Hemoglobin A1c Underestimates Glycemia in HIV Infection
- Peter S Kim, MD1,3,
- Christian Woods, MD1,
- Patrick Georgoff, BS2,
- Dana Crum, MD2,
- Alice Rosenberg, RN3,
- Margo Smith, MD1 and
- Colleen Hadigan, MD, MPH (hadiganc{at}niaid.nih.gov)3
- 1 Department of Infectious Diseases, Washington Hospital Center, Washington, DC
- 2 University of Pennsylvania School of Medicine, Philadelphia, PA
- 3 National Institute of Allergy and Infectious Diseases, NIH, Bethesda MD
Abstract
Objective: The objective of this study was to determine the relationship between hemoglobin A1c and glycemia in HIV infection.
Research Design and Methods: A prospective cross-sectional study of 100 HIV-infected adults with type 2 diabetes (77%) or fasting hyperglycemia (23%) with measured glucose, HbA1c, mean corpuscular volume (MCV) and fructosamine. Two hundred HIV-uninfected matched type 2 diabetics served as controls.
Results: Relative to controls, HbA1c underestimated glucose by 29±4 mg/dL in HIV. Current nucleoside reverse transcriptase inhibitors (NRTI), higher MCV and hemoglobin, and lower HIV RNA and haptoglobin were associated with greater HbA1c-glucose discordance. However, only MCV, current NTRI use, in particular, abacavir use, remained significant predictors in multivariate analyses. Fructosamine more closely reflected glycemia in HIV.
Conclusion: HbA1c underestimates glycemia in HIV-infected patients and is related to NRTI use. Use of abacavir and increased MCV were key correlates in multivariate analysis. Fructosamine may be more appropriate in this setting.
Footnotes
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- Received January 29, 2009.
- Accepted May 29, 2009.
- Copyright © American Diabetes Association
