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Title: A study of glycated proteins and proteinuria in diabetes
Author: Hill, R. P.
ISNI:       0000 0001 3578 4544
Awarding Body: Nottingham Trent University
Current Institution: Nottingham Trent University
Date of Award: 1995
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The extent to which haemoglobin is glycated has been examined by extracting globin from haemolysed red blood cells and measuring globin's ability to reduce the dye nitroblue tetrazolium in alkaline solution. This analytical principle has been developed into a new semi-automated assay for glycated haemoglobin. Results of a clinical evaluation of the assay suggest that it may be suitable for monitoring diabetes and could possibly join other established glycated proteins as pseudo outcome measurements for the clinical audit of diabetes care. Novel fluoroimmunoassay and latex enhanced immunoturbidimetry assays for measuring urine albumin have been developed and compared with polyethylene glycol (PEG) enhanced immunoturbidimetry. Results suggested that in-house methods requiring antibody to solid phase binding were less reproducible and sensitive than PEG enhanced immunoturbidimetry. Using polyethylene glycol enhanced immunoturbidimetry, diabetic microalbuminuria was detected in a large sample of over 1000 diabetic patients. The incidence of microalbuminuria was similar to published incidences in the medical literature. A small trial has been conducted which tests the effect of imparting knowledge of adverse health risks, as determined by the presence of microalbuminuria, upon the ability of a group of patients to improve glycaemic control. Glycaemic control has been assessed using the newly developed glycated globin assay, glycated haemoglobin and serum fructosamine. The results of the trial suggest that, surprisingly, the group of patients who were aware of their microalbuminuria did not significantly improve their glycaemic control. The median increment between measurements made on entry into the study and 12-18 months later for the patients subjected to intensive support was -1.05 mmol/g Total Protein x 10³ (glycated globin), 0.2 mmol/L (fructosamine) and -0.15% (GHb). A negative sign indicates that the median glycated protein at the end of the study period was higher than at the beginning. These results are discussed alongside the results of the recent Diabetes Control and Complications Trial. The implication of this research on the Clinical Audit of Diabetes Care are presented.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Microalbuminuria; Monitoring