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Clinical Chemistry 47: 1212-1217, 2001;
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(Clinical Chemistry. 2001;47:1212-1217.)
© 2001 American Association for Clinical Chemistry, Inc.

Articles

Interpretation of Hemoglobin A1c (HbA1c) Values among Diabetic Patients

Implications for Quality Specifications for HbA1c

Svein Skeie1a, Geir Thue1 and Sverre Sandberg1

1 NOKLUS, Norwegian Center for External Quality Improvement of Primary Care Laboratories, Division of General Practice, Department of Public Health and Primary Care, Ulriksdal 8c, University of Bergen, N-5009 Bergen, Norway.


aAddress correspondence to this author at: Department of Medicine, Rogaland Central Hospital, PO Box 8100, 4068 Stavanger, Norway. Fax 47-51-51-99-06; e-mail svskeie{at}online.no

Background: Few studies have examined patients’ views, knowledge, and understanding of glycohemoglobin A1c (HbA1c) testing. We explored such issues in patients with type 1 diabetes and used their statements to estimate analytical quality specifications for HbA1c testing.

Methods: We recruited 201 patients from a hospital outpatient clinic. A questionnaire was used to collect information on diabetes characteristics, perceived knowledge of HbA1c, last HbA1c value, HbA1c target value, and thresholds for action. Patients were asked to indicate the magnitude of change in HbA1c from 9.4% that they would consider to be a true (real) change; from their responses, we calculated patient-derived quality specifications for HbA1c.

Results: Fifty-eight percent of the patients felt they had "high" knowledge about HbA1c, and >80% of responders knew their last HbA1c value, their target HbA1c, and the threshold value of HbA1c for treatment intensification. The mean acceptable HbA1c value was 7.5%. Patients with lower values on their most recent tests reported lower target values for HbA1c and lower values for the upper HbA1c threshold for treatment intensification. An analytical CV (CVa) of 3.1% would be satisfactory for 75% of patients when HbA1c is increasing (80% confidence), and a CVa of 3.2% would be satisfactory for 75% when HbA1c is decreasing (95% confidence).

Conclusions: Type 1 patients’ perceived knowledge about HbA1c testing is high. They are well informed about their own personal results and about target values and the upper HbA1c threshold for action. The patient-derived analytical quality specification for imprecision (CV) is 3.1%.




The following articles in journals at HighWire Press have cited this article:


Home page
 Clin. DiabetesHome page
A. M. Delamater
Clinical Use of Hemoglobin A1c to Improve Diabetes Management
Clin. Diabetes, January 1, 2006; 24(1): 6 - 8.
[Full Text] [PDF]

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 Clin. Chem.Home page
S. Skeie, C. Perich, C. Ricos, A. Araczki, A. R. Horvath, W. P. Oosterhuis, T. Bubner, G. Nordin, R. Delport, G. Thue, et al.
Postanalytical External Quality Assessment of Blood Glucose and Hemoglobin A1c: An International Survey
Clin. Chem., July 1, 2005; 51(7): 1145 - 1153.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
P. Luraschi, S. Brambilla, R. Mozzi, G. Cattozzo, and C. Franzini
Monitoring Analytical Quality in Routine Glycohemoglobin Measurements
Clin. Chem., September 1, 2002; 48(9): 1594 - 1597.
[Full Text] [PDF]


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