Issue 214 Item 5 Inherent Differences in HbA1c Tied to Diabetic Complications

Individual biological variations in HbA1c for a given mean blood glucose (MBG) level are predictive of microvascular complications in type 1 diabetics. Dr. Stuart A. Chalew of Children’s Hospital of New Orleans and colleagues note that although HbA1c is highly correlated with preceding MBG, there may be considerable individual differences for any given MBG value. Moreover, “most clinicians are only using HbA1c as an estimator of average blood glucose…without taking into account who is a high or low ‘glycator.'”

The researchers devised a hemoglobin glycation index (HGI) based on observed and predicted HbA1c. Patients were then stratified into high- medium- and low-HGI groups.

At 7 years, those with higher than predicted HbA1c (the high-HGI group) had 3 times the risk of retinopathy than did those in the low-HGI group (30% versus 9%). For nephropathy, the corresponding risk was 6 times greater (6% versus 1%).

Identifying the processes underlying this variation in HbA1c, the investigators conclude, could lead to novel therapies to augment current treatments.

Dr. Chalew added that “clinicians have always noted that many well controlled diabetes patients still developed complications while many poorly controlled patients did not get complications. The glycator status of the patient helps to explain these prior clinical observations.” Diabetes Care 2004;27:1259-1264.

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