so the relation between the

duration and level of HBA1c is directly proportional.


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0

50

100

150

200

250

300

350

400

450

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

Patients

Results

RBS

HBA1c

Fig.8:Relationship between HBA1c results and RBS results

Finally the study showed that HBA1c test is better inmonitoring than the RBS test.


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Glycated Hemoglobin A1c test should be recommended as a**

routine investigation for diabetic patients the same as the blood

.glucose test, mainly in central labs

Also, patients should be taught how to control their blood**

.glucose

Doctors should request for the HBA1c test for every diabetic**

.patient every 3 months


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