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  1. Dr Satish Kumar GS

    Dr Satish Kumar GS Well-Known Member

    Messages:
    37
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    Male
    Location:
    Guntur
    Diabetic Since (dd-mm-yyyy):
    00-00-0000
    HbA1c is an accepted index of glycemic control now and regarded as the best marker for diabetic microvascular complications.

    What is standard of HbA1c testing in India? Any opinions?

    HbA1c is an accepted index of glycemic control now and regarded as the best marker for diabetic microvascular complications. But are the reports that are churned out in our labs accurate?

    I got a patient tested in three labs with following results within span 2-3 days.
    1. First test 7.2 (ERBA Diagnostics make analyzer)
    2. Second test from another lab 5.8 (Afinion make analyzer) (Three months ago - this same lab gave 8.8)
    3. Third 7.3 by HPLC (High-performance liquid chromatography) method (EDTA Whole Blood)
    Which one to believe? :banghead:


    Three different blood samples. I got tests repeated on suspicion. He was 8.8 before I started him on nutritional changes. He strictly adhered. He has been a diabetic for 18 years. He is completely off drugs now. Lost weight and abdominal girth. Feeling lot better/younger and good improvement of face (puffy eyelids gone) Headaches, fatigue too gone.


    What is prevailing standard of lab reports of HbA1c testing in India? There are many machine models that are in the market that are used for testing. Many of them claim to be NGSP certified (NGSP Home) Are they following any standard guidelines? Are samples being drawn correctly and transported to labs correctly. Any guidelines for collecting samples? What is the pre analytical stability status for HbA1C?

    No standard reporting and dismal state of affairs. Its distressing. :noidea:
     
    Last edited by a moderator: Jul 15, 2017
  2. Hariharan

    Hariharan It's the carbs, stupid!

    Messages:
    1,196
    Gender:
    Male
    Location:
    Lemuria
    Diabetic Since (dd-mm-yyyy):
    2014
    Diabetes Type:
    Type 2
    Don't know much about a1c testing & india.
    But you may be interested in this - Why Hemoglobin A1c Is Not a Reliable Marker

    As an engineer, this is what I would do.
    1. Take a minimum of 5 readings per day.
    2. Find the fudge factor for the glucometer by calibrating against my own venal samples.
    3. Apply the fudge factor to those readings and do curve fitting for 3 months or any other period greater than a month.
    4. That would be a reasonably trustworthy average.
    I know I know, it's impractical for most people except engineers. :)
     
  3. shashikantiyengar

    shashikantiyengar Moderator

    Messages:
    10,214
    Gender:
    Male
    Location:
    Mumbai
    Diabetic Since (dd-mm-yyyy):
    29/09/2015
    Diabetes Type:
    Type 2


    Great .
    The patient off drugs is a big ach
     
  4. Recyan

    Recyan Moderator

    Messages:
    3,598
    Gender:
    Male
    Location:
    Mumbai
    Diabetes Type:
    Type 2
    Long Time back, remember my Doctor saying, this one (HPLC) is the most reliable without mentioning any other name.
     
  5. Dr Satish Kumar GS

    Dr Satish Kumar GS Well-Known Member

    Messages:
    37
    Gender:
    Male
    Location:
    Guntur
    Diabetic Since (dd-mm-yyyy):
    00-00-0000
    I have put him on CGM now... will get back with results
     
    Last edited by a moderator: Jul 15, 2017
    Prabhuraman and Recyan like this.
  6. Asp

    Asp Moderator

    Messages:
    2,821
    Location:
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    Great..wish more med professionals take cue from doctors such as you.

    Also, the CGM is a revolutionary product...it along with the reader should be as easily available as any other item on amazon and ebay.
    The manufacturing companies should not only encourage a B2B approach but also put in place a B2C mechanism so that people can easily access them...
     
  7. Hariharan

    Hariharan It's the carbs, stupid!

    Messages:
    1,196
    Gender:
    Male
    Location:
    Lemuria
    Diabetic Since (dd-mm-yyyy):
    2014
    Diabetes Type:
    Type 2
    I think that's the case in Europe.
    In the us, the fda is d--king around. Probably trying to figure out ways to help its fat cat masters become fatter.
    But this is coming one way or the other.
    Interesting posts by @shashikantiyengar in the Twitter thread about the digitally enabled patient.
     
    Anup Singh, shashikantiyengar and Asp like this.
  8. Vinay Raj

    Vinay Raj Veteran Member

    Messages:
    1,429
    Gender:
    Male
    Location:
    Chennai
    Diabetes Type:
    Type 2
    @Dr Satish Kumar GS 1 & 3 are the same tests, highly automated and unlikely to have errors. 2 also has the same tests, but seems to involve an intermediate operator step that could be error inducing. FWIW, thats my observation from reading the data sheets and the test info from what you have given from an electrical engineer's perspective. 1&3 are for large hospitals and doing large batch testings. 2 is used in smaller environments.
     
    Recyan, Anup Singh and Asp like this.
  9. HSD

    HSD Moderator

    Messages:
    4,983
    Gender:
    Male
    Location:
    Pune, India
    Diabetic Since (dd-mm-yyyy):
    14-05-2012
    Diabetes Type:
    Type 2
    1 and 2 are analyzers and 3rd one is technology. 1st one could have used HPLC also depending on model of the analyzer.
    no. 2 is for POC (point of care) for immediate analysis.
    And we can see 1 and 3 have minimum difference. So no 2 can be ignored.
    We can check whether the av. on meter matches with eav. BS with Hba1c.
     
    Recyan, Asp and Anup Singh like this.
  10. HSD

    HSD Moderator

    Messages:
    4,983
    Gender:
    Male
    Location:
    Pune, India
    Diabetic Since (dd-mm-yyyy):
    14-05-2012
    Diabetes Type:
    Type 2
    IMHO, no need to delete the thread.
     
    Recyan and Anup Singh like this.
  11. Vinay Raj

    Vinay Raj Veteran Member

    Messages:
    1,429
    Gender:
    Male
    Location:
    Chennai
    Diabetes Type:
    Type 2
    Needed to clarify based on @HSD 's post above, 1&2 are analyzers and 3 is a test, as he has said. 3 is the gold standard for testing and the analyzer in 1 also uses the test method described in 3. Hence my description above where I analyzed the nature of tests the analyzers carried out, without stating it. HSD said it better.
     
    Recyan and shashikantiyengar like this.
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