<prompt> Long term glycaemic control in DM withTotal proteinGlycated haemoglobinTotal haemoglobinGlucose tolerance test  <response>: Glycated haemoglobin 2296-H17thMeasurement of glycated haemoglobin is the standard method for assessing long term glycaemic controlWhen plasma glucose is consistently elevated there is an increase in non enzymatic glycation of haemoglobin small amount of HbA are non enzymaticaly glycated to form HbAjcThis alteration reflects the glycemic history over previous 2-3 months since erythrocytes have an average life span of 120 days HbAlc assay performed by the high performance liquid chromatography HPLCHbAir measurement becomes unreliable in condition like- Haemoglobinopathies- Hemolytic anemia- Uremia An alternative indicator of glycemic control when HbAjc is inaccurate is glycated albumin Nomal values 4-6 of the total hemoglobin When HPLC the HbAlc approximate the following mean plasma glucose value HbAlc 6 is 7.5 mmolL 135mg ldl7 is 9.5 mmol.L 170 mgdl8 is 11.5 mmolL 205 mgdLal rise in HbA1c translates into 2.0 mmoldL 35mgdL increase the mean glucoseGLUCOSE TOLERANCE TEST Most valuable in investigating a case of symptomless glycosuria such as renal glycosuria and lag type glycosuria Helpful in recognizing milder case of DM and early DMDecrease Glucose toleranceIncreased glucose tolerance DM In hyper activity of anterior pituitary and adrenal cortex Hyperthyroidism Hypopitutarism Hyperinsulinism Hypothyroidism Adrenal cortical hypofunction such as Addisons disease If there is decreased absorption like sprue, celiac disease Fructosamine assay albumin generally reflects the status of glycemic control for only the preceding 2 weeks Important for - hemoglobinopathies or hemolytic states or when a narrower time frame is required such as for ascertaining glycemic control at the time of conception in a diabetic women who has recently become pregnant CMDT 