Diabetes (diabetes mellitus)

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.
When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin makes it possible for our cells to take in the glucose.
Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop.
A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.
How to determine whether you have diabetes, prediabetes or neither
Doctors can determine whether a patient has a normal metabolism, prediabetes or diabetes in one of three different ways - there are three possible tests:
The A1C test
  • at least 6.5% means diabetes
  • between 5.7% and 5.99% means prediabetes
  • less than 5.7% means normal
The FPG (fasting plasma glucose) test
  • at least 126 mg/dl means diabetes
  • between 100 mg/dl and 125.99 mg/dl means prediabetes
  • less than 100 mg/dl means normal
An abnormal reading following the FPG means the patient has impaired fasting glucose (IFG)
The OGTT (oral glucose tolerance test)
  • at least 200 mg/dl means diabetes
  • between 140 and 199.9 mg/dl means prediabetes
  • less than 140 mg/dl means normal
An abnormal reading following the OGTT means the patient has impaired glucose tolerance (IGT)
Reference :
Medical New Today


New test for detecting biomarkers for cancer and diabetes is more than 1000x more detailed and 100% faster than existing methods, new research by the University of Warwick suggests. Developed to undertake a detailed study of collagen, the researchers argue that the same methodology can be used with any protein-based sample and is currently being tested with cancer cells and proteins relevant to Type II diabetes. Named 2D Mass Spectrometry (2DMS), the test provides a new tool in the rapidly expanding field research into the structure and function of proteins, Proteomics. Led by the O'Connor Research Group in the University of Warwick's Department of Chemistry, the researchers found that the large protein collagen can be sliced into smaller fragments and analyzed by multidimensional mass spectrometry to yield data which is 1000x more detailed than previously possible with mass spectrometry, and 100% faster than analyzing the same sample by existing techniques. Commenting on 2DMS and its potential Prof. Peter O'Connor, of the University of Warwick's department of Chemistry and leader of the O’Connor Group, said: "Within each and every cancer cell there are at least a million peptides comprising the protein machines that enable the cell to function.

Understanding the structure and chemistry of all peptides and proteins will enable ground-breaking treatments to be developed, with 2DMS providing a new tool for studying them in far greater detail than before". 2DMS was inspired by tools from the field of nuclear magnetic resonance whereby signals are spread out on a multidimensional canvas, by modulating particular signals in the sample and then tracing those modulation frequencies in the final signal. O'Connor explains: "The 2DMS method modulates ion signal intensities in a way which carries over into fragment ion signals, and therefore allows the researchers to correlate individual fragment ion signals with their precursor ion - effectively allowing sequencing of each molecule in the sample simultaneously." "Since collagen has more than 400 individual peptide signals and whole cells have tens of thousands, this method saves a huge amount of time because there is no need to individually isolate and fragment each one serially; they are all fragmented together in parallel, and the data can be then extracted into individual fragment scans." This application of 2DMS originates in the undergraduate thesis project of University of Warwick Chemistry student Hayley Simon. Initially aiming to find all the known crosslinks in collagen she ran into difficulty in processing the data due to the need to isolate each of the >400 precursor peptide ions and sequence them individually. Ms. Simon then decided to try the new 2DMS technique and managed to achieve a remarkable level of separation and very detailed information.

Discussing the work Ms. Simon said: "When studied by mass spectrometry, many species in the digested collagen sample appear similar. Disentangling this data, while accounting for multiple possible explanations, presented us with a significant challenge. Usually, the separation of species like this would not be possible without running many experiments." "By using 2DMS, we were able to collect information about everything we observed in the collagen sample, performing just one experiment. After processing, the results are presented as a single spectrum, allowing patterns to be easily recognized. This helps identify components in the sample, which in turn can be used to determine structural information about the protein.

'Multiplicative' Benefit of Cholesterol and Blood Pressure-Lowering on Cardiovascular Risk
Long-term exposure to the combination of even modestly lower LDL cholesterol (LDL-C) and systolic blood pressure (SBP) has the potential to "dramatically reduce" a person's lifetime risk of cardiovascular disease, according to new findings reported at ESC Congress 2016.
The results, presented in a Hot Line session here, "demonstrate for the first time that LDL cholesterol and SBP have independent, multiplicative, and cumulative causal effects on the risk of cardiovascular disease," said the study's lead investigator Brian Ference MD, from Wayne State University School of Medicine, in Detroit.
"This suggests that a simple strategy that encourages long-term exposure to the combined reduction of both one mmol/L in LDL-C and 10 mmHg SBP has the potential to "largely eliminate" the lifetime risk of cardiovascular disease -- with a reduction of up to 90%," he explained.
The study used genetic and cardiovascular risk factor data from 102,773 individuals who had participated in 14 prospective cohort or case-control studies.
Investigators calculated genetic scores for each patient based on inherited polymorphisms known to be associated of LDL-C or SBP and the number of alleles associated with raised LDL-C or SBP levels.
Participants were then divided into 4 groups: the reference group, a group with an LDL-C genetic score below the median (resulting in lower LDL-C), a group with a SBP genetic score below the median (resulting in lower SBP), and a group with both LDL-C and SBP genetic scores below the median (resulting in both lower LDL-C and lower SBP).
The researchers then looked at the cardiovascular risk associated with the different genetic scores, with the primary outcome being a composite of the first occurrence of either coronary death, non-fatal myocardial infarction (MI), non-fatal stroke, or coronary revascularization.
There were 14,368 primary outcome events among the subjects.
Compared to the reference group, subjects in the lower LDL-C group had 54.2% lower risk of the primary outcome (OR 0.458), those in the lower SBP group had 44.7% lower risk (OR 0.553), and those in the combined lower LDL-C and SBP group had 86.1% lower risk (OR 0.139).
"The results of our study confirm that cardiovascular disease is largely preventable and suggest that this prevention can be substantially simplified by focusing on programs that promote longterm exposure to the combination of both lower LDL and lower SBP," concluded Dr. Ference. He added that "further study is needed to identify who might benefit most from this type of early intervention."

“Now measuring Coagulation factors made easy … with Mispa Clog Plus”

Mispa Clog Plus is a Semi-automated single channel coagulation analyzer which is based on Photometry principle. Very simple & convenient with Card Calibration. No programming required. Just insert the card & start the testing.
Two modes are available - Control & sample mode. User friendly, easy to operate software. Number of test done and remaining and stability of the reagent will be displayed on the screen every time you insert the card. Three Parameter are available PT, APTT and Fibrinogen.
  • Smart card technology: Entering ISI value for the PT reagent is now easy. Just insert the smart card provided with the kit and all the details regarding the reagent is loaded automatically.
  •  Dual Channel System: Two different wavelengths are available for performing coagulation and quantification assays.
  •  Complete solution for testing: The reagent kit is having all the reagents and consumables like Cuvettes and beads. No need to buy them separately.
  • Quality Control: To assure the quality of testing, specific quality control materials are available
  • Real time monitoring: Number of tests remaining in a kit is monitored to have better control on the inventory
  • Stability check: Stability of the reagent is checked always to make sure that no false results are given due to expired reagent
  • Ergonomic design: New generation design which requires very less space.

“AGA1c – The HbA1c with a difference”

Diabetes is one of the world's major diseases and India ranks among top 3 countries with diabetic population of more than 62 million.
To satisfy the need of the medical community towards the management of diabetes, Agappe introduced AGA1c.

  • Agappe was THE FIRST COMPANY to offer Double reagent HbA1C to Indian market. - The Trend setter
  • Agappe is THE ONLY company with  the capability to manufacture HbA1c in India. - The Leader
  • Agappe is the FIRST Indian manufacturer to get NGSP certificate - Quality at its Best
  • Agappe is THE ONLY company in India to get NGSP certification for SIX YEARS CONSEQUITIVELY - The Best . Always
  • Agappe is THE LARGEST HbA1c seller in India - The most Trusted
What makes AGA1c different?

  • Latex enhanced Immunoturbidimetry Method - Uses ultra-micron latex particles and 2 types of antibodies for High Specificity, Sensitivity & Reproducibility
  • Direct Method - Directly measures A1c in % - Highly Precise & Accurate result
  • Two Reagent Liquid stable Reagents - No stability problems
  • NGSP Standardized DCCT Reference material & correlated with HPLC - Ensured Accuracy
  • 4 level calibrator provided along with kit - No extra cost
Agappe salutes Medical fraternity for your contributions in  controlling this deadly disease.

Agappe's AGCRP with LEIT is the Gold Standard Inflammation Marker in the Indian IVD…

CRP is one of the most effective early marker of inflammation and infection. CRP is the earliest to measure inflammation because it increases so drastically, for faster Treatment and monitoring. It can signal flare-ups of inflammatory diseases such as rheumatoid arthritis, lupus, and vasculitis.
What makes AGCRP a Gold Standard Product?

  • Latex Enhanced Immunoturbidimetric assay for better sensitivity & specificity
  • Unique Ultra-micron Latex particles coated with Anti CRP  antibodies gives better sensitivity
  • Ultra-micron latex particles ensures no interference & no flow cell blockages
  • Wide measuring range of 1 - 200 mg/L
  • High Prozone limit > 1000mg/L
  • No false negative because of high antibody content of 3:1 ratio (R1:R2) whereas in turbilatex assay it is 9:1
  • Calibrator is provided with every kit to takes out extra calibrator cost
  • Limited interference from common interfering substances ensures specificity
An accurate CRP test result provides valuable information to prevent unnecessary antibiotic prescriptions!

“'AGECRT' The New Era”

Once upon a time, Conventional Calorimetric Jaffe's test ( discovered on 1886) had assayed creatinine.

  • Giving Poor precision and accuracy at low creatinine concentrations
  • Staining analyzer tubing and cuvettes with caustic Picric Acid.
  • Suffered greatly from interferences from Bilirubin, Ascorbic acid, Hb
  • Failed to assay neonatal samples where non-creatinine chromogens interfere
It's the time to move on to Enzymatic Creatinine Method -  'AGECRT' The New Era.
  • Trouble Free
  • 4 weeks calibration and on- board stability
  • High Specificity
  • No interferences from Bilirubin & drugs 
  • Non-toxic reagents
  • No residue Deposit
  • Low Sample volume
  • Suitable for neonatal, paediatric and urine samples
  • High Linearity
  • Results Correlated with HPLC –
  • Accuracy Traceable with NIST SRM
Several studies concluded that enzymatic method is suitable as a routine diagnostic laboratory method for the measurement of serum creatinine, particularly for diabetic ketotic patients, neonates, and patients receiving cephalosporins.
Interferences in Jaffe Creatinine Assay  Can Lead To Misdiagnosis And Misclassification…
For Highly Specific, Accurate & Reproducible Results… AGECRT is the only option.

“Agappe’s AGHDL is unique, because it is the only HDL with Selective inhibition”

Simple and precise methods for HDL-C measurements are essential for assessment of cardiovascular disease (CVD) risks. Agappe always bring innovative products to serve the humanity…

What makes AGHDL different from Others?
  • AGHDL uses the most innovative & specific methodology with ions for HDL estimation. By this electrostatic interaction, all lipoproteins other than HDL will be suppressed. Also, it detects all kinds of HDL(free, ester, Apo E-rich) and ensures 100% accuracy.
  • Other players are using Detergents for the separation of Lipoprotein. Detergent is not specific, so incomplete precipitation. Detergent may cause interference & carry over.  This leads to inaccuracy in reporting.
  • AGHDL gives accurate results even with Lipemic samples.
  • As per the comparison studies, many of the competitor HDL sometimes affected by high Triglyceride because it captures some abnormal lipoprotein as HDL cholesterol. This leads to misleading results.
We have accuracy Proof…  CDC certification and high correlation with Ultracentrifugation.
Let’s experience the most accurate HDL, AGHDL, From… The top HDL reagent seller of India… The largest IVD reagent manufacturer of India…

‘Agappe is the first Indian company to launch Glucose Hexokinase in open market….AGGLH’

Diabetes mellitus is major health problem in India. The accurate measurement of glucose is important in the diagnosis and management of diabetes. That’s why American Association of Clinical Chemistry developed Hexokinase method and this method has been accepted as the Reference method for glucose determination.
  • Hexokinase Method – The reference method for Glucose estimation developed by AACC 
  • Excellent Linearity of 900 mg/dL - Reduce rerun of the high sample, saves time & cost
  • Fast Reaction - Only 5 minutes to complete reaction, fast reporting
  • High accuracy, CV <2% - Excellent CV shows the reliability of method
  • High Reagent Stability – One-month on board reagent stability, No frequent calibration required
  • Provided 2mL Calibrator for along with kit - Accuracy ensured with no Extra Cost

Why Direct LDL is better than … Calculation???

LDL is an vital tool to access individuals risk for developing Coronary Heart Disease. This is a key factor for 70% heart diseases. Studies proved that >60% misclassification of patient happened by Friedewald equation. That’s why, NCEP ATP III recommends that LDL should be directly measured as a new feature of the guidelines.

Why Direct LDL is better than … Calculation???

• Calculation an Indirect measurement, an estimation – AGLDL is a direct assay
• Multiple assays and multiple sample steps, increased imprecision and inaccuracy in calculation – AGLDL is with highly specific Selective Solubilization method
• Triglycerides / 5 algorithm is inaccurate with increasing triglyceride levels, with triglycerides >200 mg/dL, LDL cannot be reported – AGLDL assay has no interference for TGL upto 3000mg/dL, safe to report lipemic samples
• Calculated LDL does not correlate well in patients with diabetes, coronary disease, or other atheroscleroic diseases (In Metabolic Disorders). - AGLDL assay has no such limitations
• For calculation, sample must be fasting to avoid triglyceride bias – AGLDL assay does not require fasting
• HDL reagent/method variation will affect calculation – AGLDL is a direct assay, not depends on HDL estimation
What makes AGLDL a Gold Standard product
• Selective Solubilization method  for better specificity & accuracy
• Improved less reactivity to VLDL remnant similar to IDL for better specificity
• Accuracy traceable to Centre for Disease Control & Prevention reference
• Excellent correlation with Gold standard ultra-centrifugation method
• Wide measuring range of 1 - 700 mg/dL
• Calibrator is provided with every kit to takes out extra cost
• Limited interference from common interfering substances like TGL, Bil, Hb, Ascorbic Acid etc, no sample pre-treatment

Importance of Lipid profile.
Monitoring and maintaining healthy lipid levels in the blood is crucial to stay healthy.
Lipid profile test or lipid panel measures the specific levels of lipids in blood. The lipid profile test is usually performed as a screening test in healthy people, to estimate their cardiovascular risk (of heart attack or stroke).
Today, it is estimated that 50% of the population have cardiovascular disease. With all our sedentary lives, bad dietary choices, genetic predisposition, and of course diabetes, there is a build-up of cholesterol. This cholesterol colludes with fat and calcium, and forms a deadly mixture called plaque that tends to obstruct the blood flow in the arteries. This leads to serious complications like atherosclerosis, coronary heart disease, cerebrovascular disease, peripheral artery disease, and heart attack.
What should be the frequency of Lipid profile check?
AACC recommendations:
Screening when no risk factors present: for adults, every four to six years; for youths, once between the ages of 9 and 11 and again between ages 17 and 21.
Monitoring: at regular intervals when risk factors are present, when prior results showed high risk levels, and/or to monitor effectiveness of treatment
Complete Lipid Profile can be divided to three and it includes,
Standard Lipid Profile:  Cholesterol, Triglycerides, HDL, LDL
Extended Lipid Profile: Apo A & Apo B
Emerging Risk Factors: CRP ultra & Lipoprotein(a)
Total cholesterol —This test measures all of the cholesterol in all the lipoprotein particles. Directly linked to risk of heart and blood vessel disease.
Triglycerides — Elevated in obese or diabetic patients. TGL level increases from eating simple sugars or drinking alcohol. It is associated with heart and blood vessel disease.
High-density lipoprotein cholesterol (HDL-C) — measures the cholesterol in HDL particles; often called "good cholesterol. High levels linked to a reduced risk of heart and blood vessel disease.
Low-density lipoprotein cholesterol (LDL-C) — measures the cholesterol in LDL particles; often called "bad cholesterol".  High levels are linked to an increased risk of heart. LDL levels is a major treatment target for cholesterol-lowering medications.
Apo A - It is a component of HDL particles and is often used as a biomarker for prediction of cardiovascular diseases. This test is important especially a person has low level of high-density lipoprotein (HDL-C).
Apo B - It is a component of LDL particles and it may eventually prove to be a better indicator of risk of cardiovascular disease (CVD) than LDL-C
The ratio ApoB/ApoA  had a stronger correlation with myocardial infarction event rates than lipid and lipoprotein concentrations.
CRP ultra – this test accurately measures low levels of C-reactive protein to identify low but persistent levels of inflammation and thus helps to predict a person's risk of developing CVD.
Lipoprotein(a)- As high levels of Lp(a) travel through the bloodstream, it collects in the arteries, leading to gradual narrowing of the artery. It can increase the risk of blood clots, heart attack or stroke.
A lipid profile is a fast, efficient way to stay healthy and deal with any future heart disease or stock.

Mispa i3 – Innovation at its finest
We designed our first product identity “The intelligent Breed” pictured as a child following the word “i” that reflects intelligence. Launch of intelligent breed series is more than a diagnostic innovation, it was an answer to the customer’s every day challenges.
Mispa i3 is an automated Cartridge based specific protein analyzer that offers the benefits of automated analyzer, like high precision and quick turnaround results, for all protein assays and supports the clinical management of variety of disease, such as Diabetes, cardiovascular risk, inflammation, kidney disease and other specific protein assays.
Mispa i3 reagents coming in sealed cartridges, so there is no chance for contamination and no reagent wastage. Mispa i3 provides convenient pack sizes for high work load as well as for low work load customers. There is no need of cuvettes or other accessories for running test, no consumable cost.
For the innovation of Mispa i3, AGAPPE has been selected as the winner of National Awards 2018 for the “Indigenous Development of Technology and Commercialisation” and also awarded with "CII Industrial Innovation Awards 2017 - one of the Top 26 Innovative Organisation".

Mispa Count

We at Agappe always try to bring innovative products in IVD industry. Mispa count is a revolutionary 3 part + hematology analyser which offers advanced technology solutions to meet the laboratory quality needs. Mispa Count comes with German Technology, having benefits of an entry level 5 part analyser with smaller aperture size for better electrical impedance to get high quality results.
Our Mispa Count is 3 Part differential Hematology Analyzer with 18 parameters and 3 histograms, 10,00,000 sample result storage capacity and through put of 60 samples per hour.

  • Mispa Count has got a large colorful 8.4” LCD display. Due to Large screen, both hemogram and results can be seen in a better way.
  • The ergonomic shape of the equipment gives a better visibility which will avoid, documentation error.
  • Mispa Count has dual sampling mode, only 10ul for Whole blood, and 20ul for Pre-diluted sample.
  • Mispa Count use PTFE (Poly Tetra Fluro Ethylene) syringe module for high precision in aspiration and dispensing. PTFE is long lasting and durable.
  • Mispa Count has got dual measuring chamber. (Auto diluted sample, RBC & PLT is measured in one chamber and WBC & HGB is measured in another chamber.
  • HGB is measured through 545nm LED.
  • In Mispa Count, we provide 50 aperture size for RBC/PLT and 80 for WBC for the optimum measurement.
  • Dual counting of each sample gives precise value. If there is any deviation above 5% in these two counts, equipment will Fixed multi discriminator in RBC, PLT & WBC differentiate the cells for better counting.

Importance of Diabetic Profile
Diabetes mellitus (DM), simply means high blood sugar level, is a silent killer and it kills you 10 years before your time as per the study conducted by Oxford university. Diabetes is a condition in which the body either does not produce enough insulin, or does not properly respond to insulin. Individuals with diabetes are at increased risk of heart and kidney disease, retinopathy, neuropathy, and nonalcoholic fatty liver disease.
Along with blood sugar control, people with diabetes need to have an eye on their cholesterol levels because Diabetes is associated with high lipids, clinically known as diabetic dyslipidemia. Later this excess fat may build up in liver and leads to nonalcoholic fatty liver disease. Medical health experts assert that regular check-ups and timely detection plays a vital role in controlling and managing the diabetic problems. Proper Diabetic profile testing is very important for the timely detection and monitoring of Diabetes.
What should be the frequency of Diabetic profile check?
The guidelines for frequency are based on diabetes risk.
Screening when no risk factors present: Test in every three years
Screening when risk factors present: Older than 45, a family history of diabetes / high blood pressure / high cholesterol should test once in a year
  • If your blood sugar control is good – four times a year
  • If your blood sugar control is poor – Every month
Complete Diabetic Profile can be divided to two and it includes,
  • Routine diabetic tests – Glucose, Microalbumin, Dipstick test
  • Standard diabetic tests - HbA1c, C-peptide
  • Comprehensive Metabolic Panel (CMP) – Creatinine, lipid profile, liver profile, Urea, Electrolytes
Routine diabetic tests
Fasting blood glucose test (8 or 12 or 14 hours after eating), glucose tolerance test, Postprandial glucose test (2 hours after eating) & Random blood sugar test help to diagnose diabetes, prediabetes and gestational diabetes.
A urine microalbumin test is a test to detect very small levels of a blood protein (albumin) in urine. By this method, it can find out whether diabetes has damaged kidneys because Diabetes is the leading cause of kidney failure.
Dipstick test
Kidney damage can cause proteins to leak through the kidneys and exit the body via urine. This test is to evaluate severe hyperglycemia (severe high blood sugar) by looking for ketones & microalbumin in the urine.
Standard diabetic tests
It is the ideal parameter which can be used to assess the diabetic control. It shows how well your diabetes has been controlled in the past 2 to 3 months and whether your medicine needs to be changed. As per the recent studies, People with diabetes who reduced their HbA1c by less than 1% can cut their risk of dying within 5 years by 50%
This test is used to differentiate between type I (low level of insulin and C-peptide) and type II (normal or high level of C-peptide) diabetes. C-peptide levels are measured instead of insulin levels because C-peptide can assess a person's own insulin secretion even if they receive insulin injections.
Comprehensive Metabolic Panel (CMP)
This panel evaluates liver and kidney function along with important cholesterol levels including HDL, LDL, VLDL and triglycerides. Diabetes tends to lower "good" cholesterol levels and raise triglyceride and "bad" cholesterol levels, which increases risk for heart disease and stroke. An increased level of electrolyte may indicate kidney disease, so Electrolytes also need be tested.

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