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Laboratory HbA 1c  does not always predict diabetes complications and our aim was to establish a glycaemic measure that better reflects intracellular glucose exposure in organs susceptible to complications. Six months of continuous glucose monitoring data and concurrent laboratory HbA 1c  were evaluated from 51 type 1 diabetes (T1D) and 80 type 2 diabetes (T2D) patients. Red blood cell (RBC) lifespan was estimated using a kinetic model of glucose and HbA 1c , allowing the calculation of person-specific adjusted HbA 1c  (aHbA 1c ). Median (IQR) RBC lifespan was 100 (86–102) and 100 (83–101) days in T1D and T2D, respectively. The median (IQR) absolute difference between aHbA 1c  and laboratory HbA 1c  was 3.9 (3.0–14.3) mmol/mol [0.4 (0.3–1.3%)] in T1D and 5.3 (4.1–22.5) mmol/mol [0.5 (0.4–2.0%)] in T2D. aHbA 1c  and laboratory HbA 1c  showed clinically relevant differences. This suggests that the widely used measurement of HbA 1c  can underestimate or overestimate diabetes complication risks, which may have future clinical implications.

Addressing shortfalls of laboratory HbA 1c using a model that incorporates red cell lifespan