La HbA1c en el diagnóstico y en el manejo de la diabetes

  • Germán Campuzano Maya Laboratorio Clínico Hematológico, Universidad de Antioquia
  • Guillermo Latorre Sierra Universidad de Antioquia
Palabras clave: diabetes, hemoglobina glicada, HbA1c, diagnóstico y manejo de la diabetes, métodos para medir HbA1c, factores preanalíticos, factores analíticos, factores posanalíticos.

Resumen

La humanidad enfrenta una epidemia de diabetes que avanza incontenible. De acuerdo con la Organización Mundial de la Salud, la población mundial de diabéticos ha pasado de 30 millones en 1985 a 220 millones en 2009 y se espera que para el 2030 esta cifra llegue 336 millones. La diabetes se define como un estado hiperglucémico que con el correr de los años se manifiesta por daño a múltiples órganos, siendo la primera causa de ceguera, de falla renal y de amputaciones en los adultos, y una de las principales causas de enfermedad cardiaca y de trombosis. Desde que se descubrió la hemoglobina A1C (HbA1c), ésta ha sido el indicador más fiel para monitorear los pacientes diabéticos y gracias a la estandarización alcanzada en la prueba en los últimos años, la American Diabetes Association (ADA) la incorporó recientemente como el primer criterio de diagnóstico de diabetes en individuos asintomáticos o con sospecha clínica de esta enfermedad. La ADA ha definido tres puntos de corte para la HbA1c: ≤ 5,6%, nivel no diabético; entre 5,7% y 6,4%, nivel prediabético; y, ≥ 6,5%, compatible con el diagnóstico de diabetes. Igualmente, la ADA mantiene como la meta en el tratamiento del paciente diabético un nivel de HbA1c ≤ 7%. Además de la definición de los puntos de corte, enfatiza en la necesidad de que las pruebas se hagan en un laboratorio clínico que utilice instrumentos y reactivos certificados por el NGSP (National Glycohemoglobin Standardization Program) y estandarizados de acuerdo con las especificaciones del DCCT (Diabetes Control and Complications Trial). En el módulo se analizan los aspectos clínicos y epidemiológicos de la diabetes mellitus y los aspectos históricos de la prueba, las bases de la glicación como un fenómeno bioquímico no-enzimático, los métodos disponibles para medir la HbA1c y los factores preanalíticos, analíticos y posanalíticos que podrían afectar la prueba, que tanto el médico como el laboratorio clínico deben conocer al momento de solicitar o de hacer la prueba, respectivamente.

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Biografía del autor/a

Germán Campuzano Maya, Laboratorio Clínico Hematológico, Universidad de Antioquia

Médico especialista en Hematología y Patología Clínica. Docente, Ad Honorem, Facultad de Medicina, Universidad de Antioquia. Médico Director, Laboratorio Clínico Hematológico.

Guillermo Latorre Sierra, Universidad de Antioquia

Médico especialista en Medicina Interna y Endocrinología. Profesor titular, Jefe de la Sección de Endocrinología y Metabolismo. Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

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Cómo citar
1.
Campuzano Maya G, Latorre Sierra G. La HbA1c en el diagnóstico y en el manejo de la diabetes. Med. Lab. [Internet]. 1 de mayo de 2010 [citado 17 de octubre de 2021];16(5-6):211-4. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/388
Publicado
2010-05-01
Sección
La Clínica y el Laboratorio

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