Assessment of Glycemic Control and Hemoglobinopathy: When HbA1c Testing Is Unreliable in High Risk Cardiovascular Patients
International Journal of Diabetes and Endocrinology
Volume 2, Issue 1, March 2017, Pages: 5-9
Received: Jan. 2, 2017; Accepted: Jan. 18, 2017; Published: Mar. 15, 2017
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Clauden Louis, Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York, USA
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To assess the evidence underlying Hemoglobin A1c (HbA1c) in patients with hemoglobinopathy and the use of this modality to evaluate confounders, sources of error, upcoming developments and reach evidence-based conclusions on their optimal use in patients who require tight glucose control. This was a retrospective chart review of 7 patients with data collected between the years 2004 - 2009. Participants were selected based on the criteria that they were 1) diagnosed with Type 2 Diabetes Mellitus; 2) patients of the North Florida Thyroid Center for at least one year; and 3) had hemoglobinopathy. These patients were selected using electronic medical records (EMR). Researchers were blinded of patients’ gender, race and any other personal identifiers. A random search was performed for hemoglobinopathy within physician patient database. Assessing glycemia in diabetics can be a challenge, in particular subgroup patients with hemoglobinopathies face several pitfalls that can implicate glycemia assessment rather difficult. Our results suggest there may be a discrepancy between mean blood glucose and A1C levels of individuals with a hemoglobinopathy in small cohorts at risk of cardiovascular demise.
Cardiovascular, Diabetes, Glycemic, Hemoglobinopathy, HbA1c, Cardiothoracic
To cite this article
Clauden Louis, Assessment of Glycemic Control and Hemoglobinopathy: When HbA1c Testing Is Unreliable in High Risk Cardiovascular Patients, International Journal of Diabetes and Endocrinology. Vol. 2, No. 1, 2017, pp. 5-9. doi: 10.11648/j.ijde.20170201.12
Copyright © 2017 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Adekanmbi J, Higgins T, Rodriguez-capote K, et al. Erroneous HbA1c results in a patient with elevated HbC and HbF. Clin Chim Acta. 2016; 462: 153-157.
Behan KJ, Mbizo J, Johnston MA. Is the Correlation of HbA1c to Average Glucose Predictable in Individuals With Sickle Cell Trait? J Diabetes Sci Technol. 2015; 10 (1): 236-7.
DCCT Research Group. The Diabetes Control and Complications Trial (DCCT). Design and methodologic considerations for the feasibility phase. Diabetes. 1986; 35: 530-545.
Bry L, Chen PC, Sacks DB. Effects of hemoglobin variants and chemically modified derivatives on assays for glycohemoglobin. Clinical Chemistry. 2001; 47 (2): 153–163.
Dorland, W. A. (1965). Dorland s medical dictionary. Kentucky: APH.
Greer JP, Arber DA, Rodgers GM. Wintrobe's Clinical Hematology. Amirsys; 2014. Disorders of red cells, 4 (33), 856-857
Herman, W. H., Ma, Y., Uwaifo, G., Haffner, S., Kahn, S. E., Horton, E. S., et al. (2007). Differences in A1C by race and ethnicity among patients with impaired glucose tolerance in the diabetes prevention program. Diabetes Care, 30 (10), 2453-2457.
Melmed S, Williams RH. Williams Textbook of Endocrinology. Saunders; 2011. Type 2 Diabetes, 31 (6), 1404-1405
Saudek, C. D., Derr, R. L., & Kalyani, R. R. (2006). Assessing glycemia in diabetes using self-monitoring blood glucose and hemoglobin A1c. JAMA: The Journal of the American Medical Association, 295 (14), 1688-1697.
Smaldone, A. (2008). Glycemic control and hemoglobinopathy: When A1C may not be reliable. Diabetes Spectrum, 21 (1), 46-49.
Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights. 2016; 11: 95-104.
Subramaniam B, Lerner A, Novack V, et al. Increased glycemic variability in patients with elevated preoperative HbA1C predicts adverse outcomes following coronary artery bypass grafting surgery. Anesth Analg. 2014; 118 (2): 277-87.
Tran, H., Silva, D., & Petrovsky, N. (2004). Case study: Potential pitfalls of using hemoglobin A1C as the sole measure of glycemic control. Clinical Diabetes, 22 (3), 141-143.
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