ARKRAY ADAMS A1c HA-8180의 분석능 평가

유은형,김병인,조현정 대한진단검사의학회 2014 Laboratory Medicine Online Vol.4 No.3

The hemoglobin A1c (Hb A1c) test is widely used to diagnose diabetes mellitus and monitor glycemic control in patients with diabetes. We evaluated the performance of the ARKRAY ADAMS A1c HA-8180 (ARKRAY KDK, Japan), an automated, HPLC-based Hb A1c analyzer. The ARKRAY ADAMS A1c HA-8180 was evaluated for its linearity and precision and compared to the HLC-723 G7 (Tosoh Corporation, Japan), according to the Clinical and Laboratory Standards Institute’s guidelines. The coefficients of variation (CVs) for within-run precision at low and high levels were 0.6% and 0.3%, respectively, and the total CVs at low and high levels were 0.8% and 0.6%, respectively. The coefficient of determination (R2) was 0.9975, with linearity in the range of 3.0-18.5%. A comparison between the ARKRAY ADAMS A1c HA-8180 and HLC-723 G7 revealed a good correlation (r=0.9955) in the range of 4.8-14.6%. The runtime was 57 s per sample. The ARKRAY ADAMS A1c HA-8180 showed good analytical performance and high throughput. Therefore, it is suitable for routine use for clinical measurements of Hb A1c. 당화혈색소 Hb A1c는 당뇨병의 진단기준과 혈당 조절의 모니터링 지표로 널리 이용되고 있다. 본 연구에서는 Hb A1c 측정 자동화 장비인 ARKRAY ADAMS A1c HA-8180 (ARKRAY KDK, Japan)의 성능을 평가하였다. ARKRAY ADAMS A1c HA-8180의 직선성, 정밀도 및 기존 검사실 장비인 HLC-723 G7 (Tosoh Corporation, Japan)과의 상관성을 CLSI 지침에 따라 평가하였고, 분석속도를 측정하였다. 저농도와 고농도의 Hb A1c 정도관리물질의 검사 내 변이계수는 각각 0.6%와 0.3%였으며, 총 변이계수는 0.8%와 0.6%였다. 직선성은 3.0-18.5% 범위에서 R2=0.9975였다. Tosoh HLC-723 G7과의 상관성 평가에서도 4.8-14.6% 범위에서 r=0.9955의 상관성을 보였고, 분석 속도는 검체 당 57초였다. ARKRAY ADAMS A1c HA-8180는 임상검사실에서 우수한 분석성능으로 대량 검체를 신속하게 검사할 수 있을 것으로 생각된다.

Bio-Rad D-100의 헤모글로빈 A1c 분석능 평가

유창승,최은혜,배인철,이상국,김정호 대한진단검사의학회 2017 Laboratory Medicine Online Vol.7 No.2

Background: Hemoglobin A1c (HbA1c) is considered a marker useful for the follow-up and diagnosis of diabetes and implies the importance of reliable assay methods that are traceable to a reference method. We evaluated analytical performance of a new high-performance liquid chromatography system for the HbA1c assay: D-100 from Bio-Rad Laboratories (USA). Methods: We evaluated precision, linearity, and carry-over of D-100, according to the Clinical and Laboratory Standards Institute’s guidelines. Comparative analysis of D-100 with Integra 800 (Roche Diagnostics, Germany) and Capillarys 3 (Sebia, France) was conducted. Additionally, we evaluated the throughput of the three instruments. Results: Precision of low- and high-concentration controls in D-100 showed a CV of less than 1%. The linearity was excellent (R2=0.999) in the range of 3.51-18.7%, and carry-over was not observed. HbA1c results of D-100 (n=144) showed good correlation with those of Integra 800 (r=0.993) and Capillarys 3 (r=0.996). The % bias between D-100 and Integra 800 or Capillarys 3 was within the allowable range at all 3 medical decision levels (5.7%, 6.5%, and 10.0%). Elapsed time in the analysis of the first sample by D-100 was shorter than that of Integra 800 (2.4 vs. 11.1 minutes), but subsequent samples took more time (0.8 vs. 0.3 minutes per sample). Conclusions: D-100 showed reliable analytical performance with good precision and linearity, minimal carry-over, and acceptable comparative characteristics relative to other instruments. D-100 is expected to be useful for clinical measurements of HbA1c for diabetes diagnosis and theranostics. 배경: 헤모글로빈 A1c (HbA1c)는 당뇨의 진단과 치료, 추적 관찰에 유용한 지표로서 표준화된 검사법에 의한 정확한 검사 결과를 제공하는 것이 중요하다. 본 연구에서는 고성능 액체크로마토그래피법(HPLC)을 이용하여 HbA1c를 측정하는 장비인 D-100 (Bio-Rad Laboratories, USA)의 분석 성능을 평가하고자 하였다. 방법: Clinical and Laboratory Standards Institute (CLSI)의 지침에따라 D-100의 정밀도와 직선성, 검체 간 교차오염률을 평가하였다. 그리고 D-100과 기존 운용장비인 Integra 800 (Roche Diagnostics, Germany), Capillarys 3 (Sebia, France)와의 상관성 및 일치도를 조사하였다. 마지막으로 세 검사법의 검사 소요 시간을 비교 분석하였다. 결과: D-100을 사용한 HbA1c 측정의 검사차례 내 정밀도와 총 정밀도는 저농도와 고농도 모두에서 1% 미만의 변이계수를 보였다. 직선성은 HbA1c 3.51-18.7%에서 우수하였고 검체 간 교차오염률은 관찰되지 않았다. D-100의 Integra 800과 Capillarys 3에 대한 상관성 평가(n=144)에서 상관계수는 각각 0.993, 0.996으로 높은 상관성을 보였으며 세 가지의 임상적 의사결정 농도(5.7%, 6.5%, 10.0%) 모두에서 바이어스(%bias)는 허용범위 이내에 존재하였다. 검사 소요시간은 세 장비의 특성에 따라 차이가 있었다. D-100은 Integra 800에 비해 최초 검체를 더 빨리 처리하였으나(2.4분 vs. 11.1분) 연속 검체 처리시간은 더 길었다(0.8분 vs. 0.3분). 결론: D-100은 우수한 정밀도와 직선성 및 기존의 장비와의 비교에서 높은 상관성과 빠른 검체 처리속도를 보여주었다. 임상적으로 당뇨병의 진단과 치료, 당뇨 합병증의 예방을 위한 추적 관찰에 유용하게 사용할 수 있을 것으로 예상된다.

A quartz crystal microbalance-based biosensor for enzymatic detection of hemoglobin A1c in whole blood

Park, Hyeoun Ji,Lee, Soo Suk Elsevier 2018 Sensors and actuators. B Chemical Vol.258 No.-

<P><B>Abstract</B></P> <P>Here we present a quartz crystal microbalance (QCM) biosensor for enzymatic detection of hemoglobin A1c (HbA1c). It shows average plasma glucose concentration readings over the prior three months. HbA1c can be quantitatively measured based on changes of resonance frequency of QCM following mass changes on QCM sensor surface. These mass changes were caused by size enlargement of conjugated gold nanoparticle with thiol-terminated SAMs on the sensor surface due to gold staining by hydrogen peroxide (H<SUB>2</SUB>O<SUB>2</SUB>) generated from enzymatic HbA1c assay. Finally, we investigated sensor responses due to mass changes on various concentrations of applied H<SUB>2</SUB>O<SUB>2</SUB>. We also demonstrated its capability for analyzing HbA1c in whole blood sample with enzymatic assay. Our results showed that the proposed QCM biosensor could quantitatively analyze HbA1c with a detection limit of 0.147% HbA1c with respect to hemoglobin and a coefficient variation of less than 10%.</P> <P><B>Highlights</B></P> <P> <UL> <LI> A quartz crystal microbalance-based, high performance HbA1c biosensor is presented. </LI> <LI> HbA1c can be quantitatively measured by the changes of resonance frequency of QCM. </LI> <LI> The limit of detection is of 0.147% HbA1c with respect to hemoglobin. </LI> <LI> This biosensor is useful in developing valuable devices for HbA1c sensing. </LI> </UL> </P>

수정-IPA를 통한 푸드카빙교육 효용성의 품질속성 분류에 관한 연구

이성주(Lee, Sung-Ju),임현철(Lim, Hyun-Cheo),김상미(Kim, Sang-Mi) 한국외식경영학회 2022 외식경영연구 Vol.25 No.2

본 연구는 푸드카빙 교육을 받은 수강생들이 지각하는 푸드카빙 효용성은 어떠한지 살펴보고, 어떠한 효용성들이 있고, 효용성의 품질 속성은 어떠한지 살펴보고자 하였다. 이러한 연구목적을 규명하기 위하여 푸드카빙 교육을 받은 경험이 있는 수강생을 모집단으로 설정하였고, 설문조사는 2020년 7월 20일부터 8월 20일까지 한 달간 진행되었다. 설문지는 총 500부를 배부하였고, 435부가 회수되었고, 불성실한 설문지 38부를 제외하고 397부가 최종 분석에 사용되었다. 분석결과, 중요 실행 요소로는 푸드카빙 교육은 지루하지 않고, 남녀노소 할 수 있고, 잡생각이 사라지고, 자존감이 높아지고, 자신의 가치가 높아지고, 마음이 편해지고, 우울함이 사라지는 등의 수업 자체에서 오는 만족감의 속성들이 포함되었다. 매력적 요소에는 푸드카빙 기술이 수익으로 연결되고, 강좌를 개설하고, 적은 금액으로 공방을 오픈하는 등의 수익 측면과 관련된 항목들이 포함되었다. 아울러, 기본적 요소에는 집중할 수 있고, 기분이 좋아지고, 자격증을 취득하고, 전문가가 될 수 있다는 측면의 항목들이 포함되었다. 이는 대체로 푸드카빙을 처음 배우는 수강생들이 기본적으로 가지는 목적들이 포함되었다. This study aims to examine the food carving utility perceived by students who received food carving education, the types of the utility, and its quality attributes. To investigate this research purpose, students who had received food carving education were set as a population, and the survey was conducted for one month from July 20 through August 20, 2020. 500 copies of the questionnaire were distributed in total, and 435 copies were collected. 397 copies were used in the final analysis, excluding 38 unreliable copies. As a result of the analysis, important execution factors included the attributes of satisfaction with the class itself, e.g., Food carving education was not boring; it could be done by men and women of all ages; it made cockeyed ideas disappear; it promoted their self-esteem; it enhanced their value; it comforted their hearts; and it made their depression disappear. Attractive elements included revenue-related items, such as food carving skills connected to profits; they could open lectures; and they could open a workshop with little money. Along with this, the basic elements included the following: They could concentrate; they could feel better; they could get a certificate; and they could become an expert. They usually included the purposes the students who would learn food carving for the first time had basically.

ARKRAY ADAMS HA-8180 HbA1c Analyzer의 수행능 평가

임진숙,김지명,구선회,권계철 대한진단검사의학회 2012 Laboratory Medicine Online Vol.2 No.3

Background: Hemoglobin (Hb)-A1c is routinely used for the management of diabetes. In 2010, HbA1c was included into the diagnostic criteria for diabetes by the American Diabetes Association. A newly developed HbA1c analyzer, ARKRAY ADAMS HA-8180 (ARKRAY KDK, Japan) was introduced. In this study, we evaluated the analytical performance of ARKRAY ADAMS HA-8180 HbA1c analyzer and compared it with the previously used Variant II Turbo (Bio-Rad Laboratories, USA), which is a National Glycohemoglobin Standardization Program (NGSP) certified analyzer. Methods: According to Clinical Laboratory and Standards Institute (CLSI) evaluation protocol (EP) 5-A, Lyphochek Diabetes Controls (Bio-Rad Laboratories, USA) are used for precision. Two (low and high) levels of quality control materials were analyzed twice a day for 20 days, after which the mean, total standard deviation (SD) and total coefficient of variation (CV), including the between-run CV and between-day CV were calculated. ARKRAY ADAMS HA-8180 HbA1c analyzer and Variant II Turbo were compared with 150 samples according to CLSI EP9-A2. In addition, the linearity and carry over rate were evaluated. Results: Between-run CVs for low and high level quality control materials were 0.0% and 0.3%, respectively, whereas between-day CVs for low and high level quality control materials were 0.3% and 0.2%, respectively. In the linearity test, the coefficient of determination (R2) was 0.99 (range,3.1-19.3%). Thus, a good correlation was observed between ARKRAY ADAMS HA-8180 HbA1c analyzer and Variant II Turbo (R2=0.994). The carry over rate was 0.0%. Conclusions: The ARKRAY ADAMS HA-8180 HbA1c analyzer showed excellent precision, linearity, and carryover rate. It also showed excellent correlation with the NGSP certified Variant II Turbo. In conclusion, the ARKRAY ADAMS HA-8180 HbA1c analyzer is a reliable high-performance liquid chromatography (HPLC) analyzer for HbA1c analysis and could be very useful for the diagnosis, treatment, monitoring, and risk assessment of diabetes. 배경: HbA1c는 당뇨조절에 통상적으로 사용되어 왔다. 2010년 미국당뇨병협회에서는 HbA1c를 당뇨의 선별검사의 항목으로 추가시켰다. 최근 새롭게 개발된 ARKRAY ADAMDS HA-8180 HbA1c analyzer (ARKRAY KDK, Japan)가 소개되었다. 이에 본 연구에서는ARKRAY ADAMDS HA-8180 HbA1c analyzer를 이용한 HbA1c의측정 수행능을 평가하였다. 방법: CLSI EP5-A에 따라 Lyphochek Diabetes Control (Bio-Rad Laboratories, USA)을 사용하여 정밀도를 평가하였다. 2가지 농도(저농도 그리고 고농도)의 정도관리 물질을 20일에 걸쳐 하루에 2회씩 매 검사마다 반복 측정하였으며 평균, 총표준편차, 총변이계수, 검사 간 그리고 검사일 간 변이계수가 측정되었다. 총 150검체에 대해 ARKRAY ADAMDS HA-8180 HbA1c analyzer와 Variant II Turbo (Bio-Rad Laboratories, USA)의 HbA1c 측정값을 비교하여 상관성을 평가하였으며, CLSI EP9-A2에 따라 변이를 결정하였다. 또한 직선성과 검체 간 교차오염률을 평가하였다. 결과: ARKRAY ADAMDS HA-8180 HbA1c analyzer의 HbA1c 측정정밀도는 고농도에서의 총변이계수, 검사 간 변이계수, 검사일 간변이계수는 각각 0.7%, 0.0%, 0.3%였으며 저농도에서 총변이계수,검사 간 변이계수, 검사일 간 변이계수는 각각 0.5%, 0.3%, 0.2%로나타났다. 직선성은 3.1-19.3% 범위에서 R2 =0.99로 나타났다. Variant II Turbo와도 상관성은 매우 높았다(R2 =0.994). 검체 간 교차오염률은 0%로 나타났다. 결론: ARKRAY ADAMDS HA-8180 HbA1c analyzer는 우수한 정밀도, 직선성 및 검체 간 교차오염률을 나타냈다. 또한 NGSP 인증된Variant II Turbo 기기와 우수한 상관성을 나타내었다. 결론적으로,ARKRAY ADAMDS HA-8180 HbA1c analyzer는 HbA1c 측정에 있어신뢰할 수 있는 HPCL 장비로 당뇨병의 진단, 추적감시 그리고 위험도 측정에 있어 유용할 것이라고 생각한다.

만성신부전증 환자에서 Recombinant Human Erythropoietin 치료에 따른 혈액지표와 Hemoglobin A1c에 대한 연구

이세영,배성한,변동원,서교일,유명희,김극배 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Hemoglobin A1c is produced by a progressive, non-enzymatic reaction between glucose and hemoglobin within the erythrocytes. The HbA1c concentration is dependent on the plasma glucose level and the stage of development of the erythrocytes. Immature erythrocytes contain lower levels of glycosylated hemoglobin than mature erythrocytes. HbA1c level was decreased in short RBC life span. Therefore, HbA1c level is not only measure for assessment of moderate to long term glycemic status in diabetics, but also as a possible diagnostic parameter of anemia. The aim of this study was to evaluate the HbA1c level in patients with chronic renal failure with anemia. HbA1c concentration, iron, ferritin, TIBC and hematologic parameters were measured before treatment and 1, 2 months after administration of recombinant human erythropoietin. The HbA1c concentration was measured by high performance liquid chromatography with cation exchange column (Pharmacia). The results were as follows; 1. The mean of hemoglobin was 8.66 g/dL in the controls and 7.84 g/dL in the patients with chronic renal failure. The mean of hematocrit was 25.19 % in the controls and 23.14 % in the patients with chronic renal failure. The mean of MCV was 93.23 fL in the controls and 92.73 fL in the patients with chronic renal failure. The mean of MCH was 32.56 pg in the controls and 31.76 pg in the patients with chronic renal failure. The mean of HbA1c was 3.15 % in the controls and 2.95 % in the patients with chronic renal failure. 2. Hematologic parameters in the patients with chronic renal failure 1) The results of hemoglobins were 7.84 g/dL, 8.11 g/dL, 8.92 g/dL, the MCH were 31.76 pg, 32.87 pg, 33.20 pg, the results of MCV were 92.73 fL, 97.37 fL, 92.85 fL at before treatment and 1, 2 months after administration of r-HuEpo. 2) The results of hematocrits were 23.14 %, 23.73 %, 26.73 % at before treatment and 1, 2 months after administration of r-HuEpo. 3. Iron metabolism parameters in the patients with chronic renal failure 1) The results of iron test were 180.92 ㎍/dL, 137.79 ㎍/dL, 126.83 ㎍/dL at before treatment and 1, 2 months after administration of r-HuEpo. 2) The results of ferritin test were 1500.2 ng/ml, 1311.6 ng/ml, 1151.0 ng/ml at before treatment and 1, 2 months after administration of r-HuEpo. 3) The results of TIBC test were 282.17 ㎍/dL, 282.45 ㎍/dL, 278.83 ㎍/dL at before treatment and 1, 2 months after administration of r-HuEpo. 4. The results of HbA1c test were 2.95 %, 3.08 %, 3.18 % at before treatment and 1, 2 months after administration of r-HuEpo. It is suggested that, in patients with chronic renal failure, evaluation of HbA1c in diabetics who have anemia with chronic renal failure should be consider possible hematologic parameters, and HbA1c level would be one of the marker of anemia status, but further studies are needed.

실험적으로 당뇨병을 유발시킨 개에 있어서 혈당량과 Hemoglobin A₁ 농도의 변화의 시간적인 상관관계

이창우,김본원,Lee, Chang-woo,Kim, Bonn-won 대한수의학회 1998 大韓獸醫學會誌 Vol.38 No.4

Fifteen mongrel dogs (14 male and 1 female) were injected intravenously with 30mg of streptozotocin and 50mg of alloxan monohydrate per kilogram of body weight to induce diabetes mellitus. Before treatment with streptozotocin and alloxan fasting serum glucose concentration was determined every other day or thrice a week (Monday, Wednesday, Friday) for 3 months. Among 15 dogs 4 dogs developed diabetes mellitus and survived more than 9 weeks without injection of insulin. After treatment fasting serum glucose and hemoglobin $A_1$ concentrations of the 4 dogs were determined every other day or thrice a week. Fasting serum glucose concentration increased acutely from 24 hours after treatment and then showed severe fluctuation. Hemoglobin $A_1$ concentration increased gradually until 7~9 weeks after treatment and then showed very slow increase afterwards. Correlation of hemoglobin $A_1$ to fasting glucose concentration was relatively weak(r = 0.10~0.80). Hemoglobin $A_1$ and fasting glucose concentration of preceding 7 week showed very high correlation (r = 0.98~0.99). It was indicated that hemoglobin $A_1$ concentration in chemically induced diabetic dogs reflects mean glucose concentration of preceding 7~9 weeks.

단시간의 혈당량 변화에 따른 당화혈색소량의 변동

안재수 ( An Jae Su ),최은진 ( Choe Eun Jin ),박상선 ( Park Sang Seon ),이대호 ( Lee Dae Ho ),정민영 ( Jeong Min Yeong ),이태희 ( Lee Tae Hui ) 대한내과학회 1993 대한내과학회지 Vol.44 No.1

연구배경 : 혈당농도가 올라감에 따라 혈중의 혈색소가 당화되어 당화혈색소가 증가됨은 잘 알려져 있다. 이러한 당화혈색소는 적혈구 성숙과정동안 서서히 당화되므로 이를 측정함으로써 수주전의 혈당조절 상태를 알수 있다. 이렇게 당화혈색소는 장기간에 걸쳐 서서히 당화되는 것으로 알려져 있으나, 저자들은 짧은 시간의 혈당농도 변화에도 약간의 변동이 있음을 경험할 수 있었다. 이에 저자들은 인슐린 비의존형 당뇨병환자를 대상으로 공복 및 식후 두시간의 혈당농도 및 당화혈색소량, 안정형 당화혈색소량, 불안정형 당화혈색소량을 측정한 후 비교검토하였다. 방법 : 인슐린 비의존형 당뇨병환자 166예를 대상으로 공복 및 식후 두시간의 혈당농도와 당화혈색소량을 동시에 측정한 후 식후 두시간에 공복시의 당화혈색소량을 뺀 값이 -0.3%이하를 Ⅰ군(n=9), +0.3%이상을 Ⅱ군(n=88), 그 사이를 Ⅲ군(n=69)으로 나누어 공복 및 식후 두시간의 혈당농도 변화에 따른 당화혈색소량의 변동을 고찰 하였다. 음식 및 치료에 따른 당화혈색소량의 변화를 배제하기 위하여 15예의 치료받지 않은 인슐린 비의존형 당뇨병환자에서 75g 경구당부하 검사를 하면서 혈당농도 변화에 따른 당화혈색소량의 변화를 관찰하였다. 단시간의 당화혈색소량 변동이 불안정형 당화혈색소량의 변동에 의한 것인가를 알아보기 위하여 37예의 인슐린 비의존형 당뇨병환자에서 식사전후에 혈당량 및 안정형 당화혈색소량과 불안정형 당화혈색소량을 측정한 후 비교 검토하였다. 혈당은 glucose oxidase 법으로 측정하였고 당화혈색소는 HPLC 법을 이용하여 측정하였다. 불안정형 당화혈색소는 식염수로 전항온을 이용하여 얻어진 안정형 당화혈색소를 총당화혈색소에서 빼내어 구하였다. 결과 : 1)공복시 혈당농도는 Ⅰ, Ⅱ, Ⅲ군에서 각각 264.9±51.63(평균±SEM)mg/dl, 203.1±12.16mg/dl, 205.5±13.40mg/dl였고, 공복시 당화혈소량은 11.1±1.37%, 9.8±1.32%, 10.5±0.36%로 각군간의 유의한 차이는 없었다. 2) 식후 두시간 혈당농도는 Ⅰ, Ⅱ, Ⅲ군에서 각각 185.1±33.42mg/dl, 306.3±13.69mg/dl, 248.4±10.25mg/dl로 각군간에 유의한 차이를 보였으나(p<0.01), 식후 두시간 당화혈색소량은 10.5±1.42%, 10.5±1.22%, 10.6±0.36%로 유의한 차이가 없었다. 3) 식후 두시간 혈당농도에서 공복시 혈당농도를 뺀값은 Ⅰ, Ⅱ, Ⅲ군에서 각각 -79.8±43.79mg/dl, 103.2±14.61mg/dl, 42.9±11.17mg/dl,로 각군간의 유의한 차이를 보였고 (p<0.001), 당화혈색소량의 찻값은 각각 -0.6±0.49%, 0.6±0.33%, 0.08±0.01%로 각군간의 유의한 차이를 보였다(p<0.001). 4) 75g 경구당부하 검사를 시행한 치료받지 않은 15예의 인슐린 비의존형 당뇨병환자에서 당부하전의 혈당농도가 113±13.4mg/dl에서 당부하후 두시간에 222±11.3mg/dl로 증가함에 따라 당화혈색소량은 7.2±1.3%에서 7.8±1.9%로 증가하였다(p<0.001). 5) 37예의 인슐린 비의존형 당뇨병환자에서 공복시, 식후 두시간 혈당농도가 164.1±9.61mg/dl에서 285.3±14.42mg/dl로 증가함에 따라 불안정형 당화혈색소량은 0.6±0.08%에서 1.3±0.16%로 유의한 증가를 보였으나(P<0.001), 안정형 당화혈색소량은 유의한 변화가 없었다. 6) 혈당농도와 당화혈색소량의 상관계수는 불안정형 당화혈색소량에서는 0.41, 안정형 당화혈색소량에서는 0.28로 불안정형 당화혈색소와의 상관계수가 더 높았다(p<0.001). 결론 : 이상의 결과로 단시간의 혈당량 변동이 HPLC법에 의한 당화혈색소량의 측정에 영향을 미칠수 있는 인자의 하나로 생각되며, 이는 단시간의 혈당농도 변동에 따른 불안정형 당화혈색소량의 변동에 의한 것임을 시사한다. Background : HbA_1C is formed slowly throughout the 120-day life span of the red blood cell by non-enzymatic glycosylation of HbA_O. HbA_1C concentrations reflect mean blood glucose levels over the previous several weeks, but we experienced the changes of hemoglobin A_1C values according to the short term changes of blood glucose levels. We investigated the changes of HbA_1C values with a HPLC technique according to the short term changes of blood glucose concentration. Method : HbA_1C values were measured at fasting and postprandial 2-hour state with a HPLC method in 166 NIDDM patients, and they are divided into three groups (Group Ⅰ : ??HbA_1C<-0.3%, Group Ⅱ : ??HbA_1C>0.3%, Group Ⅲ : -0.3%≤??HbA_1C≤0.3, ??HbA_1C : postprandial 2 hour HbAlc values-fasting HbA_1C values) and compared respectively. In 15 untreated NIDDM patients, blood glucose and HbA_1C were measured during the oral glucose tolerance test to exclude the influence of food and treatment on the HPLC method. Stable HbA_1C and labile HbA_1C were measured in 37 NIDDM patients to evaluate the influence of labile HbAlC on the HPLC method. Results : 1) In group Ⅰ, Ⅱ, Ⅲ, Postprandial 2-hour blood glucose levels (man±SEM) were 185.1±33.42mg/dl, 306. different respectively (p<0.01). fasting blood glucose levels, fasting HbA_1C values and postprandial 2-hour HbA_1C values were not significantly different among three gruops. 2) In group Ⅰ, Ⅱ, Ⅲ, the differences between postprandial 2-hour levels and fasting blood glucose levels were -79.8±43.79mg/dl, 103.2±14.61mg/dl, 42.9±11.17mg/dl, and the differences were highly significant (p<0.001). The mean ??HbA_1C values were -0.6±0.49%, 0.6±0.33, 0.08±0.01% respectively. 3) In 15 untreated NIDDM patients, HbA_1C values were significantly increased from 7.2±1.3% to 7.8±1.9% according to the increment of blood glucose levels from 164.1±9.61mg/dl to 285.3±14.42mg/dl (p<0.001), but stable HbA_1C values were not significantly changed. 5) Correlation between labile HbA_1C and blood glucose (r=0.41, p<0.001) was higher than that between stable HbA_1C and blood glucose (r=0.28, p<0.001). Conclusion :From the above results we can find that HbA_1C values measured with a HPLC technique change according to the short term changes of blood glucose levels, and the changes of HbA_1C values are caused by the short term changes of labile HbA_1C values.

제1형(Type I) 당뇨병 환자에서 급격한 당화혈색소 감소와 관련된 양안 당뇨유두병증

정승일(Seung Il Jung),한지상(Ji Sang Han),김도균(Do Gyun Kim) 대한안과학회 2015 대한안과학회지 Vol.56 No.12

목적: 제1형 당뇨병 환자에서 급격한 당화혈색소 감소로 인해 유발된 양안 당뇨유두병증을 경험하였기에 이를 보고하고자 한다. 증례요약: 39세 여자로 본원 내분비 내과에서 제1형(Type I) 당뇨병으로 진단 받았다. 최초 당뇨병 진단 시 당화혈색소 수치는 15.3%였고, 이때 시행한 안과적 검사에서 최대교정시력은 우안 1.0, 좌안 1.0이었으며 시력저하, 시야결손 등의 자각 증상은 없었으나 안저검사에서 가벼운 비증식당뇨망막병증의 소견이 보여 정기적으로 경과관찰하기로 했다. 인슐린을 이용해 혈당을 조절하여 두 달 후 당화혈색소는 7.6%로 급격한 감소를 보였으며, 최초 당뇨병 진단 3달 후 안과 정기검진에서 최대교정시력 및 자각 증상의 차이는 없었으나 안저검사에서 양안 유두부종의 소견이 관찰되었다. 유두부종의 원인을 밝히기 위하여 시행한 시신경기능검사, 망막의 형태 및 혈류검사와 뇌 자기공명영상검사에서 특이소견을 보이지 않아 양안 당뇨유두병증으로 진단하고 특별한 치료 없이 경과관찰하는 도중 양안 유두부종은 거의 회복되는 양상을 보였다. 결론: 본 증례는 제1형(Type I) 당뇨병 환자에서 급격한 당화혈색소 감소가 양안 당뇨유두병증 발생과 관련이 있다는 것을 보여주는 것으로, 급격한 혈당조절이 양안 당뇨유두병증의 위험인자일 것이라는 이전 연구결과를 뒷받침하는 증례라 생각되어 보고하는 바이다. Purpose: To report a case of bilateral diabetic papillopathy related to rapid hemoglobin A1c (HbA1c) decrease in a type I diabetic patient. Case summary: A 39-year-old female who was diagnosed with type I diabetes mellitus for the first time at this hospital was presented to our clinic for evaluation of diabetic retinopathy. There were no subjective symptoms, including blurred vision or visual defect. Her best corrected visual acuity in both eyes was 1.0, but her fundus resembled mild nonproliferative diabetic retinopathy. When diagnosed with type I diabetes mellitus, her HbA1c was 15.3%. She used insulin to control her blood glucose and her HbA1c reached 7.3% two months after controlling the blood glucose. Three months after her diabetic diagnosis, there were no differences in subjective symptoms and best corrected visual acuity. Fundus examination showed optic disc swelling in both eyes. To evaluate for the etiology of optic disc swelling, we did the examinations of the optic disc, fundus, and brain magnetic resonance imaging. No specific signs were observed. We diagnosed diabetic papillopathy and observed the patient without any treatments. Her optic disc swelling showed gradual improvement. Conclusions: This case shows that the rapid HbA1c decrease in type I diabetes mellitus is related to the occurrence of bilateral diabetic papillopathy. This supports previous studies that estimated that the rapid HbA1c decrease in type I diabetes mellitus in response to insulin treatment is one of the risk factors for bilateral diabetic papillopathy.

Features of partial remission in children with type 1 diabetes using the insulin dose-adjusted A1c definition and risk factors associated with nonremission

Wong Tsz Wai Catherine,Wong Man Yee Shirley,But Wai Man Betty 대한소아내분비학회 2021 Annals of Pediatirc Endocrinology & Metabolism Vol.26 No.2

Purpose: We sought to evaluate features of partial remission (PR) in children with type 1 diabetes mellitus (T1DM) using the insulin-dose adjusted A1c (IDAA1c) definition and to identify risk factors associated with nonremission. Methods: Medical records of patients with newly diagnosed T1DM between January 1, 2008, and June 30, 2018, were retrospectively reviewed. Hemoglobin A1c (HbA1c) readings and insulin total daily doses (TDDs) of each patient at each follow-up visit were obtained with IDAA1c values calculated. PR was defined as an IDAA1c score of 9 points or less within 6 months of diagnosis. The trends of HbA1c and TDD within 2 years after diagnosis were compared between remitters and nonremitters. Factors that may predict the occurrence of PR were studied, with their relative risks of nonremission calculated. Results: PR occurred in 26 patients (45.6%), including 8 girls and 18 boys, with a median duration of 8 months. The frequency of remission in male patients was significantly higher (P=0.002) and the relative risk of female sex with nonremission was 2.20 (95% confidence interval [CI], 1.24–3.91), which remained significant when adjusted by multivariate regression modeling. The initial HbA1c level at diagnosis was also significantly higher in the nonremission group (P=0.029), with a relative risk of 1.12 (95% CI, 1.01–1.25). Both HbA1c (P=0.012) and TDD (P=0.006) were significantly lower within 2 years after diagnosis among remitters than in nonremitters. TDD was significantly lower in male patients (P=0.029) during the same period, while there was no significant difference in HbA1c level between male and female patients (P=0.163). Conclusion: Both the initial HbA1c level at diagnosis and sex were factors associated with the occurrence of PR. Female sex was an independent risk factor of nonremission, likely resulting from a higher insulin requirement in female T1DM patients.