The relationship between fasting plasma glucose and HbA1c during intensive periods of glucose control in antidiabetic therapy

Abstract

Objective: HbA1c measurements are typically less variable than fasting plasma glucose (FPG) for diagnosing diabetes, and for assessment of progress on glucose control therapy. However HbA1c reaches steady-state relative to average plasma glucose over about 120 days. HbA1c thus overestimates average FPG during first three months of starting therapy in newly diagnosed diabetic patients, and care needs to be exercised in interpreting HbA1c measurements during this period. At steady-state excellent regression exists between HbA1c and FPG. We hypothesize that this regression can also be used to obtain reliable estimates of HbA1c relative to FPG at 4 and 8 weeks following the onset of therapy.

Materials and methods: We collected FPG and HbA1c data of type 2 diabetic patients over the first 8 weeks of starting antidiabetic treatment. We fit linear and nonlinear regression models to steady-state data, and estimated how much measured HbA1c deviates at 4 and 8 weeks from these theoretical relations.

Results: If measured HbA1c is decremented by 0.7% (8 mmol/mol) at 4 weeks and 0.3% (3 mmol/mol) at 8 weeks, this corrected HbA1c is a better predictor of the corresponding FPG. Using hyperbolic regression, corrections to HbA1c are 0.5 and 0.1% (5 and 1 mmol/mol), respectively.

Conclusion: With the corrections proposed here, HbA1c measurements can be better interpreted in the early weeks of antidiabetic treatment.

Keywords: Glycated hemoglobin; Nonlinear regression analysis; Type 2 diabetes mellitus.