Relationship of A1C to Glucose Concentrations in Children With Type 1 Diabetes

Abstract

Assessments by high-frequency glucose determinations by sensors DIABETES RESEARCH IN CHILDREN NETWORK (DIRECNET) STUDY GROUP*OBJECTIVE -Despite the standing of A1C as the most validated and widely used measure for average glycemic control over time, the relationship between A1C and glucose concentrations is not completely understood. The purpose of this Diabetes Research in Children Network (DirecNet) study was to use continuous glucose monitoring data to examine the relationship between A1C and glucose in type 1 diabetes.RESEARCH DESIGN AND METHODS -Forty-eight youth enrolled in studies of the Navigator continuous glucose monitor were encouraged to wear the Navigator sensor at home continuously. A1C was measured at baseline, at 3 months, and at 6 months. Sensor glucose data were directly transmitted via the Internet, assuring that essentially all glucose values were analyzed.RESULTS -Subjects had a median of 112 h/week of Navigator data in the first 3 months and 115 h/week in the second 3 months. The slope of mean glucose over the previous 3 months versus A1C was only 18 mg/dl per 1.0% A1C. Individually, there was substantial variation in the relationship between mean glucose and A1C. A1C was not associated with glucose lability after controlling for mean glucose. Measures of an individual's rate of glycation were moderately correlated at the 3-and 6-month visits.CONCLUSIONS -As the chemistry of glycation would predict, we found no evidence to contradict the simple hypothesis that A1C directly reflects mean glucose over time. There is, however, substantial variability in individual mean glucose concentrations for a given A1C. Transforming reliable A1C values into calculated mean glucose values would, when applied to an individual, introduce substantial error.

Standards of Medical Care in Diabetes—2010

“…A recent study comparing A1C to CGM data in 48 type 1 diabetic children found a highly statistically significant correlation between A1C and mean blood glucose, although the correlation ( r = 0.7) was significantly lower than in the ADAG trial (51). Whether there are significant differences in how A1C relates to average glucose in children or in African American patients is an area for further study.…”

Standards of Medical Care in Diabetes—2012

“…A small study comparing A1C to CGM data in type 1 children found a highly statistically significant correlation between A1C and mean blood glucose, although the correlation ( r = 0.7) was significantly lower than in the ADAG trial (69). Whether there are significant differences in how A1C relates to average glucose in children or in African American patients is an area for further study.…”

Estimated Average Glucose and Self-Monitored Mean Blood Glucose Are Discordant Estimates of Glycemic Control

“…Controversy persists over the underlying assumption that A1C levels depend exclusively on long-term previous blood glucose concentration (2–6). A number of studies have shown that biological variation in A1C is influenced by factors other than blood glucose concentration (7–13). This suggests that eAG may be a systematically biased estimate of self-monitored mean blood glucose (MBG).…”