2024-03-21 07:57:18
Continuous glucose measurement has shown that with the same average blood sugar, the hemoglobin of different individuals can be glycated differently. The clinical conclusions from this finding are not yet completely clear.
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Glycated hemoglobin (HbA1c) has been used for many years to diagnose diabetes mellitus and to monitor the quality of therapy. Compared to fasting glucose determination, it has the advantage of reflecting longer-term glycemic control. However, in times of continuous glucose measurement (CGM), disadvantages of HbA1c have also become apparent. In particular, it does not always correlate with blood sugar levels with the same accuracy in all people. “We have known since the 1980s that anemia, hemoglobinopathies, kidney failure and many other conditions have an influence on HbA1c,” says Prof. Dr. Irl Hirsch from the Diabetes Institute at the University of Washington. With the help of CGM, the relationship between average blood sugar levels and HbA1c was determined in 2008 as part of the ADAG study. What was striking was the large statistical fluctuations, says Hirsch, who also emphasizes that this observation was confirmed in numerous other studies and that people with diseases such as anemia or kidney failure were excluded from these studies.1 Hirsch: “So it is clear that it In addition to the known comorbidities and the physiology of hemoglobin, there must be other factors that influence HbA1c.”
This could include the survival time of erythrocytes, which in a study with subjects without anemia varied by around 50% between approx. 40 and 60 days.2 Therefore, the term “estimated HbA1c” was abandoned in connection with CGM and replaced by the “glucose management indicator (GMI).3 The deviation from the measured HbA1c varies individually and can be considerable. In a cohort of more than 600 patients, half of their HbA1c and GMI differed by more than half a percent, and in 22% it was even a full percent apart.4
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