Glycated hemoglobin fundamentals. Value and advantages in practical clinical

Abstract

Theglycatedhemoglobin(HbA1c)testisauseful,economic, and practical clinical tool for long-term glycemic control in patientswithdiabetesmellitus(DM).Historically,since1955, the HbA1c was described for the first time by Kunkel and Walleniusasaminorfractionofhumanhemoglobin.However, untilthe70s,themoleculewasrecognizedasaglycemiccontrol marker. The HbA1c is a conjugated protein (heteroprotein, hemoglobin-glucose) formed through the non-enzymatic and post-translational process called glycation (Maillard reaction)asastableAmadoriproduct.Ifthereactioncontinues, the final results are irreversible products called advanced glycation end products (AGEs). AGEs are responsible for modifying proteins of the whole tissues and contribute to inflammatory reactions mediated by the AGE receptor and complications of DM. Additionally, HbA1c levels of less than 7% have been associated with reducing microvascular and macrovascular lesions. An adequate evaluation and monitoring routinely of HbA1c levels would allow adequa te glycemic control and help to reduce the risk of future complications.