HbA_1c in der Diabetesdiagnostik

ZUSAMMENFASSUNG

Glykiertes Hämoglobin (HbA_1c) ist ein Maß für die Stoffwechseleinstellung und als Prädiktor für die Entwicklung diabetischer Komplikationen und als primärer Endpunkt für Interventionsstudien eingeführt. Seit 2010 wird HbA_1c auch als ein Diagnoseinstrument von vielen Fachgesellschaften und Organisationen wie der WHO und IDF eingesetzt. Trotz Standardisierung (IFCC-Standard) und Verbesserung der Bestimmungsmethoden, die insbesondere für die Diagnostik von großer Bedeutung sind, schwankt die Messgenauigkeit erheblich und erst kürzlich hat die Bundesärztekammer die Richtlinien (Rili-BÄK) für die analytische Richtigkeit und Präzision der HbA_1c-Messung deutlich verschärft. HbA_1c als ein zu Glukoseparametern alternativer/alleiniger Laborparameter ist für die Diabetesdiagnose zu wenig sensitiv. Zahlreiche Störfaktoren und unzählige in der Routinediagnostik kaum zu überschauende und zum Teil kaum bestimmbare Einflussfaktoren limitieren den Einsatz von HbA_1c als Diagnoseinstrument. Der HbA_1c- Schwellenwert von ≥ 48 mmol/mol Hb (≥ 6,5 %) ist ein expertenkonsentierter, viel zu hoher Wert, um in der Frühphase einen manifesten Diabetes auszuschließen. Daher sollten immer Glukoseparameter plus HbA_1c gleichzeitig zur Diagnostik bestimmt werden.

Publication History

Article published online:
02 March 2021

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