Disparity Between Plasma Glucose and HbA1c in Assessment of Glycemic Control Among Type 2 Diabetes Patients on Oral Antidiabetic Drugs: A Real-world, Retrospective Study Based on Electronic Medical Records
Keywords:
Real-world data, Disparity, Glycemic values, HbA1C value, Oral Anti-diabetic Drugs
Abstract
Background: Disparity between plasma glucose [FPG &PPG] and HbA1c has its implication in diagnosis as well as assessing glycemic control in diabetes. The effect of this disparity in assessing glycemic control during diabetes needs more research.
Objective: Assessment of degree of disparity between fasting, postprandial glucose with HbA1C among type 2 diabetes patients on oral anti-diabetic drugs.
Methodology: A total 12829 electronic medical records [EMR] of people living with diabetes, who attended clinics between Oct-2014 to Jul-2019 were included for the analysis and this data was retrieved from more than 75 physicians across 26 cities. Based on the disparity between plasma glucose and HbA1c, EMRs were categorized in five different categories: Disparity groups [Group A and B], Non-disparity groups [Groups C and D], and Others [Group E].
Results: A disparity of 17.89% [2296] was reported in the study. Mean age and BMI were found to be significantly different among all the five groups. Amongst all the groups, the average duration of diabetes was highest in group D [8.06 years], and there was a significant difference among the five groups. The Pearson correlation coefficient [r] between HbA1c and FPG was found to be 0.71 [P < 0.001, 95 % CI; 0.69-0.72] while between HbA1c and PPG it was 0.67 [P < 0.001, 95 % CI; 0.66-0.68]. A total of 56 [0.43 %], hypoglycemia episodes were reported based on FPG values, while 108 [0.84 %] were recorded by the physician based on patient’s complaints or medical history.
Conclusion: Our study showed disparity between plasma glucose and HbA1c in assessing glycemic control among people living with type 2 diabetes and taking OADs. This disparity should be considered during the management of diabetes.
Source[s] of support: No funding was provided.
Conflict of Interest: None declared.
References
1. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clinical diabetes. 2008;26[2]:77-82.
2. Association AD. Standards of medical care in diabetes—2016: summary of revisions. Diabetes care. 2016;39[Supplement
1]:S4-S5.
3. Rosediani M, Azidah AK, Mafauzy M. Correlation between Fasting Plasma Glucose, Post Prandial Glucose and Glycated
Haemoglobin and Fructosamine. Med J Malaysia 2006;61[1]: 67-71.
4. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA et. al., Association of glycemia with macrovascular and microvascular complications of type 2 diabetes [UKPDS 35]: prospective observational study. British Medical Journal 2000;321:405-12.
5. ADVANCE Collaborative Group. Intensive blood glucose
control and vascular outcomes in patients with type 2 diabetes. New England journal of medicine. 2008;358[24]:2560-72.
6. Group UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment
and risk of complications in patients with type 2 diabetes [UKPDS 33]. The lancet. 1998;352[9131]:837-53.
7. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20[7]:1183–1197.
8. Dorcely B, Katz K, Jagannathan R, Chiang SS, Oluwadare B, Goldberg IJ, Bergman M. Novel biomarkers for prediabetes, diabetes, and associated complications. Diabetes, metabolic syndrome and obesity: targets and therapy. 2017;10:345.
9. Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing
diabetes mellitus. J Clin Endocrinol Metab. 2008;93[7]:2447– 2453.
10. Petersen PH, Jørgensen LG, Brandslund I, De Fine Olivarius
N, Stahl M. Consequences of bias and imprecision in measurements of glucose and HbA1C for the diagnosis and
prognosis of diabetes mellitus. Scand J Clin Lab Invest Suppl. 2005;240:51–60.
11. American Diabetes Association. Standards of medical care in diabetes–2010. Diabetes Care. 2010;33[suppl 1]:S11–S61.
12. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ. Translating the A1C assay into estimated average glucose values. Diabetes care. 2008;31[8]:1473-8.
13. Kilpatrick ES. Haemoglobin A1c in the diagnosis and monitoring of diabetes mellitus. J Clin Pathol. 2008;61[9]:977–82.
14. Bloomgarden ZT. A1c: recommendations, debates, and questions. Diabetes Care. 2009;32[12]:141–7.
15. Bouma M, Dekker JH, de Sonnaville JJ, van der Does FE, de Vries H, Kriegsman DM, et al. How valid is fasting plasma
glucose as a parameter of glycemic control in non-insulin- using patients with type 2 diabetes? Diabetes care.
1999;22[6]:904-7.
16. Ho-Pham LT, Nguyen UDT, Tran TX, Nguyen TV. Discordance in the diagnosis of diabetes: Comparison between
HbA1c and fasting plasma glucose. Bjornstad P, editor. PLOS ONE. 2017;12[8]:e0182192.
17. Pam Anderson, Nathan Grills, Rajesh Singh, Rajkumari Singh, Roger G. Evans, Paramita Sengupta and Amanda G.
Thrift. Prevalence of diabetes and pre-diabetes in rural Tehri Garhwal, India: influence of diagnostic method. BMC Public
Health [2019] 19:817.
18. Cowie CC, Rust KF, Byrd-Holt DD, Gregg EW, Ford ES, Geiss LS, et al. Prevalence of Diabetes and High Risk for
Diabetes Using A1C Criteria in the U.S. Population in 1988- 2006. Diabetes Care [Internet]. 2010;33[3]:562–8.
19. Lorenzo C, Wagenknecht LE, Hanley AJG, Rewers MJ, Karter AJ, Haffner SM. A1C Between 5.7 and 6.4% as a Marker for
Identifying Pre-Diabetes, Insulin Sensitivity and Secretion, and Cardiovascular Risk Factors: The Insulin Resistance
Atherosclerosis Study [IRAS]. Diabetes Care. 2010;33[9]:2104– 9.
20. Akka K, Wali V. Fasting blood sugar and post prandial blood sugar among diabetics at a tertiary care hospital. [cited
2020 Feb 5]; Available from: https://www.medpulse.in/ Biochemistry/Article/Volume4Issue1/Biochem_4_1_7.pdf
21. American Diabetes Association. Standards of Medical Care in Diabetes-2020 Abridged for Primary Care Providers. Clinical
diabetes: a publication of the American Diabetes Association. 2020 Jan;38[1]:10.
22. Rathmann W, Bongaerts B, Kostev K. Association of characteristics of people with type 2 diabetes mellitus with discordant
values of fasting glucose and HbA1c: Journal of diabetes. 2018 Dec;10[12]:934-41.
23. Sharma S, Rana MS. Discrepancies between the glycosylated haemoglobin based criteria and glucose based criteria
for diagnosis of diabetes and pre-diabetes. In17th European Congress of Endocrinology 2015 May 1 [Vol. 37]. BioScientifica.
24. Krishna SV, Kota SK, Modi KD. Glycemic variability: clinical implications. Indian journal of endocrinology and metabolism.
2013 Jul;17[4]:611.
25. Banshi Saboo. Role of ambulatory glucose profile in identifying and managing a patient with disparity between FPG,
PPG and HbAlc levels: a case report. B. Int J Res Med Sci. 2020 Feb;8[2]
26. Tylee TS, Trence DL. Glycemic variability: looking beyond the A1C. Diabetes Spectrum. 2012 Aug 1;25[3]:149-53.
27. Danne T, Nimri R, Battelino T et al. International consensus on use of continuous glucose monitoring. Diabetes Care.
2017; 40: 1631–1640.
28. American Diabetes Association. Postprandial blood glucose. Diabetes care. 2001 Apr 1;24[4]:775-8
29. Hossain T, Latif ZA, Sarkar AA. Relationship of HbA1c with Fasting and Plasma Glucose 2 Hours after Oral Glucose
Load in Non Diabetic and Newly Diagnosed Pre Diabetic and Diabetic Patients. BIRDEM Medical Journal. 2012 Oct
21;2[2]:81–3.
30. Bonora E, Calcaterra F, Lombardi S, Bonfante N, Formentini G, Bonadonna RC, et al. Plasma Glucose Levels Throughout
the Day and HbA1c Interrelationships in Type 2 Diabetes: Implications for treatment and monitoring of metabolic control.
Diabetes Care. 2001 Dec 1;24[12]:2023–9.
31. Gupta S, Puppalwar P, Chalak A. Correlation of fasting and post meal plasma glucose level to increased HbA1c levels in
type-2 diabetes mellitus. International Journal of Advances in Medicine. 2014;1[2]:1
32. Bodmer M, Meier C, Krähenbühl S, Jick SS, Meier CR. Metformin, sulfonylureas, or other antidiabetes drugs and
the risk of lactic acidosis or hypoglycemia: a nested casecontrol analysis. Diabetes care. 2008 Nov 1;31[11]:2086-91.
33. Miller CD, Phillips LS, Ziemer DC, Gallina DL, Cook CB, El-Kebbi IM. Hypoglycemia in patients with type 2 diabetes
mellitus. Archives of internal medicine. 2001 Jul 9;161[13]:1653- 9.
34. Vigersky R, Shrivastav M. Role of continuous glucose monitoring for type 2 in diabetes management and research.
Journal of Diabetes and its Complications. 2017;31[1]:280–7.
35. Welsh JB. Role of Continuous Glucose Monitoring in Insulin- Requiring Patients with Diabetes. Diabetes Technology &
Therapeutics. 2018;20[S2]:S2-42-S2-49.
36. Beck RW, Riddlesworth T, Ruedy K, Ahmann A, Bergenstal R, Haller S, et al. Effect of continuous glucose monitoring on
glycemic control in adults with type 1 diabetes using insulin injections: The DIAMOND randomized clinical trial. JAMA
2017;317:371-8.
37. Lind M, Polonsky W, Hirsch IB, Heise T, Bolinder J, Dahlqvist S, et al. Continuous glucose monitoring vs. conventional
therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: The GOLD randomized clinical trial. JAMA 2017;317:379-87.
38. Yoo HJ, An HG, Park SY, Ryu OH, Kim HY, Seo JA, Hong EG, Shin DH, Kim YH, Kim SG, Choi KM. Use of a real time continuous glucose monitoring system as a motivational device for poorly controlled type 2 diabetes. Diabetes research and clinical practice. 2008 Oct 1;82[1]:73-9.
39. Unnikrishnan AG, Saboo B, Joshi S, Kesavadev J, Makkar BM, Agarwal S, et al. Consensus Statement on Use of Ambulatory Glucose Profile in Patients with Type 2 Diabetes Mellitus Receiving Oral Antidiabetic Drugs. The Journal of the Association of Physicians of India [Internet]. 2019;67[11]:76–
83.
40. Chawla M, Saboo B, Jha S, Bhandari S, Kumar P, Kesavadev J, Munjal YP, Mohan V, Unnikrishnan R, Katswar V, Arun N, Sosale B, Anjana RM, Hasnani D. Consensus and recommendations on continuous glucose monitoring. J Diabetol 2019;10:4-14.
2. Association AD. Standards of medical care in diabetes—2016: summary of revisions. Diabetes care. 2016;39[Supplement
1]:S4-S5.
3. Rosediani M, Azidah AK, Mafauzy M. Correlation between Fasting Plasma Glucose, Post Prandial Glucose and Glycated
Haemoglobin and Fructosamine. Med J Malaysia 2006;61[1]: 67-71.
4. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA et. al., Association of glycemia with macrovascular and microvascular complications of type 2 diabetes [UKPDS 35]: prospective observational study. British Medical Journal 2000;321:405-12.
5. ADVANCE Collaborative Group. Intensive blood glucose
control and vascular outcomes in patients with type 2 diabetes. New England journal of medicine. 2008;358[24]:2560-72.
6. Group UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment
and risk of complications in patients with type 2 diabetes [UKPDS 33]. The lancet. 1998;352[9131]:837-53.
7. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20[7]:1183–1197.
8. Dorcely B, Katz K, Jagannathan R, Chiang SS, Oluwadare B, Goldberg IJ, Bergman M. Novel biomarkers for prediabetes, diabetes, and associated complications. Diabetes, metabolic syndrome and obesity: targets and therapy. 2017;10:345.
9. Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing
diabetes mellitus. J Clin Endocrinol Metab. 2008;93[7]:2447– 2453.
10. Petersen PH, Jørgensen LG, Brandslund I, De Fine Olivarius
N, Stahl M. Consequences of bias and imprecision in measurements of glucose and HbA1C for the diagnosis and
prognosis of diabetes mellitus. Scand J Clin Lab Invest Suppl. 2005;240:51–60.
11. American Diabetes Association. Standards of medical care in diabetes–2010. Diabetes Care. 2010;33[suppl 1]:S11–S61.
12. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ. Translating the A1C assay into estimated average glucose values. Diabetes care. 2008;31[8]:1473-8.
13. Kilpatrick ES. Haemoglobin A1c in the diagnosis and monitoring of diabetes mellitus. J Clin Pathol. 2008;61[9]:977–82.
14. Bloomgarden ZT. A1c: recommendations, debates, and questions. Diabetes Care. 2009;32[12]:141–7.
15. Bouma M, Dekker JH, de Sonnaville JJ, van der Does FE, de Vries H, Kriegsman DM, et al. How valid is fasting plasma
glucose as a parameter of glycemic control in non-insulin- using patients with type 2 diabetes? Diabetes care.
1999;22[6]:904-7.
16. Ho-Pham LT, Nguyen UDT, Tran TX, Nguyen TV. Discordance in the diagnosis of diabetes: Comparison between
HbA1c and fasting plasma glucose. Bjornstad P, editor. PLOS ONE. 2017;12[8]:e0182192.
17. Pam Anderson, Nathan Grills, Rajesh Singh, Rajkumari Singh, Roger G. Evans, Paramita Sengupta and Amanda G.
Thrift. Prevalence of diabetes and pre-diabetes in rural Tehri Garhwal, India: influence of diagnostic method. BMC Public
Health [2019] 19:817.
18. Cowie CC, Rust KF, Byrd-Holt DD, Gregg EW, Ford ES, Geiss LS, et al. Prevalence of Diabetes and High Risk for
Diabetes Using A1C Criteria in the U.S. Population in 1988- 2006. Diabetes Care [Internet]. 2010;33[3]:562–8.
19. Lorenzo C, Wagenknecht LE, Hanley AJG, Rewers MJ, Karter AJ, Haffner SM. A1C Between 5.7 and 6.4% as a Marker for
Identifying Pre-Diabetes, Insulin Sensitivity and Secretion, and Cardiovascular Risk Factors: The Insulin Resistance
Atherosclerosis Study [IRAS]. Diabetes Care. 2010;33[9]:2104– 9.
20. Akka K, Wali V. Fasting blood sugar and post prandial blood sugar among diabetics at a tertiary care hospital. [cited
2020 Feb 5]; Available from: https://www.medpulse.in/ Biochemistry/Article/Volume4Issue1/Biochem_4_1_7.pdf
21. American Diabetes Association. Standards of Medical Care in Diabetes-2020 Abridged for Primary Care Providers. Clinical
diabetes: a publication of the American Diabetes Association. 2020 Jan;38[1]:10.
22. Rathmann W, Bongaerts B, Kostev K. Association of characteristics of people with type 2 diabetes mellitus with discordant
values of fasting glucose and HbA1c: Journal of diabetes. 2018 Dec;10[12]:934-41.
23. Sharma S, Rana MS. Discrepancies between the glycosylated haemoglobin based criteria and glucose based criteria
for diagnosis of diabetes and pre-diabetes. In17th European Congress of Endocrinology 2015 May 1 [Vol. 37]. BioScientifica.
24. Krishna SV, Kota SK, Modi KD. Glycemic variability: clinical implications. Indian journal of endocrinology and metabolism.
2013 Jul;17[4]:611.
25. Banshi Saboo. Role of ambulatory glucose profile in identifying and managing a patient with disparity between FPG,
PPG and HbAlc levels: a case report. B. Int J Res Med Sci. 2020 Feb;8[2]
26. Tylee TS, Trence DL. Glycemic variability: looking beyond the A1C. Diabetes Spectrum. 2012 Aug 1;25[3]:149-53.
27. Danne T, Nimri R, Battelino T et al. International consensus on use of continuous glucose monitoring. Diabetes Care.
2017; 40: 1631–1640.
28. American Diabetes Association. Postprandial blood glucose. Diabetes care. 2001 Apr 1;24[4]:775-8
29. Hossain T, Latif ZA, Sarkar AA. Relationship of HbA1c with Fasting and Plasma Glucose 2 Hours after Oral Glucose
Load in Non Diabetic and Newly Diagnosed Pre Diabetic and Diabetic Patients. BIRDEM Medical Journal. 2012 Oct
21;2[2]:81–3.
30. Bonora E, Calcaterra F, Lombardi S, Bonfante N, Formentini G, Bonadonna RC, et al. Plasma Glucose Levels Throughout
the Day and HbA1c Interrelationships in Type 2 Diabetes: Implications for treatment and monitoring of metabolic control.
Diabetes Care. 2001 Dec 1;24[12]:2023–9.
31. Gupta S, Puppalwar P, Chalak A. Correlation of fasting and post meal plasma glucose level to increased HbA1c levels in
type-2 diabetes mellitus. International Journal of Advances in Medicine. 2014;1[2]:1
32. Bodmer M, Meier C, Krähenbühl S, Jick SS, Meier CR. Metformin, sulfonylureas, or other antidiabetes drugs and
the risk of lactic acidosis or hypoglycemia: a nested casecontrol analysis. Diabetes care. 2008 Nov 1;31[11]:2086-91.
33. Miller CD, Phillips LS, Ziemer DC, Gallina DL, Cook CB, El-Kebbi IM. Hypoglycemia in patients with type 2 diabetes
mellitus. Archives of internal medicine. 2001 Jul 9;161[13]:1653- 9.
34. Vigersky R, Shrivastav M. Role of continuous glucose monitoring for type 2 in diabetes management and research.
Journal of Diabetes and its Complications. 2017;31[1]:280–7.
35. Welsh JB. Role of Continuous Glucose Monitoring in Insulin- Requiring Patients with Diabetes. Diabetes Technology &
Therapeutics. 2018;20[S2]:S2-42-S2-49.
36. Beck RW, Riddlesworth T, Ruedy K, Ahmann A, Bergenstal R, Haller S, et al. Effect of continuous glucose monitoring on
glycemic control in adults with type 1 diabetes using insulin injections: The DIAMOND randomized clinical trial. JAMA
2017;317:371-8.
37. Lind M, Polonsky W, Hirsch IB, Heise T, Bolinder J, Dahlqvist S, et al. Continuous glucose monitoring vs. conventional
therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: The GOLD randomized clinical trial. JAMA 2017;317:379-87.
38. Yoo HJ, An HG, Park SY, Ryu OH, Kim HY, Seo JA, Hong EG, Shin DH, Kim YH, Kim SG, Choi KM. Use of a real time continuous glucose monitoring system as a motivational device for poorly controlled type 2 diabetes. Diabetes research and clinical practice. 2008 Oct 1;82[1]:73-9.
39. Unnikrishnan AG, Saboo B, Joshi S, Kesavadev J, Makkar BM, Agarwal S, et al. Consensus Statement on Use of Ambulatory Glucose Profile in Patients with Type 2 Diabetes Mellitus Receiving Oral Antidiabetic Drugs. The Journal of the Association of Physicians of India [Internet]. 2019;67[11]:76–
83.
40. Chawla M, Saboo B, Jha S, Bhandari S, Kumar P, Kesavadev J, Munjal YP, Mohan V, Unnikrishnan R, Katswar V, Arun N, Sosale B, Anjana RM, Hasnani D. Consensus and recommendations on continuous glucose monitoring. J Diabetol 2019;10:4-14.
Published
2020-07-27
How to Cite
Dr Manmohan Singh, Dr. Manoj Chawla , Dr. Mangesh Tiwaskar , Dr. Banshi Saboo. (2020). Disparity Between Plasma Glucose and HbA1c in Assessment of Glycemic Control Among Type 2 Diabetes Patients on Oral Antidiabetic Drugs: A Real-world, Retrospective Study Based on Electronic Medical Records. The Indian Practitioner, 73(7), 22-28. Retrieved from https://articles.theindianpractitioner.com/index.php/tip/article/view/1007
Section
Original Article
