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Title: Age and Red Blood Cell Parameters Mainly Explain the Differences Between HbA1c and Glycemic Management Indicator Among Patients With Type 1 Diabetes Using Intermittent Continuous Glucose Monitoring
Authors: Azcoitia, Pablo
Rodríguez-Castellano, Raquel
Saavedra Santana, Pedro 
Alberiche Ruano,Maria Del Pino 
Marrero, Dunia
Wägner, Anna Maria Claudia 
Ojeda, Antonio
Boronat Cortés, Mauro 
UNESCO Clasification: 32 Ciencias médicas
320502 Endocrinología
3206 Ciencias de la nutrición
Keywords: Continuous Glucose Monitoring
Glucose Management Indicator
Mean Corpuscular Volume
Red Cell Distribution Width, et al
Issue Date: 2023
Journal: Journal of diabetes science and technology 
Abstract: Background: Glycated hemoglobin (HbA1c) is the gold standard to assess glycemic control in patients with diabetes. Glucose management indicator (GMI), a metric generated by continuous glucose monitoring (CGM), has been proposed as an alternative to HbA1c, but the two values may differ, complicating clinical decision-making. This study aimed to identify the factors that may explain the discrepancy between them. Methods: Subjects were patients with type 1 diabetes, with one or more HbA1c measurements after starting the use of the Freestyle Libre 2 intermittent CGM, who shared their data with the center on the Libreview platform. The 14-day glucometric reports were retrieved, with the end date coinciding with the date of each HbA1c measurement, and those with sensor use ≥70% were selected. Clinical data prior to the start of CGM use, glucometric data from each report, and other simultaneous laboratory measurements with HbA1c were collected. Results: A total of 646 HbA1c values and their corresponding glucometric reports were obtained from 339 patients. The absolute difference between HbA1c and GMI was <0.3% in only 38.7% of cases. Univariate analysis showed that the HbA1c-GMI value was associated with age, diabetes duration, estimated glomerular filtration rate, mean corpuscular volume (MCV), red cell distribution width (RDW), and time with glucose between 180 and 250 mg/dL. In a multilevel model, only age and RDW, positively, and MCV, negatively, were correlated to HbA1c-GMI. Conclusion: The difference between HbA1c and GMI is clinically relevant in a high percentage of cases. Age and easily accessible hematological parameters (MCV and RDW) can help to interpret these differences.
ISSN: 1932-2968
DOI: 10.1177/19322968231191544
Source: Journal of Diabetes Science and Technology[EISSN 1932-2968], (Agosto 2023)
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