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The Fallacy of Average: How Using HbA1c Alone to Assess Glycemic Control Can Be Misleading
- Source :
- Diabetes Care
- Publication Year :
- 2017
- Publisher :
- American Diabetes Association, 2017.
-
Abstract
- HbA1c is a valuable metric for comparing treatment groups in a randomized trial, for assessing glycemic trends in a population over time, or for cross-sectional comparisons of glycemic control in different populations. However, what is not widely appreciated is that HbA1c may not be a good indicator of an individual patient’s glycemic control because of the wide range of mean glucose concentrations and glucose profiles that can be associated with a given HbA1c level. To illustrate this point, we plotted mean glucose measured with continuous glucose monitoring (CGM) versus central laboratory–measured HbA1c in 387 participants in three randomized trials, showing that not infrequently HbA1c may underestimate or overestimate mean glucose, sometimes substantially. Thus, if HbA1c is to be used to assess glycemic control, it is imperative to know the patient’s actual mean glucose to understand how well HbA1c is an indicator of the patient’s glycemic control. With knowledge of the mean glucose, an estimated HbA1c (eA1C) can be calculated with the formula provided in this article to compare with the measured HbA1c. Estimating glycemic control from HbA1c alone is in essence applying a population average to an individual, which can be misleading. Thus, a patient’s CGM glucose profile has considerable value for optimizing his or her diabetes management. In this era of personalized, precision medicine, there are few better examples with respect to the fallacy of applying a population average to a specific patient rather than using specific information about the patient to determine the optimal approach to treatment.
- Subjects :
- Adult
Blood Glucose
Male
medicine.medical_specialty
endocrine system diseases
Cross-sectional study
Endocrinology, Diabetes and Metabolism
Population
030209 endocrinology & metabolism
law.invention
Perspectives in Care
Young Adult
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Diabetes management
Internal medicine
Blood Glucose Self-Monitoring
Diabetes mellitus
Internal Medicine
medicine
Humans
030212 general & internal medicine
Precision Medicine
Intensive care medicine
education
Aged
Glycemic
Glycated Hemoglobin
Advanced and Specialized Nursing
education.field_of_study
business.industry
Disease Management
nutritional and metabolic diseases
Middle Aged
medicine.disease
Cross-Sectional Studies
Diabetes Mellitus, Type 1
Endocrinology
Diabetes Mellitus, Type 2
Female
Metric (unit)
business
Subjects
Details
- ISSN :
- 19355548 and 01495992
- Volume :
- 40
- Database :
- OpenAIRE
- Journal :
- Diabetes Care
- Accession number :
- edsair.doi.dedup.....db64f9929911719372a8c14f36e07cc5