title: Prevalence of hemoglobin variants in a diabetic population at high risk of hemoglobinopathies and optimization of HbA1c monitoring by incorporating HPLC in the laboratory workup.
abstract: In Tunisia, diabetes mellitus and hemoglobinopathies are major public health problems. Glycated hemoglobin (HbA1c) is recommended for long-term monitoring of diabetes mellitus, but the presence of hemoglobin variants may interfere with HbA1c measurement. The aim was to determine the prevalence of hemoglobin variants in Tunisian diabetics and optimize the monitoring of diabetics using HbA1c.
  
  
  
  The study enrolled 9,792 Tunisian diabetic patients. HbA1c was measured by cation-exchange high-pressure liquid chromatography (HPLC). All the chromatograms were analyzed for the presence of Hb variants.
  
  
  
  We identified 228 cases (2.33%) of Hb variants with D-10 HPLC (Bio-Rad): 191 with HbA/S trait, 27 with HbA/C trait, and 10 hemoglobin variants with the mention 'Variant-Window' on the chromatograms and subsequently identified as HbA/S on Variant I HPLC (Bio-Rad). Thus, the prevalence of HbS was 2.05%. We did not find any homozygous variant. All HbA1c results were reported to the treating physician.
  
  
  
  To evaluate glycated hemoglobin in populations with a high prevalence of hemoglobinopathies, we should use the HPLC method, which is easy, economical, and reliable. Based on an algorithm, hemoglobin variants visualized on HPLC should be reported to the physician to improve the management of patients.
authors.affiliation: Laboratory of Clinical Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia; Faculty of Medicine University El Manar-Tunis, El Manar, Tunisia; Laboratory of Engineering of Proteins and Bioactive Molecules: LR 11EES24:LIP-MB, Tunis, Tunisia; kahh2005@yahoo.fr.
authors.forename: Kahena
authors.initials: K
authors.lastname: Bouzid
authors.affiliation: Department of Cardiology, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Habib B
authors.initials: HB
authors.lastname: Ahmed
authors.affiliation: Laboratory of Clinical Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Eya
authors.initials: E
authors.lastname: Kalai
authors.affiliation: Laboratory of Clinical Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia;
authors.forename: Salma
authors.initials: S
authors.lastname: Blibeche
authors.affiliation: Department of Molecular Genetics and Biochemistry, Robert Debré Hospital, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Couque
authors.affiliation: Department of Endocrinology, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Karima
authors.initials: K
authors.lastname: Khiari
authors.affiliation: Laboratory of Clinical Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Afef
authors.initials: A
authors.lastname: Bahlous
authors.affiliation: Laboratory of Clinical Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Jaouida
authors.initials: J
authors.lastname: Abdelmoula
mesh_terms: D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D002851:Chromatography, High Pressure Liquid; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D014644:Genetic Variation; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006453:Hemoglobinopathies / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015995:Prevalence; D012306:Risk; D014416:Tunisia / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: HPLC; HbA1c; Tunisia; diabetes mellitus; hemoglobinopathies; prevalence