0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Metrics for Monitoring Glycemic Control

Stuart Chalew, MD; James Hempe, PhD; Robert McCarter, DSc
JAMA. 2011;305(24):2522-2523. doi:10.1001/jama.2011.845.
Text Size: A A A
Published online

Extract

To the Editor: Hemoglobin A1c (HbA1c) measures contain information regarding mean blood glucose (MBG) as well as MBG-independent factors.1 In their Commentary, Drs Rubinow and Hirsch pointed out that the presence of considerable between-patient variation in HbA1c values not due to MBG poses an important challenge for clinical interpretation of HbA1c tests.2 The hemoglobin glycation index (HGI) was created specifically to quantify and assess this MBG-independent component of HbA1c measurement.1 HGI is the difference between a patient's observed HbA1c value and the predicted HbA1c value (calculated by inserting the patient's observed MBG into the population regression equation of HbA1c vs MBG1,3). HGI is highly correlated with HbA1c values but statistically independent of MBG values.1,3 In an analysis of data from the Diabetes Control and Complications Trial, we used HGI to demonstrate that HbA1c level was a predictor of retinopathy and nephropathy that was statistically independent of MBG level.3 The authors referenced a critique by Lachin et al4 that questioned the value of HGI and its strong association with complications because it is not independent of HbA1c level. As HGI is a component of HbA1c measurement, it cannot be independent of HbA1c level. But it is independent of MBG values and thus can be used to assess the importance of MBG-independent variation in HbA1c values as a predictor of complications.3

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Letters

June 22, 2011
Katya B. Rubinow, MD; Irl B. Hirsch, MD
JAMA. 2011;305(24):2522-2523. doi:10.1001/jama.2011.846.
CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();