Hemoglobina glicosilada

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Si eres diabético habrás oído hablar de la hemoglobina glicosilada o hemoglobina A1C. Es posible que te hayan explicado por encima que significa o para qué sirve. A lo largo de este post vamos a intentar explicarte en qué consiste, para que poco a poco vayas conociendo mejor tu diabetes.

Dentro que los controles de las personas diabéticas, hay algunas pruebas que deben pedirse cada cierto tiempo para ir valorando si existe un buen control. Una de esas pruebas es la hemoglobina glicosilada.

¿Qué es la hemoglobina glicosilada?

La hemoglobina glicosilada es un valor de la analítica de sangre que nos dice la media de tus glucemias de los últimos 3 meses.

Cuando te haces controles de glucemia con el glucómetro, lo que obtenemos es una glucemia puntual, la del momento en que te pinchas. Pero como bien sabrás, la glucemia va cambiando a lo largo del día. Si te pinchas muchas veces a lo largo del día para ver tus niveles de azúcar, verás que los resultados van variando. Podría decirse que la glucemia que obtienes al usar el glucómetro es como una foto del momento, nos da la información de ese momento en concreto.

La hemoglobina glicosilada nos hace una media de los niveles de azúcar en sangre de los últimos 3 meses.niveles glucemia

Nuestros glóbulos rojos en la sangre contienen una proteína que se llama hemoglobina. La glucosa que circula con la sangre, tiene la capacidad de adherirse a la hemoglobina del glóbulo rojo. La glucosa permanece unida a la hemoglobina durante todo el tiempo que vive el glóbulo rojo, que son 90-120 días.

Cuando medimos la hemoglobina glicosilada lo que hacemos es medir la cantidad de glucosa unida a los glóbulos rojos de la sangre. El resultado se expresa en porcentaje (%) y expresa el promedio de glucemias de los 3 meses previos a la analítica.

El estudio DDCT (Diabetes Control and Complications Trial), realizado en EEUU a lo largo de 10 años con personas que padecían Diabetes Tipo 1, demostró que mantener la hemoglobina glicosilada en valores cercanos a los normales reduce significativamente la posibilidad de desarrollar complicaciones crónicas como consecuencia de la diabetes.

¿Los valores de la hemoglobina glicosilada pueden alterarse por otras causas distintas a mis glucemias?

La respuesta es sí. Cualquier alteración que afecte el recambio natural de los glóbulos rojos puede modificar los valores de tu hemoglobina glicosilada.

Por ejemplo, una hemorragia intensa, una anemia hemolítica, una transfusión de sangre o el embarazo son algunas de las situaciones que podrían causar falsos descensos.

Por otra parte, la ingesta de elevadas dosis de ácido acetil salicílico, de vitamina C, de alcohol o unas cifras altas de lípidos en sangre podrías darnos falsos aumentos de las cifras de hemoglobina glicosilada.

hemoglobina glicosilada

¿Cuál es el valor ideal de hemoglobina glicosilada?

Aunque generalmente se recomienda un valor de hemoglobina glicosilada de 6.5-7%, el valor ideal de hemoglobina glicosilada hay que determinarlo de forma individual para cada uno.

En niños y ancianos, hemos de ser más cuidadosos porque corremos el riesgo de hacer hipoglucemias.

El valor ideal depende de muchos factores como si tienes una diabetes tipo 1 o una diabetes tipo 2. También depende de tu edad, de otras enfermedades que puedas tener y del tiempo de evolución de su diabetes. De manera que la cifra adecuada de hemoglobina glicosilada que debes alcanzar tendrá que determinarla tu médico en función de varios factores.

¿Puedo saber cuáles son mis niveles medios de glucosa en sangre a partir de la hemoglobina glicosilada?

Sí. Aquí tenéis una tabla de equivalencias que nos permite calcular un promedio aproximado de nuestra glucemia en sangre las 24 horas del día en función de la hemoglobina glicosilada. Es un promedio estimado, no real. Recordemos que los valores de glucosa en sangre van cambiando a lo largo del día como si de una montaña rusa se tratase.

equivalencia glicada y promedio gucemia

 ¿Cada cuánto tiempo debo hacerme una valoración si soy diabético?

Las guías recomiendan medir la hemoglobina glicosilada al menos 2 veces al año. Dado que la hemoglobina glicosilada nos da el resultado de las glucemias de los últimos 3 meses, podría solicitarse un control de hemoglobina glicosilada cada 3 meses. Esto lo valorará el médico en función del grado de control de tu diabetes.

¿Cómo me hacen la prueba para medir la hemoglobina glicosilada?

La prueba consiste en una analítica de sangre normal. Se manda a laboratorio y allí la calculan.

En algunos centros existen equipos portátiles que la calculan a través de una muestra de sangre capilar, como la que te haces tú en casa para ver los niveles de azúcar. Se mete la muestra en el aparato y en 5-6 minutos se obtiene el resultado.


Marta Cano Pazos
Médico especialista en Medicina Familiar y Comunitaria, C. S. Puebla de Sanabria

REFERENCIAS:

  1. American Diabetes Association
  2. http://care.diabetesjournals.org/content/10/1/1
  3. American Diabetes Association. Standards of medical care in diabetes–2014. Diabetes Care. 2014;37 Suppl 1:S14-80. PubMed PMID: 24357209

Revisado: junio 2016

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