Point Of Care Testing In Diabetic Patients: The Use Of Glycated Hemoglobin And Blood Glucose Assays And Their Application In Diabetic Mice Model

Abstract

This study aimed at using point of care testing for glycated hemoglobin and blood glucose assays to determine management of diabetes in patients at Nyeri provincial general hospital and the trends of the same in induced hyperglycemic mice. It studied the relationship of glycated hemoglobin and casual blood glucose in 157 diabetic patients. Five mice induced with intraperitoneal alloxan monohydrate were used to detect early changes in glycated hemoglobin. Patients who consented to the study were purposefully selected using inclusion/exclusion criteria. A questionnaire was then administered to the selected patients and their venous blood collected for HbAlc and casual blood glucose measurement. The same parameters were also assayed in Balb C mice model. Mean age of patients was 61±14 years (mean ± SD with a range of 18-90 years) with 62% females and 38% males. Glycemic control varied in different age groups with poor glycemic control (HbAlc: >9%) being highest in age group 60-79 years (27.4%). Age and medication significantly influenced the outcome of glycated hemoglobin (p<0.05). Mean casual blood glucose was 12.1 ± 7.03mmol/L (lSD). Twenty four percent of the patients had borderline controlled glucose while 44% were uncontrolled and 32% had controlled glucose. Correlation between casual blood glucose and glycated hemoglobin was significant (r=0.66, p<0.05) and casual blood glucose when compared with previous blood glucose (r=0.59, p<0.05) was also significantly correlated. Hypertension and retinopathy were highest in patients with poor glycemic control (34.4% and 14.7%, respectively) but the difference was not significant (p=0.783). Glycated hemoglobin and blood glucose in humans study showed linear associations (y=0.256x + 6.224, r=0.65). Effective dose that produced hyperglycemia in mice was found to be 300mg/kg alloxan monohydrate at volume of 0.2ml given intraperitoneally as a single dose. The study showed that age and medication used by patients significantly (p=0.001, p=0.004 respectively) affect glycemic control. Mice experiments revealed that glycated hemoglobin can be measured as it increases steadily after induction of hyperglycemia and the linear equations can be used to predict glycated hemoglobin. In conclusion, majority of patients had poor glycemic control resulting in complications such as retinopathy and hypertension. Human kits for glycated hemoglobin can be used to measure glycated hemoglobin in hyperglycemic mice, a model that may be used in diabetes mellitus patients. Regular glycated hemoglobin testing is therefore recommended clinically as a national test for diabetes management