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Abstract

VALUE OF ASSESSING POST PRANDIAL AND FASTING PLASMA GLUCOSE AS A SURROGATE FOR GLYCATED HEMOGLOBIN IN DIABETIC GLYCEMIC CONTROL

Dr. Subinay Datta, Dr. Mrinal Pal ?, Dr. Ritabrata Mitra, Dr. Amrita Ganguly,Dr. Subhadeep Basu, Dr. Subhasish Manna

ABSTRACT

Background: Control of plasma glucose could prevent the progression of most of the complications of diabetes mellitus and glycated hemoglobin is the most important criterion in controlling these complications. But its non-availability in grass root level of health sector and high cost, post-prandial and fasting blood glucose estimation have came into the field particularly in developing countries to assess glycemic control. Aim: To assess the better surrogate parameter fasing or post-prandial blood glucose for glycated haemoglobin that help in detecting the glycemic control status of diabetic patients. Methods: In the study One 120 diabetic patients attending an out-patient medical clinic were selected after simple random method. The study population was divided into three groups based on the HbA1c values i.e. Group 1 (HbA1c<7%-good control), Group 2 (HbA1c 7-9%- fairly controlled), Group 3 (HbA1c >9%-Poorly controlled). Glycated haemoglobin and blood glucose estimations in all patients were carried out in the fasting state (at least after 8 hours of fasting) as well as postprandial state (two hours after lunch) on the same day. Result: The mean glycated haemoglobin in three groups were 121.29 ± 28.91mg/dl and 165.61 ± 34.51mg/dl for group I, 154.78 ± 12.83 mg/dl and 206.92 ± 46.95 mg/dl for group II and for group III 179.38 ± 26.02 mg/dl and 179.38 ± 26.02 mg/dl respectively and the difference was statistically significant (p < 0.001). Regression analysis has pointed that PPBS is more significantly correlated with HbA1C than FBS. PPBS showed better sensitivity (92.5% vs. 85%), specificity (90% vs. 81%), positive predictive value (95% vs. 89%), negative predictive value (86% vs. 74%) and accuracy (92% vs. 83%) than Fasting glucose. Conclusion: HbA1c remains the gold standard in assessment of glycemic control with availability of standardized methods. However in resource poor settings & in conditions with limitations for using HbA1c, PPBS can be used to monitor the glycemic control of diabetes.

Keywords: Glycated hemoglobin, glycemic control, fasting glucose, post-prandial glucose.


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