Open AccessReview of hemoglobin A 1c in the management of diabetes
Author(s) -
GALLAGHER Emily Jane,
LE ROITH Derek,
BLOOMGARDEN Zachary
Publication year - 2009
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/j.1753-0407.2009.00009.x
Subject(s) - medicine , glycemic , diabetes mellitus , confusion , diabetes management , hemoglobin a , intensive care medicine , hemoglobin , endocrinology , type 2 diabetes , psychology , psychoanalysis
Hemoglobin HbA 1c (A 1c ) has been used clinically since the 1980s as a test of glycemic control in individuals with diabetes. The Diabetes Control and Complications Trial (DCCT) demonstrated that tight glycemic control, quantified by lower blood glucose and A 1c levels, reduced the risk of the development of complications from diabetes. Subsequently, standardization of A 1c measurement was introduced in different countries to ensure accuracy in A 1c results. Recently, the International Federation of Clinical Chemists (IFCC) introduced a more precise measurement of A 1c , which has gained international acceptance. However, if the IFCC A 1c result is expressed as a percentage, it is lower than the current DCCT‐aligned A 1c result, which may lead to confusion and deterioration in diabetic control. Alternative methods of reporting have been proposed, including A 1c ‐derived average glucose (ADAG), which derives an average glucose from the A 1c result. Herein, we review A 1c , the components involved in A 1c formation, and the interindividual and assay variations that can lead to differences in A 1c results, despite comparable glycemic control. We discuss the proposed introduction of ADAG as a surrogate for A 1c reporting, review imprecisions that may result, and suggest alternative clinical approaches.