Hemoglobin A1c is a widely accepted tool for monitoring glycemic control. It clinically convenient and is not susceptible to acute variability in glucose fluctuations. The 1970s DCCT trial showed its importance in predicting diabetic outcomes and complication risk in people with diabetes. It’s clear that HbA1c can be a very good indicator of control. I don’t think anyone can debate this. The problem is when it is used as the only indicator of control. How many of your clinicians rely solely on your HbA1c?
HbA1c is not “the big picture.” Put simply, HbA1c is an indication of how much glucose has bound to hemoglobin, or a red blood cell, over its lifespan (three months). It cannot tell us anything about glucose fluctuations, quality of life, or time in range (the new gold standard, in my opinion).
But because HbA1c is so heavily weighted, it’s important to know when it is not accurate.
26 Comebacks to, ‘Are You Sure You’re Allowed to Eat That?’ for People With Diabetes” data-reactid=”25″ type=”text”>Related: 26 Comebacks to, ‘Are You Sure You’re Allowed to Eat That?’ for People With Diabetes
alcohol, opiates, and salycilates can also be significant.” data-reactid=”26″ type=”text”>HbA1c can be falsely elevated any time there is a condition which prolongs the life of the red blood cells. Some examples of this include iron deficiency anemia, B12 anemia, folate deficiency anemia, and asplenia (absence of normal spleen function). Additionally, blood transfusions can result in elevated (or decreased) HbA1c levels. Significant hypertriglyceridemia (high triglycerides > 1,750 mg/dL), and significant hyperbilirubinemia (high bilirubin >20mg/dL) can elevate HbA1c and ingestion of certain drugs such as excessive alcohol, opiates, and salycilates can also be significant.
Falsely low HBA1c’s can occur in conditions which shorten the lifespan of the red blood cells such as in pregnancy or splenomegaly (spleen enlargement). Chronic blood loss, vitamin E ingestion, and vitamin C ingestion can also cause the same.
Read more stories like this on The Mighty:
7 Celebrities Who Spoke Up About Diabetes Misconceptions” data-reactid=”30″ type=”text”>7 Celebrities Who Spoke Up About Diabetes Misconceptions
Americans With Diabetes Take a ‘Caravan to Canada’ for Cheaper Insulin” data-reactid=”31″ type=”text”>Americans With Diabetes Take a ‘Caravan to Canada’ for Cheaper Insulin
Parents Sue School for Not Allowing Their Son to Bring His Own Insulin” data-reactid=”32″ type=”text”>Parents Sue School for Not Allowing Their Son to Bring His Own Insulin
In New Documentary, Jonas Brothers Reveal the First Signs of Nick’s Diabetes They Noticed” data-reactid=”33″ type=”text”>In New Documentary, Jonas Brothers Reveal the First Signs of Nick’s Diabetes They Noticed
Useful Tips to Remember As You Start College With Diabetes” data-reactid=”34″ type=”text”>Useful Tips to Remember As You Start College With Diabetes