Primary care diabetes assessment when HbA1c and other measures of glycemia disagree

• Published in: Primary care diabetes 2024-04, Vol.18 (2), p.151-156
• Main Authors: Friedman, Jared G., Smith, Eric P., Awasty, Sanjana S., Behan, Morgan, Genco, Matthew T., Hempel, Hannah, Jafri, Sabih, Jandarov, Roman, Nagaraj, Tara, Franco, Robert S., Cohen, Robert M.
• Format: Article
• Language: English
• Subjects: Continuous glucose monitoring; Fructosamine, glycation gap; Glucose management indicator; HbA1c; Mismatch
• ISSN: 1751-9918; 1878-0210
• DOI: 10.1016/j.pcd.2023.12.005

Although diabetes management decisions in primary care are typically based largely on HbA1c, mismatches between HbA1c and other measures of glycemia that are increasingly more available present challenges to optimal management. This study aimed to assess a systematic approach to identify the frequency of mismatches of potential clinical significance amongst various measures of glycemia in a primary care setting. Following screening to exclude conditions known to affect HbA1c interpretation, HbA1c, and fructosamine were obtained and repeated after ∼90 days on 53 adults with prediabetes or type 2 diabetes. A subset of 13 participants with repeat labs wore continuous glucose monitoring (CGM) for 10 days. As expected, HbA1c and fructosamine only modestly correlated (initial R2 = 0.768/repeat R2 = 0.655). The HbA1c/fructosamine mismatch frequency of ± 0.5% (using the following regression HbA1c = 0.015 *fructosamine + 2.994 calculated from the initial sample) was 27.0%. Of the 13 participants with CGM data, HbA1c and CGM-based Glucose Management Indicator correlated at R2 = 0.786 with a mismatch frequency of ± 0.5% at 46.2% compared to a HbA1c/fructosamine mismatch frequency of ± 0.5% at 30.8%. HbA1c is frequently mismatched with fructosamine and CGM data. As each of the measures has strengths and weaknesses, the utilization of multiple different measures of glycemia may be informative for diabetes assessment in the clinical setting. •HbA1c limitations are becoming more recognized in primary care.•We found a high frequency of mismatch between HbA1c and other measures of glycemia.•Addition of fructosamine and/or CGM may provide a better overall estimate of glycemia.•The standard for evaluation is seeking internal consistency among these tests.