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Discordance between HbA1c and glycemia

In the present issue of the Journal, Rathmann et al. analyzed data from 64 553 people with type 2 diabetes mellitus (T2DM) from various general practice clinics in Germany. Rathmann et al. investigated relationships between patient characteristics and the highly correlated cut-off points of HbA1c (less than or more than 7%) and fasting blood glucose (FBG; less than or more than 140 mg/dL). Interestingly, they report significant discordance between these two values in 23% of patients. Each discordant category (HbA1c ≥7%, FBG <140 mg/dL, and FBG ≥ 140 mg/dL with HbA1c <7%), was associated with a distinctive set of characteristics related to the duration of diabetes, its treatment, and/or complications. Hemoglobin A (which makes up ~97% of total hemoglobin) contains five minor components (including HbA1c), comprising approximately 5%–7% of the HbA molecule. The unusual hemoglobin found in patients with diabetes (described as a “blurry band” in a 67-year-old woman with diabetes mellitus) in 1969 was similar to HbA1c prepared from normal subjects, a path-breaking discovery, the importance of which was not immediately appreciated. A correlation between glucose regulation and this glycosylated hemoglobin moiety was described in 1976, with the suggestion that: