Personal glycation factors and calculated HbA1c for diabetes management: Real-world data from the DPV registry.

Background Glycated hemoglobin A1c (HbA1c) is a key biomarker in the glycemic management of individuals with diabetes but the relationship with glucose levels can be variable. A recent kinetic model has described a calculated HbA1c (cHbA1c) that is individual-specific. Our aim was to validate the routine clinical use of this glucose metric in younger individuals with diabetes under real life-settings. Materials and methods We retrieved HbA1c and glucose data from the German-Austrian-Swiss-Luxemburgian diabetes follow-up (DPV) registry, which covers pediatric individuals with type 1 diabetes. The new glycemic measure, cHbA1c, uses two individual parameters identified by data sections which contain continuous glucose data between two laboratory HbA1c measurements. The cHbA1c was prospectively validated using longitudinal HbA1c data. Results CGM data from 352 T1D individuals in 13 clinics were analyzed together with HbA1c that ranged between 4.9-10.6%. In the prospective analysis, absolute deviations of estimated HbA1c (eHbA1c), glucose management indicator (GMI) and cHbA1c compared with laboratory HbA1c were [median (IQR)]: 1.01 (0.50, 1.75), 0.46 (0.21, 084) and 0.26 (0.12, 0.46), giving an average bias of 0.6, 0.4 and 0.0, respectively in NGSP % unit. For eHbA1c and GMI, only 25% and 54% of subjects were within ±0.5% of laboratory HbA1c values, while 82% of cHbA1c were within ±0.5% of laboratory HbA1c results. Conclusions Our data show the superior performance of cHbA1c compared with eHbA1c and GMI at reflecting laboratory HbA1c. These data indicate that cHbA1c can be potentially used instead in laboratory HbA1c, at least in younger individuals with T1D.