| Abstract: |
This article, from a series that presents patient cases using an evidence-based practice framework, describes a situation in which glycosylated hemoglobin (A1C) measures may not be a reliable marker for glycemic control and hemoglobinopathy. The case patient was an 11-year-old African-American girl newly diagnosed with type 1 diabetes and Hashimoto’s thyroiditis, who was being followed up after her initial hospitalization for diabetic ketoacidosis 2 weeks previously. The author describes her medication compliance, symptoms, concerns about preprandial hypoglycemia, and vital signs. The review of the patient’s laboratory records show that A1C was not measured by the laboratory because of an abnormal hemoglobin peak. The author considers whether hemoglobinopathies affect the clinical reliability of A1C measurement and, if so, what alternate method of assessment should be used for monitoring these patients. The author reports the results of a literature review, discussing hemoglobinopathy in patients with diabetes, variation by laboratory method, assessment of glycemic control using fructosamine, and an evidence grading system for clinical practice recommendations. The author concludes with an overview of the case patient’s present situation and recommendations for improvement of care and ongoing measurement of the child’s blood glucose levels. 33 references. |