![]() A1C inaccurately reflects glycemia with certain anemias and hemoglobinopathies. Whether the cut point would be the same to diagnose children or adolescents with type 2 diabetes is an area of uncertainty ( 3, 10). Epidemiological studies forming the framework for recommending use of the A1C to diagnose diabetes have all been in adult populations. A recent epidemiological study found that, when matched for FPG, African Americans (with and without diabetes) indeed had higher A1C than whites, but also had higher levels of fructosamine and glycated albumin and lower levels of 1,5 anhydroglucitol, suggesting that their glycemic burden (particularly postprandially) may be higher ( 9). Some have posited that glycation rates differ by race (with, for example, African Americans having higher rates of glycation), but this is controversial. In addition, HbA 1c levels may vary with patients’ race/ethnicity ( 7, 8). These advantages must be balanced by greater cost, the limited availability of A1C testing in certain regions of the developing world, and the incomplete correlation between A1C and average glucose in certain individuals. The A1C has several advantages to the FPG and OGTT, including greater convenience (since fasting is not required), evidence to suggest greater preanalytical stability, and less day-to-day perturbations during periods of stress and illness.
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