Alternative methods for assessing glycemia might prove useful in cases of discordance between glycated hemoglobin and se
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LETTER TO THE EDITOR
Alternative methods for assessing glycemia might prove useful in cases of discordance between glycated hemoglobin and self‑monitoring of blood glucose Theocharis Koufakis1 · Kalliopi Kotsa1 Received: 9 June 2020 / Accepted: 6 July 2020 © Springer-Verlag Italia S.r.l., part of Springer Nature 2020
To the editors, Since 1978, when glycated hemoglobin (HbA1c) assays became widely available, HbA1c has been the gold standard method for assessing glycemic control in people with diabetes in daily clinical practice. HbA1c values reflect the cumulative glycemic history of the preceding 2 to 3 months, but also correlate well with the risk of micro- and macrovascular complications of diabetes [1]. On the other hand, as a result of the introduction of continuous glucose monitoring into diabetes management, it is becoming increasingly recognized that HbA1c is unable to provide reliable data on hypoglycemia and glycemic variability, both of which are related to adverse clinical outcomes. Moreover, under specific circumstances, including hemoglobinopathies, anemia and the use of specific medications and substances, the test might yield falsely elevated or lowered results, thus not providing consistent information to guide clinical decisions. To emphasize this weakness of HbA1c measurement, we present the case of a 48-year-old woman who had been regularly attending our outpatient clinic appointments. She had a ten-year history of type 2 diabetes (T2D) and dyslipidemia and was on treatment with insulin degludec (18 units at night), once weekly glucagon-like peptide-1 receptor agonist dulaglutide (1.5 mg), fixed-dose combination of canagliflozin/metformin (50/1000 mg twice daily) and rosuvastatin (5 mg once daily). The patient was always compliant with both pharmacological treatment and life-style
Communicated by Massimo Porta. * Kalliopi Kotsa [email protected] 1
Division of Endocrinology and Metabolism and Diabetes Centre, First Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 St. Kiriakidi Street, 54636 Thessaloniki, Greece
measures, putting extensive effort into effectively managing her diabetes in order to avoid long-term complications. She was frequently performing self-monitoring of blood glucose (SMBG) using a FreeStyle Precision Neo glucose meter (Abbott Diabetes Care, Witney, UK) that presents 99.4% of results within ± 20% of the reference value. The vast majority of her both fasting and 2-h postmeal measurements were within the targets predefined by the medical team (80–130 and 180 mg/dl) and 0% in hypoglycemia (
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