Discordance between HbA1c and glycemia

Misra, Anoop; Bloomgarden, Zachary T.

doi:10.1111/1753-0407.12843

Cited by 11 publications

(11 citation statements)

References 28 publications

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“…Interestingly, a microsimulation study on data from India suggested varying but substantial costs involved (between US$169 million and US$567 million) in large‐scale community screenings using three questionnaire‐based risk scores for Indians, and a high number of false positives . Finally, the use of HbA1c without blood glucose data should be avoided for screening, as discussed below …”

Section: Screening For Diabetesmentioning

confidence: 99%

“…The cost of HbA1c continues to be high but, even when available at lower cost, less than 20% of patients got this test done in Kenya and India . Further, because of the presence of anemia and hemoglobinopathies in many countries (India, Sub‐Saharan Africa, China), the HbA1c values may be discordant with blood glucose concentrations, posing difficulties with diagnosis and monitoring . Self‐monitoring of blood glucose is poor, with the costs of the glucometer and testing strips being primary factors …”

Section: Challenges In Diagnosis and Monitoringmentioning

confidence: 99%

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Diabetes in developing countries

Misra

Gopalan

Jayawardena

et al. 2019

Journal of Diabetes

Self Cite

196

129

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Highlights• Diabetes in developing countries is increasing and often undiagnosed. In South Asians, diabetes and related metabolic abnormalities develop at a younger age and at a lower body mass index and waist circumference than in Whites. • Overall glycemic control and management of diabetes is suboptimal, driven by multiple factors (eg, unawareness, cost of drugs and insulin etc.), and the load of complications is high. • To stem this epidemic, strong actions for prevention and management are required using innovative and low-cost approaches. AbstractThere has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro-and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.

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Section: Screening For Diabetesmentioning

confidence: 99%

Section: Challenges In Diagnosis and Monitoringmentioning

confidence: 99%

Diabetes in developing countries

Misra

Gopalan

Jayawardena

et al. 2019

Journal of Diabetes

Self Cite

196

129

View full text Add to dashboard Cite

show abstract

“…In a study of 621 encounters, 91% with patients having type 1 diabetes, HbA1c estimated from continuous glucose monitoring analysis was within 0.1% of measured HbA1c in 11% of patients, but there were discrepancies of 0.5% or more in half, of 0.7% or more in one third, and of 0.9% or more in one quarter of patients 8 . It is important for the clinician to realize that HbA1c may not show the same relationship with mean glycemia in all persons 9 . There are suggestions of greater discordance in patients with anemia, particularly with iron deficiency, 10 with renal insufficiency; with ethnicity, and there is similarly evidence with increasing age 11 …”

Section: Limitations Of Hba1c In Reflecting Mean Glycemiamentioning

confidence: 93%

Use of HbA1c in clinical practice: New insights

Bloomgarden

2021

Journal of Diabetes

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“…8,9 Yet, hyperglycemia on random serum samples does not necessarily reflect the long-term status of glycometabolic control being potentially influenced by several concomitant factors, including underlying diseases and related treatments leading to hospitalization. 10 Hyperglycemia has been reported to act as a strong predictor of both morbidity and mortality in subjects without a previous diagnosis of DM undergoing cardiac surgery. 11 An adjunctive potentially confounding factor may be underdiagnosis and consequent underestimation of DM in the general population.…”

Section: Perspectivementioning

confidence: 99%

Impact of preoperative glycometabolic status on outcomes in cardiac surgery: Systematic review and meta-analysis

Corazzari

Matteucci

Kołodziejczak

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Background: Historically, impaired glucose metabolism has been associated with early and late complicated clinical outcomes after cardiac surgery; however, such a condition is not specific to subjects with diabetes mellitus and involves a larger patient population.Methods: Databases were screened (January 2000 to December 2020) to identify eligible articles; studies that evaluated the association between preoperative metabolic status, as assessed by glycosylated hemoglobin levels and clinical outcomes, were considered. The studies were stratified in thresholds by baseline glycosylated hemoglobin level (lower vs higher).Results: Thirty studies, involving 34,650 patients, were included in the review. In a meta-analysis stratified by glycosylated hemoglobin levels, early mortality was numerically reduced in each threshold comparison and yielded the highest reductions when less than 5.5% versus greater than 5.5% glycosylated hemoglobin levels were compared (risk ratio, 0.39; 95% confidence interval, 0.18-0.84; P ¼ .02). Comparing higher glycosylated hemoglobin threshold values yielded comparable results. Late mortality was reduced with lower levels of glycosylated hemoglobin. Low preoperative glycosylated hemoglobin was associated with the lowest risk of sternal wound infections (risk ratio, 0.50; 95% confidence interval, 0.32-0.80; P ¼ .003 and risk ratio, 0.53; 95% confidence interval, 0.39-0.70; P < .0001) for comparisons of less than 7.5% versus greater than 7.5% and less than 7.0% versus greater than 7.0% glycosylated hemoglobin thresholds, respectively. Additionally, levels of glycosylated hemoglobin lower than 7% were associated with reduced hospital stay, lower risk of stroke/transient ischemic attack (risk ratio 0.53; 95% confidence interval, 0.39-0.70; P < .0001), and acute kidney injury (risk ratio, 0.65; 95% confidence interval, 0.54-0.79; P < .0001).Conclusions: Lower levels of glycosylated hemoglobin in patients undergoing cardiac surgery are associated with a lower risk of early and late mortality, as well as in the incidence of postoperative acute kidney injury, neurologic complications, and wound infection, compared with higher levels.

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Discordance between HbA1c and glycemia

Cited by 11 publications

References 28 publications

Diabetes in developing countries

Diabetes in developing countries

Use of HbA1c in clinical practice: New insights

Impact of preoperative glycometabolic status on outcomes in cardiac surgery: Systematic review and meta-analysis

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