Hemoglobin A1C,Mean Glucose,and Persistence of Glycation Ratios in Insulin-Treated Diabetes |
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| Affiliation: | 1. Maryland Endocrine, Columbia, Maryland;2. Dexcom, Inc, San Diego, California;3. Dexcom, Inc, Sykesville, Maryland;1. Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo, São Paulo, Brazil;2. Department of Psycobiology, Sleep Disorders Center, Universidade Federal de São Paulo, São Paulo, Brazil.;1. Department of Health Science and Technology, Aalborg University, Aalborg, Denmark;2. Novo Nordisk A/S, Hilleroed, Denmark;3. Steno Diabetes Center, Gentofte, Denmark;4. Department of Endocrinology and Internal Medicine/Medical Research Laboratory, Aarhus University Hospital, Denmark;5. Nordsjaellands Hospitaler, Hilleroed, Denmark;1. Division of Endocrinology, Diabetes & Metabolism;2. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.;1. Health Economics & Epidemiology, Evidera, Lexington, Massachusetts;2. Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut;3. Department of Pharmacotherapy, University Utah College of Pharmacy, Salt Lake City, Utah.;1. Department of Internal Medicine, St. Elizabeth Medical Center/Tufts University, Boston, Massachusetts;2. Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts;3. Division of Endocrinology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. |
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| Abstract: | ObjectiveDetermine the relationship between mean glucose (MG), as assessed by continuous glucose monitoring (CGM), and hemoglobin A1c (A1C) in insulin-requiring adults in a clinical practice setting and examine the persistence of this relationship over time.MethodsIn this retrospective record review in a diabetes practice, a linear regression model was developed using data sets from all patients with ≥ 1 available download of a Dexcom SevenPlus CGM device in which there was > 50% utilization in the 60 days prior to a laboratory A1C. Persistence of the MG to A1C relationship was examined in patients with ≥ 2 data sets available.ResultsA total of 139 patients had ≥ 1 data set available for evaluation, and 101 patients had ≥ 2 data sets (range, 2 to 6; total, 279). The slope of the MG versus A1C curve was 19.5 mg/dL for each 1% change in A1C, with an intercept of 17.7 mg/dL. Although 88% of the measured MG values were within 15% of the A1C-predicted MG, there was substantial variation in individuals, with differences as large as ± 26%. The MG to A1C (MG:A1C) ratio, which is a measure of glycation, was normally distributed, with a median of 21.6. Spearman correlation coefficients for the MG:A1C ratio on repeated measures ranged from 0.52 to 0.73, demonstrating persistence.ConclusionThe relationship between MG and A1C is linear in a population but can vary between individuals. The MG:A1C ratio was normally distributed, tended to persist in individuals over time, and thus could be useful to identify apparent high and low glycators. Glycemic goals may need to be modified in such patients. (Endocr Pract. 2014;20:252-260) |
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