Limitations of glycated haemoglobin (HbA1c) in Sulaimani diagnostic laboratories

Abstract

HbA1c is the test of choice in many countries to monitor and diagnose diabetes. There are continuing debates on the HBA1c usage. HBA1c has some limitations, for example, HBA1c test should not be used in pregnant women and children under the age of 13, vitamin B12 deficiency and Hypertriglycemia increases HBA1c levels, many other conditions such as iron deficiency anemia, stage 4 or 5 chronic kidney disease, hemoglobinopathy all interfere with HBA1c results. Moreover, sensitivity and specificity of the test vary among different ethnic groups. In this study, we aimed to investigate the knowledge of health professionals on HBA1c test limitations and to assess the frequency of HBA1c usage in the pediatric population. We also assessed the quality of the instruments used in Sulaimani laboratories (labs) to evaluate HBA1c. One hundred (100) diagnostic labs in Sulaimani city was surveyed to determine HBA1c instruments types used in labs. A one-page questionnaire on the practice and HBA1c limitations test was given to 100 health professionals. Most of the health professionals in this study were unaware of the limitations of the HBA1c test, 99% of the physicians were unaware of the inaccuracy of the point of cares testing (POCT) devices and the frequency of POCT uses in Sulaimani diagnostic labs. Surprisingly, Sulaimani Pediatric hospital used the HBA1c test to monitor and diagnose type 1 diabetes patients. Our survey also showed Cobas C111 analyzer was the most common (47.8%) type of instrument used in Sulaimani city. the advantage was used by 8% of the labs, Biohermes and auto accent was used by 4.3% of labs. Surprisingly, the Diabetes and Endocrine Center in Sulaimani used the POCT device SD A1cCare instrument. In conclusion, almost all health professionals were unaware of the HBA1c limitations. Continuing education programs to all health professional should be mandated in Sulaimani city hospitals to ensure high quality of the HBA1c test. Most importantly, health professionals need to be aware that POCT is widely used in Sulaimani labs and that POCT is considered an inaccurate method for HBA1c evaluation. Pediatric physicians need to be reminded that HBA1c is not recommended in children.