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Diabetes aktuell 2021; 19(01): 22-29
DOI: 10.1055/a-1306-8016
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HbA1c in der Diabetesdiagnostik

Der Goldstandard?
Rüdiger Landgraf
1   Deutsche Diabetes Stiftung, Düsseldorf
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ZUSAMMENFASSUNG

Glykiertes Hämoglobin (HbA1c) ist ein Maß für die Stoffwechseleinstellung und als Prädiktor für die Entwicklung diabetischer Komplikationen und als primärer Endpunkt für Interventionsstudien eingeführt. Seit 2010 wird HbA1c 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 HbA1c-Messung deutlich verschärft. HbA1c 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 HbA1c als Diagnoseinstrument. Der HbA1c- 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 HbA1c gleichzeitig zur Diagnostik bestimmt werden.



Publication History

Article published online:
02 March 2021

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