Hemoglobin A1c and Self-Monitored Average Glucose: Validation of the Dynamical Tracking eA1c Algorithm in Type 1 Diabetes. (March 2016)

• Record Type: Journal Article
• Authors: Kovatchev, Boris P.; Breton, Marc D.
• Is Part Of: Journal of diabetes science and technology. Volume 10:Number 2(2016:Mar.)
• Page Start: 330
• Page End: 335
• Publication Date: 2016-03
• Subjects: average glycemia -- dynamical tracking -- HbA1c estimation -- self-monitored blood glucose; Diabetes -- Periodicals; Medical technology -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462005
• DOI: 10.1177/1932296815608870
• Languages: English
• ISSNs: 1932-2968

Abstract

Background: Previously we have introduced the eA1c —a new approach to real-time tracking of average glycemia and estimation of HbA1c from infrequent self-monitoring (SMBG) data, which was developed and tested in type 2 diabetes. We now test eA1c in type 1 diabetes and assess its relationship to the hemoglobin glycation index (HGI)—an established predictor of complications and treatment effect. Methods: Reanalysis of previously published 12-month data from 120 patients with type 1 diabetes, age 39.15 (14.35) years, 51/69 males/females, baseline HbA1c = 7.99% (1.48), duration of diabetes 20.28 (12.92) years, number SMBG/day = 4.69 (1.84). Surrogate fasting BG and 7-point daily profiles were derived from these unstructured SMBG data and the previously reported eA1c method was applied without any changes. Following the literature, we calculated HGI = HbA1c – (0.009 × Fasting BG + 6.8). Results: The correlation of eA1c with reference HbA1c was r = .75, and its deviation from reference was MARD = 7.98%; 95% of all eA1c values fell within ±20% from reference. The HGI was well approximated by a linear combination of the eA1c calibration factors: HGI = 0.007552* θ1 + 0.007645* θ2 – 3.154 ( P < .0001); 73% of low versus moderate-high HGIs were correctly classified by the same factors as well. Conclusions: The eA1c procedure developed in type 2 diabetes to track in real-time changes in average glycemia and present the results in HbA1c-equivalent units has shown similar performance in type 1 diabetes. The eA1c calibration factors are highly predictive of the HGI, thereby explaining partially the biological variation causing discrepancies between HbA1c and its linear estimates from SMBG data.