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Hemoglobin A1c: Teaching a New Dog Old Tricks

William H. Herman, MD, MPH; and Robert M. Cohen, MD
[+] Article, Author, and Disclosure Information

From University of Michigan, Ann Arbor, Michigan 48109; and University of Cincinnati, Cincinnati, OH 45267.

Grant Support: By the Michigan Diabetes Research and Training Center, funded by grant DK020572 from the National Institute of Diabetes and Digestive and Kidney Diseases and the U.S. Department of Veterans Affairs (Cincinnati Veterans Affairs Medical Center and Merit Award 5I01CX000121-02).

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0983.

Requests for Single Reprints: William H. Herman, MD, MPH, University of Michigan, 1000 Wall Street, 6th Floor, Ann Arbor, MI 48105-5714; e-mail, wherman@med.umich.edu.

Current Author Addresses: Dr. Herman: University of Michigan, 1000 Wall Street, 6th Floor, Ann Arbor, MI 48105-5714.

Dr. Cohen: University of Cincinnati Medical Center, 3125 Eden Avenue, Cincinnati, OH 45267.

Ann Intern Med. 2010;152(12):815-817. doi:10.7326/0003-4819-152-12-201006150-00011
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In 1976, Koenig and colleagues (12) suggested that hemoglobin A1c (HbA1c) might be a useful indicator of both glucose tolerance and glucose regulation in diabetes. Currently, HbA1c level is an accepted measure of glycemic control in patients with diabetes, an indicator of the risk for diabetic complications, and a measure of the quality of diabetes care. In 2010, the American Diabetes Association recommended that HbA1c level, when measured by using clinical laboratory equipment and not point-of-care instruments, is also useful for diagnosing diabetes (3). Among the advantages of using HbA1c for diagnosis are that the test does not require fasting and is widely available; HbA1c is less likely than glucose to be affected by short-term lifestyle changes, is stable at room temperature, and shows less intraindividual biological variability than fasting or post–glucose load glucose levels (4). In addition, an international effort has been made to improve assay standardization (5). Despite these advantages, HbA1c has an important limitation: A person's measured HbA1c level may be consistently higher or lower than the expected value for that person's average level of glycemia.

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