A1C result is different than expected

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A1C result is different than expected


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Old 02-18-2013, 13:19   #1
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Default A1C result is different than expected

Sickle Cell Trait and Other Hemoglobinopathies and Diabetes: Important Information for Physicians - National Diabetes Information Clearinghouse

When to Suspect that a Patient with Diabetes Has a Hemoglobinopathy

Most people who are heterozygous—having one variant gene and one standard hemoglobin gene—for a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin. Health care providers should suspect the presence of a hemoglobinopathy when

an A1C result is different than expected
an A1C result is above 15 percent
results of self-monitoring of blood glucose have a low correlation with A1C results
a patient’s A1C result is radically different from a previous A1C result following a change in laboratory A1C methods

(SNIP)

Points to Remember

The hemoglobin A1C (A1C) test can be unreliable for diagnosing or monitoring diabetes and prediabetes in people with inherited hemoglobin variants, also called hemoglobinopathies.

Hemoglobins S and E are prevalent variants in people of African, Mediterranean, or Southeast Asian descent. These variants interfere with some A1C tests—both laboratory and point-of-care tests.

With some assay methods, A1C tests in patients with hemoglobinopathies result in falsely high outcomes, overestimating actual average blood glucose levels for the previous 3 months.

Health care providers may then falsely diagnose patients or prescribe more aggressive treatments, resulting in increased episodes of hypoglycemia.

Some methods used with certain hemoglobinopathies may result in falsely low outcomes, leading to undertreatment of diabetes.

Most people who are heterozygous—having one variant gene and one standard hemoglobin gene—for a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin.

Health care providers should suspect the presence of a hemoglobinopathy when
an A1C result is different than expected
an A1C result is above 15 percent
results of self-monitoring of blood glucose have a low correlation with A1C results
a patient’s A1C result is radically different from a previous A1C result following a change in laboratory A1C methods

Health care providers or patients interested in getting information about the accuracy of a particular A1C method for patients with hemoglobin variants should first find out which method their laboratory is using.

Reliable A1C tests that do not cause interference with hemoglobin variants are available.

When the A1C test is used for diagnosis, the blood sample must be sent to a laboratory that uses an NGSP-certified method for analysis to ensure the results are standardized.

Health care providers should not use the A1C test for patients with a disease condition such as HbSS, HbCC, or HbSC. Even if an assay does not interfere with their variant, these patients may suffer anemia, increased red blood cell turnover, and transfusion requirements, which can adversely affect A1C as a marker of long-term glycemic control.

Alternative tests may be needed for people with any disorder that affects red blood cells or hemoglobin.

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