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The relationship between 24-hour integrated glucose concentrations and % glycohemoglobin

  • Youssef Hassan
    Affiliations
    Endocrinology, Metabolism and Nutrition Section, University of Minnesota, Minneapolis, Minnesota USA

    Department of Veterans Affairs Medical Center, Minneapolis, the Department of Medicine University of Minnesota, Minneapolis, Minnesota USA
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  • Bradford Johnson
    Affiliations
    Department of Veterans Affairs Medical Center, Minneapolis, the Department of Medicine University of Minnesota, Minneapolis, Minnesota USA
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  • Nicole Nader
    Affiliations
    Department of Veterans Affairs Medical Center, Minneapolis, the Department of Medicine University of Minnesota, Minneapolis, Minnesota USA
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  • Mary C. Gannon
    Affiliations
    Endocrinology, Metabolism and Nutrition Section, University of Minnesota, Minneapolis, Minnesota USA

    Department of Veterans Affairs Medical Center, Minneapolis, the Department of Medicine University of Minnesota, Minneapolis, Minnesota USA

    Department of Food Science and Nutrition, University of Minnesota, Minneapolis, Minnesota
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  • Frank Q. Nuttall
    Correspondence
    Reprint requests: Frank Q. Nuttall, Chief, Endocrinology, Metabolism, and Nutrition Section (111G), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417
    Affiliations
    Endocrinology, Metabolism and Nutrition Section, University of Minnesota, Minneapolis, Minnesota USA

    Department of Veterans Affairs Medical Center, Minneapolis, the Department of Medicine University of Minnesota, Minneapolis, Minnesota USA
    Search for articles by this author
      Objective: Since glycohemoglobin values are widely used clinically as a surrogate for average glucose concentration over an extended period of time, we decided to determine the actual relationship between 24-hour integrated glucose values and percent total glycohemoglobin (%tGHb) in cohorts of people with and without diabetes. Research Design and Methods: In 48 people without known diabetes with known stability of fasting glucose over a 1-year period of time, the calculated 24-hour integrated glucose concentration was compared with their %tGHb. In 15 normal young medical students, the glucose area response was determined from 46 venous blood samples obtained during a 24-hour period and compared with their %tGHb. In 18 people with type 2 diabetes, interstitial glucose concentrations were monitored using the Continuous Glucose Monitoring System (Medtronic MiniMed, Inc., Sylmar, Calif) for 3 days at 20-day intervals over 100 days. %tGHb was performed at 20-day intervals simultaneously. In 29 people with untreated type 2 diabetes, glucose area response was determined from 46 venous blood samples obtained during a 24-hour period and compared with their %tGHb after being on a standardized diet provided to the subjects for at least 5 weeks. The %tGHb and 24-hour profiles were stable. Results: There was an excellent correlation between the mean 24-hour glucose concentration and the %tGHb among subjects with diabetes. The correlation was poor among subjects without diabetes. The relationship was curvilinear when plotted as a single group. Alternatively when data from subjects with or without diabetes were plotted separately, the slopes were identical but the y-intercepts were different. Conclusion: The relationship between the mean glucose concentration integrated over an extended period of time and the %tGHb is not linear. The reason for this nonlinearity remains to be determined. This non-linearity needs to be considered in the clinical interpretation of %tGHb (and probably HbA1c) in reference to glucose values.

      Abbreviations:

      %HbA1c (percent hemoglobin A1c), %tGHb (percent total glycohemoglobin), RBCs (red blood cells), HPLC (high-performance liquid chromatography)
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