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HbA1c levels: falsely low in a patient taking dapsone

We write to highlight to colleagues an important clinical lesson regarding a drug-related side effect of dapsone use. A 50-year-old Caucasian male presented to the diabetes clinic in January 2019. He had taken dapsone (100mg daily) for control of dermatitis herpetiformis in the context of coeliac disease since 2011. He was diagnosed with type 1 diabetes aged 13 years and had a background of suboptimal glycaemic control. His other medications included a basal-bolus insulin regime, pamipexole, quinine and ramipril. He was an ex-smoker with a 25 pack-year history and drank 17 units of alcohol per week.