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09-08-2011 | Internal medicine | Article

HPLC for hemoglobinopathy may detect undiagnosed diabetes


Free abstract

MedWire News: Nearly a quarter of patients with an elevated peak 2 (P2) fraction during high performance liquid chromatography (HPLC) for hemoglobinopathy diagnosis have undiagnosed diabetes mellitus, study findings indicate.

Barbara Bain (St Mary's Hospital, London, UK) and colleagues explain that diabetic specimens typically exhibit an elevated P2 fraction when using a β-Thalassaemia program on a commercially available HLPC instrument.

They therefore investigated how often previously undiagnosed diabetes is detected during high HPLC for hemoglobinopathy diagnosis, using 2094 patient samples gathered during a 3-month period.

Of these, 50 (2.4%) samples had an apparent increase in the glycated hemoglobin fraction, as defined by a P2 fraction at or above 6.0%, which is equivalent to a glycosylated hemoglobin level of 6.6% or more.

Further investigation revealed that 38 of the 50 samples with elevated P2 were from patients with known diabetes.

Previously undiagnosed diabetes was discovered in 11 patients, and it is likely that the 12th patient, who was lost to follow-up, also had diabetes, remark the researchers.

Therefore, including the patient lost to follow-up, 24.0% of patients with a P2 fraction of 6% or more had previously undiagnosed diabetes. These patients represent 0.6% of the total investigated during the study.

The researchers note that if an HPLC instrument is calibrated for the diagnosis of hemoglobinopathies and thalassaemias, the P2 or equivalent peak cannot be used for either the diagnosis of diabetes or for monitoring the adequacy of control of glycemia.

"Nevertheless, we have found that following-up patients with an elevated P2 fraction leads to the diagnosis of previously unsuspected diabetes mellitus in a significant number of patients," they write in the Journal of Clinical Pathology.

"We now routinely alert clinical staff to the fact that the patient has an increased glycated fraction and that the possibility of diabetes should therefore be investigated," they conclude.

By Laura Dean

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