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Delay in Diagnosis of Diabetes Mellitus Due to Inaccurate Use of Hemoglobin A_1C Levels

From US Air Force, Medical Corps, 78th Medical Group, Warner-Robbins Air Force Base, GA (JGA); and US Air Force, Medical Corps, Malcolm Grow Medical Center, Andrews Air Force Base, MD (HJM)

Correspondence: Corresponding author: Maj Howard J. McGowan, USAF, MC, Malcolm Grow Medical Center, 79 MDOS, 1075 W. Perimeter Road, Andrews Air Force Base, MD 20762 (E-mail: howard.mcgowan{at}andrews.af.mil)

Testing of hemoglobin A_1C (HbA_1C) levels has become widespread in the management of patients with diabetes mellitus. Since the 1980s, it has proven to be an invaluable tool correlating with a patient’s average blood glucose levels as well as with their disease morbidity. Clinicians often base treatment decisions and make adjustments depending on a patient’s HbA_1C level. As useful as the HbA_1C is, it does have notable limitations. A number of conditions can lead to a falsely elevated or a falsely low HbA_1C level. When one of these conditions is present, it is important to recognize the inaccuracy of the HbA_1C test to prevent a delay or error in the diagnosis or care of patients with diabetes mellitus. It is also important to be aware of alternative methods of monitoring a patient’s diabetes such as a fructosamine assay or home and office blood glucose measurements. Presented is the case of a patient with diabetes mellitus and hereditary spherocytosis, a condition that interfered with her HbA_1C value and resulted in a delay in her care.

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