Hemoglobin A1c Accurately Predicts Continuous Glucose Monitoring-Derived Average Glucose in Youth and Young Adults With Cystic Fibrosis

OBJECTIVEIn cystic fibrosis (CF), hemoglobin A(1c) (HbA(1c)) is thought to underestimate glycemia. However, few studies have directly assessed the relationship between HbA(1c) and average glucose in CF. We determined the relationships among glycemic markersHbA(1c), fructosamine (FA), glycated albumin (%GA), and 1,5-anhydroglucitol (1,5-AG)and continuous glucose monitoring (CGM) in CF, hypothesizing that alternate markers would better predict average sensor glucose (ASG) than HbA(1c).RESEARCH DESIGN AND METHODSCF participants and a group of healthy control subjects (HCs), ages 6-25 years, wore CGM for up to 7 days. Pearson correlations assessed the relationships between CGM variables and HbA(1c), FA, %GA, and 1,5-AG. The regression line between HbA(1c) and ASG was compared in CF versus HC. Linear regressions determined whether alternate markers predicted ASG after adjustment for HbA(1c).RESULTSCF (n = 93) and HC (n = 29) groups wore CGM for 5.2 1 days. CF participants were 14 +/- 3 years of age and 47% were male, with a BMI z score -0.1 +/- 0.8 and no different from HCs in age, sex, or BMI. Mean HbA(1c) in CF was 5.7 +/- 0.8% (39 +/- 9 mmol/mol) vs. HC 5.1 +/- 0.2% (32 +/- 2 mmol/mol) (P < 0.0001). All glycemic markers correlated with ASG (P 0.01): HbA(1c) (r = 0.86), FA (r = 0.69), %GA (r = 0.83), and 1,5-AG (r = -0.26). The regression line between ASG and HbA(1c) did not differ in CF versus HC (P = 0.44). After adjustment for HbA(1c), %GA continued to predict ASG (P = 0.0009) in CF.CONCLUSIONSHbA(1c) does not underestimate ASG in CF as previously assumed. No alternate glycemic marker correlated more strongly with ASG than HbA(1c). %GA shows strong correlation with ASG and added to the prediction of ASG beyond HbA(1c). However, we are not advocating use of HbA(1c) for diabetes screening in CF based on these results. Further study will determine whether glycemic measures other than ASG differ among different types of diabetes for a given HbA(1c).