Tests for Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) Levels are intended to screen and measure the levels of these particular important substances in the body and to recommend treatments and corrective measures.

Hemoglobin A1c (HbA1c) or glycosylated hemoglobin is a rough indication of blood sugar control in people with diabetes mellitus over the preceding 3 months. As more glucose (blood sugar) circulates in the blood on a daily basis, more glucose is bound to the circulating hemoglobin. Normal hemoglobin A1c levels range between 4% to 5.9%. As this number reaches 6% or greater, it signifies poorer diabetes control. A hemoglobin A1c of 6% roughly correlates with an average blood sugar level of 135mg/dL (milligrams per deciliters) over the previous 3 months. Each 1% increase in hemoglobin A1c above 6% represents an average blood sugar of approximately 35mg/dL over 135mg/dL. For example, a hemoglobin A1c measurement of 7% corresponds to an average blood sugar level of 170mg/dL in the previous 3 months. It is a valuable tool for monitoring diabetes and diagnosing type 2 diabetes [1-5].

A serum cholesterol test, also called a lipid profile or lipid panel, is a simple blood test to monitor the cholesterol levels in the blood. A total cholesterol test, also known as the Serum Cholesterol test, is a blood test that measures cholesterol and triglyceride levels in your blood. A cholesterol test is useful to figure out how likely a person is to develop fatty deposits (plaques) in the arteries that can lead to narrowing or blockage of arteries (atherosclerosis).

High cholesterol levels are a common cause of coronary artery disease or stroke. The total serum cholesterol in adults should be less than 200mg/dL. Serum cholesterol tests help the doctor figure out whether a patient is at risk of developing heart disease in the next 10 years. The AHA recommends that adults older than 20 have their serum cholesterol levels and other indicators of heart disease checked every 4–6 years. A person with a higher risk of complications related to high blood pressure may need to have their serum cholesterol levels checked more frequently. Individuals with diabetes should also test their cholesterol levels more often, as diabetes can increase the levels of LDL cholesterol [6-10].

Thyroid Stimulating Hormone (TSH) is the primary hormone of your pituitary gland that regulates the function of your thyroid gland. Physicians depend on the serum TSH test because it keeps the production of all the other hormones in check. Also, the hormone acts as the signaling molecule that guides your thyroid gland to release other thyroid hormones in the blood. Hence, the serum TSH test is an essential parameter for understanding the functioning of the thyroid gland. Maintaining the health of your thyroid gland is very important because it has a vital role in regulating your body’s metabolism and other functions. Thus, constant fatigue, restlessness, depression, anxiety, and sudden weight gain are common symptoms to make you undergo a serum TSH test. If there are sufficient thyroid hormones in the body, TSH levels are under control. However, if thyroid hormones are low or excess, a serum TSH test will return abnormal results. A serum TSH test allows the physician to diagnose a severe problem related to the thyroid gland without the onset of symptoms. Moreover, this test is also suitable for confirming or ruling out hyperthyroidism and hypothyroidism [11-15].

There is a paucity of studies which analyzed the Laboratory Records for Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) tests. Against this backdrop, the study was conducted to evaluate the results of Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) done at a Private Laboratory in New Delhi. 

Objectives of the Study

To evaluate the results of Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) done at a Private Laboratory in New Delhi. 

Research Approach

Descriptive survey

Study Design

A retrospective review

Setting of the Study

Labcorp Diagnostics Pvt Ltd, New Delhi

Study Duration

Between 1^st to 31^st January 2022

Study Population

Participants who were undergone Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) tests.

Sample Size

All study participants who were undergone Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) tests during the study period.

Permission

Obtained from the concerned authorities of Laboratory.

Data Analysis

Laboratory data during the study period were retrieved, entered in MS Excel and analyzed using Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage.

In the present retrospective review, laboratory data of 169 study participants who were undergone Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) tests were analyzed. 

The mean Hemoglobin A1c (HbA1c) level was 6.07±1.294%. 61(36.1%) had their HbA1c level in the normal range, 77(45.6%) had HbA1c level below the normal range while only 31(18.3%) study participants had their HbA1c level above the normal range.

Mean Serum cholesterol Level was 191±47.547mg/dL. 75(44.4%) had their Serum cholesterol Level in normal range, 94(55.6%) had Serum cholesterol Level above the normal range and none of the study participants had their Serum cholesterol Level below the normal range.

Mean Serum TSH Level was 2.950±2.156mIU/L. 149(88.2%) had their Serum TSH Level in normal range, 16(9.5%) had Serum TSH Level above the normal range while only 4(2.4%) of the study participants had their Serum TSH Level below the normal range (Table 1). 

Table 1: Analysis of the results of Hemoglobin A1c (HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) tests

Present study was done to analyze the results of Hemoglobin A1c(HbA1c), Serum Cholesterol, and Thyroid Stimulating Hormone (TSH) tests done at a Private Laboratory in New Delhi. 

In the present study, 61(36.1%) had their HbA1c level in normal range, 77(45.6%) had HbA1c level below the normal range while only 31(18.3%) study participants had their HbA1c level above the normal range. An HbA1c test may be used to check for diabetes or prediabetes in adults. Prediabetes means your blood sugar levels show you are at risk for getting diabetes. If you already have diabetes, an HbA1c test can help monitor your condition and glucose levels. The Centers for Disease Control (CDC) recommends that adults over the age of 45 get tested to screen for diabetes and prediabetes. If your results are normal, you should repeat the test every 3 years. If your results show you have prediabetes, you should get tested every 1-2 years. You should also talk to your health care provider about taking steps to reduce your risk of developing diabetes. If you are under 45, you may need this test if you have certain risk factors. These include being overweight or obese, High blood pressure, History of heart disease and Physical inactivity. Testing should be done every 3 years, and more frequently if your results show you have prediabetes. You may also need an HbA1c test if you have symptoms of diabetes. These include increased thirst, increased urination, Blurred vision, Fatigue etc. A normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. Within the 5.7% to 6.4% prediabetes range, the higher your A1C, the greater your risk is for developing type 2 diabetes [1-5].

Elevated A1C levels are a significant risk factor for cardiovascular diseases and stroke in people who may have diabetes. As A1C percentages rise, so does the risk of prediabetes becoming type 2 diabetes and complications arising in those who already have a diabetes diagnosis. If you have diabetes, the American Diabetes Association recommends keeping your HbA1c levels below 7%. Your health care provider may have other recommendations for you, depending on your overall health, age, weight, and other factors. Younger people have more years with diabetes ahead, so their goal may be lower to reduce the risk of complications unless they often have hypoglycemia (low blood sugar, or a “low”). People who are older, have severe lows, or have other serious health problems may have a higher goal [1-5].

In the current study, 75(44.4%) had their Serum cholesterol Level in the normal range, 94(55.6%) had Serum cholesterol Levels above the normal range and none of the study participants had their Serum cholesterol Level below the normal range. A person’s serum cholesterol level represents the amount of total cholesterol in their blood. A person’s serum cholesterol level comprises the amount of high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides in the blood. A person’s serum cholesterol level can indicate their risk of developing conditions such as heart disease. People often refer to LDL cholesterol as “bad” cholesterol and to HDL cholesterol as “good” cholesterol. LDL cholesterol can build up in a person’s arteries, clogging them and reducing blood flow. This is why cholesterol has links to heart disease. While LDL cholesterol builds up and blocks arteries, HDL cholesterol attaches to other cholesterol in the blood and unsticks it from artery walls. Typically, a person with higher levels of HDL cholesterol and lower levels of LDL cholesterol will have a more optimal serum cholesterol measurement. This is because HDL cholesterol helps reduce the presence of LDL cholesterol in the blood. It can also prevent LDL cholesterol from collecting and from forming hard deposits, or plaques, which stick to artery walls and reduce blood flow. Plaques can become so large that they cause the arteries to narrow and stiffen over time. This in turn can lead to ischemic heart disease and diseases, such as stroke and vascular dementia. A significant amount of LDL cholesterol in arteries can prevent enough blood and oxygen from reaching organs and tissues, resulting in severe health complications. A cholesterol plaque buildup can break off and move to different arteries in the body. This will make the blockage of blood more severe, as it can lead to a stroke. Cholesterol embolism, which is a clot that moves, can also occur in different parts of the body, including other organs, such as the kidneys, and cause damage. Complications of high serum cholesterol levels include coronary artery disease, stroke, heart attack, organ or tissue damage etc [6-10].

Changing the diet is an effective way to lower LDL cholesterol levels. Reducing the consumption of trans fats can be an important first step in bringing cholesterol levels down. According to the American Heart Association (AHA), trans and saturated fats should account for no more than 6%Trusted Source of a person’s daily intake of calories. If a person consumes 2,000 calories per day, they should only take in 11–13 grams of saturated fats per day. Other dietary and lifestyle changes that can help people reach optimum cholesterol levels include eating fewer full fat dairy products, such as whole milk, butter, cream, and cheese, eating less red meat, pork, lamb, and poultry with skin, avoiding heavily processed foods, limiting the consumption of oils high in trans fats, eating fewer refined carbohydrates, such as those present in pastries, breads, crackers, and chips, avoiding sugary foods and drinks, such as candy, chocolate bars, juices, pre-made smoothies, sodas, and energy drinks, quitting smoking, if applicable, reducing alcohol consumption, if applicable, exercising regularly, addressing related medical conditions, including diabetes and high blood pressure. Keeping a food diary can help a person identify room for improvement and develop healthier habits. A doctor may prescribe medications for people with high cholesterol for whom dietary and lifestyle changes prove ineffective. The most commonly prescribed drugs for cholesterol control are statins. Several types of statins are available. Each kind works a little differently in the body, but they all work to lower your LDL levels. Some may improve HDL and triglycerides, but the main focus is LDL reduction [6-10].

In our study, 149(88.2%) had their Serum TSH Level in normal range, 16(9.5%) had Serum TSH Level above the normal range while only 4(2.4%) of the study participants had their Serum TSH Level below the normal range. A thyroid-stimulating hormone test measures the levels of this hormone in the body. The test helps determine whether or not the thyroid, a small gland in the throat, is functioning correctly. The thyroid releases hormones that regulate metabolism and other bodily functions. Normal thyroid-stimulating hormone (TSH) levels typically fall between 0.4 and 4.0 milliunits per liter(mU/L), according to the American Thyroid Association (ATA). Higher levels suggest hypothyroidism, or an underactive thyroid, while lower levels indicate hyperthyroidism, or an overactive thyroid. When TSH and thyroid hormones are out of balance, this can cause a range of issues relating to the muscles, breathing, body temperature, and more. The TSH test helps doctors diagnose common thyroid disorders, such as hyperthyroidism and hypothyroidism. The signs and symptoms of hyperthyroidism, in which the thyroid overproduces hormones, include anxiety or irritability, bulging eyes, fatigue, increased appetite, increased sensitivity to heat, menstrual changes, muscle weakness, rapid or irregular heart rate, sleep problems, increased sweating, thinning skin or hair, tremors, weight loss with no apparent cause, and goiter, which is an abnormally enlarged thyroid gland People with hypothyroidism, where the thyroid does not produce enough hormones, may experience signs and symptoms that include aches and pains, constipation, depression and memory problems, dry skin, fatigue, goiter, high cholesterol, hoarseness, low heart rate, menstrual changes, muscle weakness, sensitivity to cold temperatures, thinning hair and weight gain. A TSH test may also help indicate other types of thyroid problem, such as Graves’ disease, which causes greater activity of the thyroid, Hashimoto’s thyroiditis, an autoimmune condition where the body attacks the thyroid, thyroid nodules, which are lumps on the thyroid that contribute to an overactive thyroid, inflammation of the thyroid gland, called thyroiditis and postpartum thyroiditis, which is temporary thyroiditis following pregnancy People who have a known thyroid disorder may have regular TSH testing to monitor their condition and the effectiveness of their treatment [11-15].

If a person’s results show them to have high or low levels of TSH, they will usually require further testing to determine the underlying issue. Thyroid problems are usually easy to manage with medications, surgery, or a combination of both treatments. People who have a thyroid disorder are likely to require regular TSH testing to ensure that their symptoms remain under control [11-15].

Present study concluded that almost one fifth of the study participants had their Hemoglobin A1c (HbA1c) level above the normal range, more than half of the study participants had their Serum cholesterol Level above the normal range while almost one tenth of study participants had their Serum TSH Level above the normal range.

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