Hemoglobina glicada e frutosamina como biomarcador glicêmico em idosos

Abstract

Diabetes mellitus (DM) is a syndrome characterized by a failure in insulin secretion. DM can be classified as type I (one), caused due to the inability to secrete the hormone insulin and type II (two) that occurs through the combination between resistance to action of insulin and the inadequate compensatory secretory response of this hormone. Glycated hemoglobin, also known as HbA1c, refers to the portion of hemoglobin that binds to glucose in the bloodstream and is a widely used marker in clinical practice for monitoring the glycemia levels of the diabetic patient. Fructosamine is formed through the non-enzymatic mechanism that involves the binding of serum glucose to serum proteins, especially albumin, to form ketoamines. It is mainly used in circumstances where the use of HbA1c is not valid because of interferences, such as changes in the red cell lifetime. The use of these two methods in laboratory medicine becomes an important strategy in the glycemic control of patients. This study aimed to analyze the association of glycated hemoglobin and fructosamine exams as glycemic marker in elderly residents in a Trindade-GO shelter. This cross-sectional study analyzed serum levels of glycosylated hemoglobin, fructosamine and glucose in the investigation of the glycemic profile of elderly patients living in Lar Ana de Almeida. Thirteen elderly men and women aged between 70 and 89 years participated in this study. The dosages of fructosamine varied from 168 to 293 μmol / L, with reference values ​​of 205 to 285 μmol / L. For glycated hemoglobin there were variations between 4.8% and 8.2% with reference values: normal <5.7%, pre-diabetes 5.7% to 6.4% and diabetes ≥ 6.5%. The results showed a positive Pearson correlation between glycated hemoglobin and fructosamine, but in contrast the correlation between fructosamine and estimated glycemia was weak. High glycemic levels were evidenced among the participants, even the feeding being performed only in the asylum. This fact may be associated to a lack of physical activity, since none of the elderly practiced any exercise, besides the lack of accurate information related to the diet. Our findings also showed that the elderly were polymedicated. Studies indicate that the use of medications may interfere with clinical outcomes leading to misinterpretations, not reflecting the actual condition of the patient. Our results allowed us to conclude that glycated hemoglobin is an excellent glycemic marker and that fructosamine is a weak marker because it presents limitations when diagnosing glycemic levels acquired in the first days, thus failing to measure high levels in the long term. Taking into account the shortage of papers relating laboratory abnormalities in elderly patients with the use of medications and diet, we suggest further studies to clarify the results in order to better understand these circumstances.