The use of HbA1c for the diagnosis of type 2 Diabetes in Urban PNG.

This post is more for people in the health care profession and aims to stimulate discussion on the study I am currently doing and also about diabetes research in PNG in general. 

There has been a paucity in research on this important lifestyle disease which I hope to put an end to by stimilating a renneisance of diabetes research amongst the PNG medical community with this and subsequent studies in the future. 

I encourage more of my colleagues to take up research of any scale, even private general practitioners are positioned in a very fertile place for some very useful research. Not only will research lead to our overall knowledge but it will enhance their own practice as GPs.

For anyone wanting to collaborate in research with me whether big or small I would be happy to work through some ideas and getting on with it.

For now however my focus is on my Masters in Medicine research. For this I am doing a pilot study looking at the potential use of the HbA1c test as a diagnostic tool for type 2 diabetes in PNG. 

The HbA1c test has been used since the mid 1980’s and is now universally accepted as the most reliable means of monitoring long-term glycaemic control. A diabetes clinic in this day and age should not be without this important test.

Having said that, unfortunately its use in PNG has been very low due to lack of its availability in many of the major hospital in the country.  

With our current economic boom and an increased number of manufacturers of this important test driving down its costs we no longer have the excuse of lack of money not to have these tests available in all our hospitals for the care of our people living with diabetes.

More recently the use of HbA1c as a diagnostic tool has been accepted by several of the major organizations including the American Diabetes Association(ADA), the International Diabetes Federation (IDF) and WHO.

Advantages of HbA1c testing compared with FPG or 2HPG for the diagnosis of diabetes

● Standardized and aligned to the DCCT/ UKPDS; measurement of glucose is less well standardized

● Better index of overall glycemic exposure and risk for long-term complications

● Substantially less biologic variability

● Substantially less preanalytic instability

● No need for fasting or timed samples.

● Relatively unaffected by acute (e.g., stress or illness related) perturbations in glucose levels

● Currently used to guide management and adjust treatment.

Ref: Review article by The International Expert Committe. Diabetes Care, Vol 32, Numbe4 7, July 2009

The WHO recommendation is that:

‘HbA1c can be used as a diagnostic test for diabetes providing that stringent quality assurance tests are in place and assays are standardised to criteria aligned to the international reference values, and there are no conditions present which preclude its accurate measurement’

In my study I am assessing the performance of the HbA1c test (using a robust and internationally well validated point of care instrument) as a diagnostic test for diabetes in comparison with the fasting plasma glucose test in an urban Port Moresby population.

I will also be looking at prevalence rates and other lifestyle diseases risk factors.  The findings so far are interesting and are a cause for alarm and drastic interventions from all. Watch this space for the results and further insight into diabetes in PNG.

About Dr. Poyap J Rooney

Dr. Rooney is a medical doctor who has gained both his undergraduate medical degree and more recently his post graduate masters degree in clinical biochemistry at the University of Papua New Guinea.
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