What are the limitations of hemoglobin A1c testing?

Answer

A short note is in order with respect to hemoglobin variants. As long as one normal beta chain exists (eg, sickle cell trait, or hemoglobin C trait), one can measure hemoglobin A1c. Even in some cases with no normal beta chains (eg, sickle cell disease, or SC disease), the abnormal beta chains are glycated and can be measured by some methods. In other cases (eg, hereditary persistence of fetal hemoglobin), no beta chains exist to glycate, so glycated hemoglobin is not present. In all of these cases, though, the RBC lifespan issue may take precedence over the ability (or the lack thereof) to measure glycated hemoglobin and must be kept in mind. As noted earlier, regular fingerstick glucose monitoring throughout the course of the day can provide reliable data in these situations.^[12]

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Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic & Laboratory Test Reference. 14th ed. St. Louis, Mo: Elsevier; 2019.
[Guideline] Garber AJ, Handelsman Y, Grunberger G, et al. CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM - 2020 EXECUTIVE SUMMARY. Endocr Pract. 2020 Jan. 26 (1):107-39. [Medline]. [Full Text].
Eyth E, Naik R. Hemoglobin A1C. StatPearls. 2021 Jan. [Medline]. [Full Text].
Ensenauer R, Brandlhuber L, Burgmann M, Sobotzki C, Zwafink C, Anzill S, et al. Obese Nondiabetic Pregnancies and High Maternal Glycated Hemoglobin at Delivery as an Indicator of Offspring and Maternal Postpartum Risk: The Prospective PEACHES Mother-Child Cohort. Clin Chem. 2015 Aug 11. [Medline].
Mastronardi CA, Whittle B, Tunningley R, Neeman T, Paz-Filho G. The use of dried blood spot sampling for the measurement of HbA1c: a cross-sectional study. BMC Clin Pathol. 2015. 15:13. [Medline].
Pivovarov R, Albers DJ, Hripcsak G, Sepulveda JL, Elhadad N. Temporal trends of hemoglobin A1c testing. J Am Med Inform Assoc. 2014 Nov-Dec. 21 (6):1038-44. [Medline].
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progressions of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993. 329:977-986.
[Guideline] American Diabetes Association. Standards of Medical Care in Diabetes-2021 Abridged for Primary Care Providers. Clin Diabetes. 2021 Jan. 39 (1):14-43. [Medline]. [Full Text].
Greenwood DA, Blozis SA, Young HM, Nesbitt TS, Quinn CC. Overcoming Clinical Inertia: A Randomized Clinical Trial of a Telehealth Remote Monitoring Intervention Using Paired Glucose Testing in Adults With Type 2 Diabetes. J Med Internet Res. 2015 Jul 21. 17 (7):e178. [Medline].
Chan CL, Pyle L, Newnes L, Nadeau KJ, Zeitler PS, Kelsey MM. Continuous glucose monitoring and its relationship to hemoglobin A1c and oral glucose tolerance testing in obese and prediabetic youth. J Clin Endocrinol Metab. 2015 Mar. 100 (3):902-10. [Medline].
Holsen LM, Huang G, Cherkerzian S, et al. Sex Differences in Hemoglobin A1c Levels Related to the Comorbidity of Obesity and Depression. J Womens Health (Larchmt). 2021 Feb 2. [Medline].
Sacks DB. Hemoglobin variants and hemoglobin A1c analysis: problem solved?. Clin Chem. 2003 Aug. 49(8):1245-7. [Medline].
Wang Y, Beckwith B, Smith C, Horowitz G. Misleading glycated hemoglobin results in a patient with hemoglobin SC disease. Clin Chem. 2007 Jul. 53(7):1394-5. [Medline].
Jeppsson JO, Kobold U, Barr J, Finke A, Hoelzel W, Hoshino T. Approved IFCC reference method for the measurement of HbA1c in human blood. Clin Chem Lab Med. 2002 Jan. 40(1):78-89. [Medline].
Kahn R, Fonseca V. Translating the A1C Assay. Diabetes Care. 2008 Aug. 31(8):1704-7. [Medline].
Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008 Aug. 31(8):1473-8. [Medline].
Hempe JM, Soros AA, Chalew SA. Estimated average glucose and self-monitored mean blood glucose are discordant estimates of glycemic control. Diabetes Care. 2010 Jul. 33(7):1449-51. [Medline]. [Full Text].
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010 Jan. 33 Suppl 1:S62-9. [Medline].

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What are the limitations of hemoglobin A1c testing?

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