# Utility of Estimating Glycated Hemoglobin in Sodium Fluoride Tube and by Turbidimetric Immunoinhibition Method: Our Experience in a Tertiary Care Cancer Centre

## TL;DR

This study shows that glycated hemoglobin (HbA1c) can be accurately measured from a single blood sample in a sodium fluoride tube, eliminating the need for an additional EDTA tube in cancer patients with diabetes.

## Contribution

The study demonstrates that HbA1c can be reliably estimated from sodium fluoride tubes using turbidimetric immunoinhibition, comparable to standard HPLC methods.

## Key findings

- HbA1c values measured from sodium fluoride and EDTA tubes showed no significant difference using HPLC or turbidimetric immunoinhibition methods.
- A strong and significant correlation was observed between HbA1c values obtained from both tube types and methods.
- The results confirm that using a single sodium fluoride tube is sufficient for estimating HbA1c in cancer patients.

## Abstract

Background

Diabetes mellitus in cancer patients is monitored by measuring blood glucose levels and glycated hemoglobin (HbA1c) collected in sodium fluoride and EDTA tube respectively. This study intends to estimate HbA1c from a sodium fluoride tube and compare it with a standard EDTA tube eliminating the requirement of collecting additional samples in an already challenging venipuncture in cancer patients and also compare HbA1c levels estimated by turbidimetric immunoinhibition with reference high-performance liquid chromatography (HPLC) method.

Methods

This cross-sectional study was conducted at the Department of Biochemistry of Tata Memorial Hospital, Mumbai, India, over a period of five months. Blood samples of patients received in sodium fluoride and EDTA tubes at the same time for estimation of blood glucose and HbA1c respectively were included in the study. HbA1c results by HPLC method on Bio-Rad D10 analyzer were compared with turbidimetric immunoinhibition method on Beckman Coulter AU 5800 analyzer. Data was analyzed using statistical software SPSS version 29.

Results

Blood samples of 384 patients, of which 193 (50.3%) were female and 191 (49.7%) were male with an average age of 55.2 ± 12.4 years were included in the study. The majority of these samples were from 78 (20.3%), 77 (20.1%) and 60 (15.6%) patients with urological cancers, breast cancer and gastrointestinal cancers, respectively. There was no significant difference in the average HbA1c value estimated from EDTA and sodium fluoride tube by HPLC (6.71±1.7 and 6.71±1.7, respectively) and turbidimetric immunoinhibition (6.74±1.6 and 6.72±1.7, respectively) method. A strong and significant correlation was observed in HbA1c values estimated from either tube by both methods (p-value <0.0001).

Conclusion

Our study confirms that HbA1c can be conveniently estimated from a sodium fluoride tube, thereby eliminating the necessity of an EDTA tube for the same and it also observes that HbA1c results by HPLC and turbidimetric immunoinhibition method are comparable and thus can be analyzed by either of the methods interchangeably.