Video Lecture Diabetes Mellitus & Metabolic Syndrome

The prevalence of diabetes mellitus continues to increase. A number of complications including kidney disease, blindness, amputations, and cardiovascular disease are associated with poor glycemic control. The glycation of hemoglobin and its subsequent measurement as HbA1c is the best biomarker of these long term complications. HbA1c can be measured by ion exchange, immunoassay, enzymatic, and boronate affinity methods. All of these methods can be harmonized to provide comparable results. Data from accuracy-based proficiency testing surveys that use fresh whole blood specimens demonstrate the current state of the art of harmonization efforts. A number of factors have the potential to disrupt the normal relationship between mean plasma glucose and HbA1c. These include alterations in red cell survival and hemoglobin variants. Despite some limitations of HbA1c testing, our healthcare system has many opportunities to improve the medical management of patients with diabetes mellitus.

Different organizations have different criteria for metabolic syndrome. Even the concept of metabolic syndrome is somewhat controversial. Most definitions included central obesity, insulin resistance, dyslipidemia and hypertension. With an increase in the prevalence of obesity, the number of individuals with a constellation of these problems is increasing. Individuals with metabolic syndrome have an increased risk for myocardial infarction, cerebrovascular disease, and diabetes mellitus. A number of laboratory tests may be useful in patients with metabolic syndrome including various lipid parameters, markers of inflammation like C-reactive protein, serum creatinine, and urine microalbumin. The dyslipidemia associated with metabolic syndrome is associated with a decrease in HDL-cholesterol, an increase in triglycerides and triglyceride-rich lipoprotein particles and an increase in the number of LDL particles. Therapeutic lifestyle changes, including diet and exercise, can be beneficial to patients with the metabolic syndrome by reducing their risk of cardiovascular disease and diabetes mellitus.

Originally presented February 23th, 2009 in Park City, Utah.

Lecture Presenter

William L. Roberts, MD, PhD William L. Roberts, MD, PhD
Professor, Department of Pathology, University of Utah
Medical Director, Automated Core Lab and Director of Clinical Chemistry at ARUP Laboratories

Dr. Roberts has engaged in research on the performance characteristics of a large number of clinical chemistry assays. Factors that have been evaluated include linearity, imprecision, pediatric and adult reference intervals, comparison with other methods, interferences, and cross-reacting substances, both endogenous and exogenous. Some analytes that require additional efforts to standardize results have been identified.

Objectives

After this presentation, attendees will be able to:

  • Explain the rationale for using HbA1c to diagnose diabetes mellitus.
  • List the components of a HbA1c result report based on international consensus.
  • Be able to describe how the estimated average glucose is calculated and the limitations of its use.
  • Be able to outline the pathophysiology of the metabolic syndrome
  • Be able to list diagnostic criteria for the metabolic syndrome
  • Be familiar with laboratory tests useful for the diagnosis and monitoring of the metabolic syndrome

Sponsored by:

University of Utah School of Medicine and ARUP Laboratories