Hemoglobin A1c and mean glucose in patients with type 1 diabetes: analysis of data from the Juvenile Diabetes Research Foundation continuous glucose monitoring randomized trial

Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Darrell M Wilson, Dongyuan Xing, Roy W Beck, Jennifer Block, Bruce Bode, Larry A Fox, Irl Hirsch, Craig Kollman, Lori Laffel, Katrina J Ruedy, Michael Steffes, William V Tamborlane, Irl B Hirsch, Lisa K Gilliam, Kathy Fitzpatrick, Dori Khakpour, Stuart A Weinzimer, William V Tamborlane, Brett Ives, Joan Bosson-Heenan, Howard Wolpert, Greeshma Shetty, Astrid Atakov-Castillo, Judith Giusti, Stacey O'Donnell, Suzanne Ghiloni, Bruce W Bode, Kelli O'Neil, Lisa Tolbert, Tim Wysocki, Larry A Fox, Nelly Mauras, Kimberly Englert, Joe Permuy, Bruce Buckingham, Darrell M Wilson, Jennifer Block, Kari Benassi, Eva Tsalikian, Michael Tansey, Debra Kucera, Julie Coffey, Joanne Cabbage, Lori Laffel, Kerry Milaszewski, Katherine Pratt, Elise Bismuth, Joyce Keady, Margie Lawlor, H Peter Chase, Rosanna Fiallo-Scharer, Paul Wadwa, Laurel Messer, Victoria Gage, Patricia Burdick, Jean M Lawrence, Robert Clemons, Michelle Maeva, Bonnie Sattler, Roy W Beck, Katrina J Ruedy, Craig Kollman, Dongyuan Xing, Judy Sibayan, Jean M Bucksa, Maren L Nowicki, Carol Van Hale, Vicky Makky, Michael O'Grady, Elbert Huang, Anirban Basu, David O Meltzer, Lan Zhao, Joyce Lee, Aaron J Kowalski, Lori Laffel, William V Tamborlane, Roy W Beck, Aaron J Kowalski, Katrina J Ruedy, Ruth S Weinstock, Barbara J Anderson, Davida Kruger, Lisa LaVange, Henry Rodriguez, Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Darrell M Wilson, Dongyuan Xing, Roy W Beck, Jennifer Block, Bruce Bode, Larry A Fox, Irl Hirsch, Craig Kollman, Lori Laffel, Katrina J Ruedy, Michael Steffes, William V Tamborlane, Irl B Hirsch, Lisa K Gilliam, Kathy Fitzpatrick, Dori Khakpour, Stuart A Weinzimer, William V Tamborlane, Brett Ives, Joan Bosson-Heenan, Howard Wolpert, Greeshma Shetty, Astrid Atakov-Castillo, Judith Giusti, Stacey O'Donnell, Suzanne Ghiloni, Bruce W Bode, Kelli O'Neil, Lisa Tolbert, Tim Wysocki, Larry A Fox, Nelly Mauras, Kimberly Englert, Joe Permuy, Bruce Buckingham, Darrell M Wilson, Jennifer Block, Kari Benassi, Eva Tsalikian, Michael Tansey, Debra Kucera, Julie Coffey, Joanne Cabbage, Lori Laffel, Kerry Milaszewski, Katherine Pratt, Elise Bismuth, Joyce Keady, Margie Lawlor, H Peter Chase, Rosanna Fiallo-Scharer, Paul Wadwa, Laurel Messer, Victoria Gage, Patricia Burdick, Jean M Lawrence, Robert Clemons, Michelle Maeva, Bonnie Sattler, Roy W Beck, Katrina J Ruedy, Craig Kollman, Dongyuan Xing, Judy Sibayan, Jean M Bucksa, Maren L Nowicki, Carol Van Hale, Vicky Makky, Michael O'Grady, Elbert Huang, Anirban Basu, David O Meltzer, Lan Zhao, Joyce Lee, Aaron J Kowalski, Lori Laffel, William V Tamborlane, Roy W Beck, Aaron J Kowalski, Katrina J Ruedy, Ruth S Weinstock, Barbara J Anderson, Davida Kruger, Lisa LaVange, Henry Rodriguez

Abstract

Objective: To determine the relationship between mean sensor glucose concentrations and hemoglobin A(1c) (HbA(1c)) values measured in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications laboratory at the University of Minnesota in a cohort of subjects with type 1 diabetes from the Juvenile Diabetes Research Foundation continuous glucose monitoring randomized trial.

Research design and methods: Near-continuous glucose sensor data (≥ 4 days/week) were collected for 3 months before a central laboratory-measured HbA(1c) was performed for 252 subjects aged 8-74 years, the majority of whom had stable HbA(1c) values (77% within ± 0.4% of the patient mean).

Results: The slope (95% CI) for mean sensor glucose concentration (area under the curve) versus a centrally measured HbA(1c) was 24.4 mg/dL (22.0-26.7) for each 1% change in HbA(1c), with an intercept of -16.2 mg/dL (-32.9 to 0.6). Although the slope did not vary with age or sex, there was substantial individual variability, with mean sensor glucose concentrations ranging from 128 to 187 mg/dL for an HbA(1c) of 6.9-7.1%. The root mean square of the errors between the actual mean sensor glucose concentration versus the value calculated using the regression equation was 14.3 mg/dL, whereas the median absolute difference was 10.1 mg/dL.

Conclusions: There is substantial individual variability between the measured versus calculated mean glucose concentrations. Consequently, estimated average glucose concentrations calculated from measured HbA(1c) values should be used with caution.

Trial registration: ClinicalTrials.gov NCT00406133.

Figures

Figure 1
Figure 1
Mean glucose versus HbA1c: mean glucose measured by the CGM device over 3 months (91 days) before the HbA1c measurement (n = 252). Regression line was calculated using least squares. (A high-quality color representation of this figure is available in the online issue.)

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