Falsely Decreased Hba1c in A Type 2 Diabetic Patient Treated with Dapsone |
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| Affiliation: | 1. Division of Endocrinology and Metabolism, University of California, San Francisco;2. Division of General Internal Medicine, Department of Medicine, University of California, San Francisco.;1. Departments of Endocrinology, Instituto Português de Oncologia de Lisboa;2. Departments of Nuclear Medicine Department, Instituto Português de Oncologia de Lisboa;3. Departments of University Clinic of Endocrinology, Faculdade de Ciências Médicas, Universidade Nova de Lisboa.;1. From Bristol-Myers Squibb, Princeton, New, Jersey;2. AstraZeneca, Mölndal, Sweden;3. AstraZeneca, Wilmington, Delaware.;1. Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., Chair of Endocrinology, University of Pavia, Pavia, Italy,;2. Department of General and Minimally Invasive Surgery, Fondazione Salvatore Maugeri I.R.C.C.S., Pavia, Italy.;1. Division of Pediatric Endocrinology and Diabetes, Children’s Hospital of Philadelphia;2. University of Pennsylvania School of Nursing;3. The Craig-Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia;4. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania;5. Institute for Translational Medicine & Therapeutics; Clinical & Translational Research Center, Perelman School of Medicine at the University of Pennsylvania;6. Leonard Davis Institute of Health Economics, University of Pennsylvania.;1. Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota;2. Departments of Medicine, University of Minnesota, Minneapolis, Minnesota;3. Departments of Pharmacology, University of Minnesota, Minneapolis, Minnesota |
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| Abstract: | ObjectiveTo discuss a case of a falsely low hemoglobin A1c (HbA1c) in a transplant patient treated with dapsone and its implications. HbA1c is widely used as a measure of glycemic control in diabetic patients. With the increasing transplant population, it is important to be mindful of medications used in this population that can affect HbA1c and to use other measures of glycemic control to guide treatment decisions.MethodsWe present details of the case and review the relevant literature.ResultsA 61-year-old patient received a liver transplant in 2012 and subsequently was noted to have a falling HbA1c despite evidence of hyperglycemia based on fingerstick glucose and fructosamine measurements. Review of the medical records revealed that the discordance between HbA1c and fingerstick glucose levels developed after initiation of dapsone therapy. Dapsone may lead to a falsely low HbA1c via several mechanisms. Upon cessation of dapsone therapy, the patient’s HbA1c returned to pre-dapsone levels.ConclusionIt is important to be aware of medications commonly used in transplant patients that may lead to a falsely low HbA1c level so that incorrect treatment decisions are not made. Fructosamine correlates with HbA1c and can be used as a measure of glycemic control in transplant patients when HbA1c cannot be used. (Endocr Pract. 2014;20:e229-e232) |
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