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Rapid in clinic measurement of glycated hemoglogin (HbA1c) allows to determine the level of metabolic control within a few minutes on capillary blood. We have evaluated the new DCA Vantage (Siemens) based on an immunological technique, replacing the DCA 2000+ (Siemens). The study included 120 unselected young type 1 diabetic patients, with different degrees of metabolic control. The DCA Vantage was compared with the HPLC system (Menarini HA 8160) whose deviation from the DCCT was < 0.1% across the clinical range. The mean underestimation of the DCA Vantage was -0.40%. The agreement limits (+/- 1.96 SD) were between 0.14% and -0.93%; this means +/- 0.53% around -0.40%. In conclusion, the DCA Vantage underestimates HbA1c levels; however it met the acceptance criteria of having a coefficient of variation < 3%.

The aim of the study was to assess the relative influence of mean blood glucose (MBG), glucose instability (GI) and biological variation of glycohemoglobin (BVG) on HbA1c. The study included 378 unselected young type 1 diabetic patients with a diabetes duration > 1 year. There were 1,409 visits with simultaneous HbA1c determinations and self-monitoring of BG meter downloads. GI was quantified by measuring the standard deviation (SD) of the recorded BG values. A statistical model was developed to predict HbA1c from MBG. Hemoglobin glycation index (HGI) was calculated (HGI = observed HbA1c--predicted HbA1c) for each visit to assess BVG based on the directional deviation of observed HbA1c from that predicted by MBG in the model. Afterwards, the population was divided by thirds into high-, moderate-, and low-HGI groups, i.e. high-, moderate-, and low-glycators, reflecting BVG. A total of 246,000 preprandial BG measurements were analysed, with a mean of 177 per visit. Grand MBG +/- SD was 171 +/- 40 mg/dl. Predicted HbA1c was calculated from the equation: 3.8399 + 0.0242 x MBG (r = 0.66; p < 0.0001). A MBG change of 40 mg/dl corresponded to 1% change in HbA1c, within the range 6-12%. Multiple regression analysis showed no significant relationship between SD and HbA1c, after adjustment for MBG. MBG was 10 times more important than SD to predict HbA1c. MBG was not statistically different between the high- and low glycators, but HbA1c was significantly different. Multiple linear regression was used to predict HbA1c from MBG, SD and BVG (measured by HGI), adjusted for age, duration, gender and ethnic origin. BVG and MBG had large influences on HbA1c, the impact of BVG being 84% of the impact of MBG. On the other hand, GI had only 17% of the impact of MBG. In conclusion the effect of BVG on HbA1c is independent and much greater that the influence attributable to GI. Hemoglobin glycation phenotype, responsible for BVG, may be important for the clinical assessment of diabetic patients in order to avoid complications.

Objective: To investigate whether high sensitivity C-reactive protein (hs CRP) levels are elevated in young type 1 diabetic patients and to determine the relationships with age, degree of metabolic control determined by glycated hemoglobin (HbA1c), blood lipids, and subclinical complications., Methods: High sensitivity CRP was determined in young type 1 diabetic patients and in healthy controls. Blood lipids and HbA1c were also determined. The patients were divided into 2 groups. In group A, patients were free from subclinical complications (retinopathy, nephropathy and neuropathy) and in group B, patients had at least one subclinical complication., Results: The hs CRP concentrations were significantly higher in the 126 diabetic patients (55 girls and 71 boys) than in the 52 controls (2.6+/-4mg/L vs 0.7+/-0.7mg/L; p<0.001). This difference persisted when comparing the normal subjects with the 81 patients of group A (2.0+/-3.1mg/L; p<0.01) and the 45 patients of group B (3.6+/-5.1mg/L; p<0.001). The hs CRP concentrations were significantly correlated with total cholesterol, total cholesterol/HDL-cholesterol ratio, and LDL cholesterol for the 2 groups of patients. In the patients of group A, significant correlations were observed between hs CRP and age or duration of diabetes. No correlation was observed between hs CRP levels and glycaemia, HbA1c and HDL-cholesterol in the two groups of patients., Conclusion: Levels of hs CRP were 3-fold greater in diabetic patients without complications than in controls and 5-fold greater in diabetic patients with subclinical complications. High sensitive CRP therefore appears to be an interesting indicator of the risk for developing complications.

The aim of this study is to determine, in an unselected population of diabetic children and adolescents < 18 years of age, which HbA1c levels can be achieved, and to compare 2 different HPLC (High Performance Liquid Chromatography) methods. One hundred and fourty-four unselected subjects (73 boys and 71 girls), with a diabetes duration ranging from 5 months to 15 years were included. HbA1c was measured simultaneously in our hospital and at the Steno Institute in Danemark. The mean (SD) HbA1c levels in the 144 children and adolescents were 6.6 +/- 1.2% using our method (normal values: 3.9-5.5%), and 7.7 +/- 1.1% at the Steno Institute (normal values : 4.4-6.3%), with a mean difference of 1.1 +/- 0.4%. Therefore, one must be cautious when comparing HbA1c levels, even by HPLC, between laboratories. Moreover, the lack of HbA1c standardization makes difficult to define HbA1c thresholds in order to avoid diabetic complications. In more than 60% of the patients, it is possible to obtain an HbA1c level under the normal mean value plus 5 SD. In the other paediatric studies, HbA1c levels are higher, whatever the type of treatment.

The pathogenesis of premature atherosclerosis in diabetic patients has not yet been fully elucidated, but it seems to be related to changes in circulating lipoproteins and to a poor metabolic balance. In this study plasma levels of triglycerides (TG), total cholesterol (TC), HDL- and LDL-cholesterols, apolipoproteins (Apo) A1 and B were measured in 120 young patients aged from 4 to 32 years (mean +/- 1 SD: 17 +/- 6 years) whose diabetes had been present for a mean period of 10 +/- 6 years (range: less than one year to 25 years). The results obtained were analysed in relation to glycosylated haemoglobin (N: 6.8 +/- 0.6 per cent) and plasma fructosamine (N: 1.9 +/- 0.2 mmol/l) levels. The patients were divided into 3 groups according to their HbA 1 level: (group 1: less than 9 per cent, group 2: 9 per cent less than or equal to HbA1 less than 11 per cent; group 3: greater than or equal to 11 per cent. The most significant increases of TG, TC, LDL-C and ApoB levels were observed in group 3, i.e. in patients whose diabetes was the most poorly controlled (HbA 1: 12.9 +/- 1.3 per cent; fructosamine: 4.6 +/- 0.9 mmol/l). These parameters were significantly correlated with HbA1 (p less than 0.01) and even more significantly with fructosamine (p less than 0.001). No significant difference in HDL-C and ApoA1 levels was found in the 3 groups of patients. Thus, TG, TC, LDL-C and ApoB are increased in young diabetics whose HbA1 and fructosamine levels exceed reference values by more than 5 standard deviations.

Recent studies have cast doubt on the concept of causative association between parathyroidectomy for primary hyperparathyroidism and postoperative pancreatitis. The present study indicated that the relationship was real and that the development of acute pancreatitis after parathyroid surgery was not purely incidental. Acute pancreatitis was observed postoperatively in 3 p. 100 of cases after parathyroidectomy (6/196 cases), in 37 p. 100 after pancreatic surgery (19/51 cases), but never after thyroidectomy (100 cases) or other extra-abdominal operations (100 cases). During the first five postoperative days, the incidence of hyperamylasemia was 16 p. 100 after parathyroidectomy, 47 p. 100 after pancreatic surgery, 3 p. 100 after thyroidectomy, 2 p. 100 after other extra-abdominal operations. During the same period, the frequency of hyperlipasemia was similar: 20 p. 100 after parathyroidectomy, 54 p. 100 after pancreatic surgery, 1 p. 100 after thyroidectomy, 0 p. 100 after other extra-abdominal operations. In all cases with hyperamylasemia after parathyroidectomy, the pancreatic fractions of amylase isoenzymes were abnormally elevated.