HbA1c Is Disproportionately Higher in Women and Older People With Type 1 Diabetes Compared With Flash Glucose Monitoring Metrics of Glycemic Control

Abstract

Aims: Discrepancy between HbA1c and glucose exposure may have significant clinical implications. We sought to assess predictors of disparity between HbA1c and flash monitoring metrics and how these relate to microvascular complications. Methods: We conducted a cross-sectional study of adults with type 1 diabetes ( n = 518). We assessed the relationship between clinic HbA1c and flash monitoring metrics, predictors of discrepancy between these measurements, and whether discrepancy was associated with microvascular complications. Results: Actual HbA1c and estimated HbA1c were strongly correlated ( r = .779, P < .001). The likelihood of having a higher actual HbA1c than estimated HbA1c was greater with increasing age (OR = 1.055 per year, P < .001) and lower in men (OR = .208, P < .001). HbA1c was significantly lower in men (58 mmol/mol [51-67]) (7.5% [6.8-8.3]) compared to women (61 mmol/mol [54-70], P = .021) (7.7% [7.1-8.6]), despite no significant differences in any flash monitoring metrics. Whereas HbA1c was not different between younger (≤39 years) and older individuals (>39 years) despite significantly higher glucose exposure, in younger people, based on multiple flash monitoring metrics. Having a lower estimated than actual HbA1c was independently associated with a lower prevalence of retinopathy (OR = .55, P = .004). Conclusions: HbA1c appears to overestimate glucose exposure in women and older people with type 1 diabetes. This has potentially important clinical implications, as is hinted at by the independent relationship with retinopathy prevalence. It may also be of relevance when considering the use of HbA1c for the diagnosis of diabetes.

Factors associated with hemoglobin glycation index in adults with type 1 diabetes mellitus: The FGM‐Japan study

“…This is the first study to examine the association of HGI with diabetic complications and CGM metrics in Japanese adults with type 1 diabetes. In this study, a high HGI was significantly associated with female sex, as reported previously in people with a high risk of diabetes 34,35 . The relationship between HGI and female sex was consistent across studies.…”

linkage between the duration of diabetes mellitus type-2 with the biochemical measurements and the extent of chronic complications

“…The demography of the study is represented in Table 1 showing all the parameters measured in T2DM individuals with and without retinopathy according to gender. (15).…”