Introduction The utility of HbA1c (glycosylated hemoglobin) to estimate glycemic control in populations of African and other low-resource countries has been questioned because of high prevalence of other medical conditions that may affect its reliability. Using continuous glucose monitoring (CGM), we aimed to determine the comparative performance of HbA1c, fasting plasma glucose (FPG) (within 5 hours of a meal) and random non-fasting glucose (RPG) in assessing glycemic burden. Research design and methods We assessed the performance of HbA1c, FPG and RPG in comparison to CGM mean glucose in 192 Ugandan participants with type 2 diabetes. Analysis was undertaken in all participants, and in subgroups with and without medical conditions reported to affect HbA1c reliability. We then assessed the performance of FPG and RPG, and optimal thresholds, in comparison to HbA1c in participants without medical conditions thought to alter HbA1c reliability. Results 32.8% (63/192) of participants had medical conditions that may affect HbA1c reliability: anemia 9.4% (18/192), sickle cell trait and/or hemoglobin C (HbC) 22.4% (43/192), or renal impairment 6.3% (12/192). Despite high prevalence of medical conditions thought to affect HbA1c reliability, HbA1c had the strongest correlation with CGM measured glucose in day-to-day living (0.88, 95% CI 0.84 to 0.91), followed by FPG (0.82, 95% CI 0.76 to 0.86) and RPG (0.76, 95% CI 0.69 to 0.81). Among participants without conditions thought to affect HbA1c reliability, FPG and RPG had a similar diagnostic performance in identifying poor glycemic control defined by a range of HbA1c thresholds. FPG of ≥7.1 mmol/L and RPG of ≥10.5 mmol/L correctly identified 78.2% and 78.8%, respectively, of patients with an HbA1c of ≥7.0%. Conclusions HbA1c is the optimal test for monitoring glucose control even in low-income and middle-income countries where medical conditions that may alter its reliability are prevalent; FPG and RPG are valuable alternatives where HbA1c is not available. Data are available upon reasonable request.

中文翻译：

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HbA1c 在监测血糖控制方面表现良好，即使在可能改变其可靠性的医疗条件高流行的人群中：OPTIMAL 观察性多中心研究

简介 HbA1c（糖基化血红蛋白）用于估计非洲和其他资源匮乏国家人群血糖控制的效用受到质疑，因为其他医疗条件的高患病率可能会影响其可靠性。使用连续血糖监测 (CGM)，我们旨在确定 HbA1c、空腹血糖 (FPG)（餐后 5 小时内）和随机非空腹血糖 (RPG) 在评估血糖负荷方面的比较表现。研究设计和方法 我们评估了 192 名乌干达 2 型糖尿病参与者的 HbA1c、FPG 和 RPG 与 CGM 平均血糖的表现。对所有参与者以及有和没有报告影响 HbA1c 可靠性的医疗条件的亚组进行了分析。然后我们评估了 FPG 和 RPG 的性能，以及最佳阈值，与没有被认为会改变 HbA1c 可靠性的医疗条件的参与者的 HbA1c 相比。结果 32.8% (63/192) 的参与者患有可能影响 HbA1c 可靠性的医疗状况：贫血 9.4% (18/192)、镰状细胞性状和/或血红蛋白 C (HbC) 22.4% (43/192) 或肾功能不全6.3% (12/192)。尽管被认为会影响 HbA1c 可靠性的医疗状况的流行率很高，但 HbA1c 与日常生活中 CGM 测量的葡萄糖的相关性最强（0.88, 95% CI 0.84 至 0.91），其次是 FPG（0.82, 95% CI 0.76 至0.86) 和 RPG (0.76, 95% CI 0.69 至 0.81)。在没有被认为会影响 HbA1c 可靠性的条件的参与者中，FPG 和 RPG 在识别由一系列 HbA1c 阈值定义的不良血糖控制方面具有相似的诊断性能。FPG ≥7.1 mmol/L 和 RPG ≥10。5 mmol/L 分别正确识别 HbA1c ≥ 7.0% 的患者的 78.2% 和 78.8%。结论 HbA1c 是监测血糖控制的最佳测试，即使在可能改变其可靠性的医疗条件普遍存在的低收入和中等收入国家也是如此；在 HbA1c 不可用的情况下，FPG 和 RPG 是有价值的替代品。可根据合理要求提供数据。