Relationship of A1C to Glucose Concentrations in Children With Type 1 Diabetes

Diabetes Research in Children Network (DirecNet) Study Group

doi:10.2337/dc07-1835

Cited by 115Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

Relationship of A1C to Glucose Concentrations in Children With Type 1 Diabetes

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Diabetes Research in Children Network (DirecNet) Study Group·2008·Diabetes Care

DOI 10.2337/dc07-1835PMC PMC2274897

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Abstract

OBJECTIVE: Despite the standing of A1C as the most validated and widely used measure for average glycemic control over time, the relationship between A1C and glucose concentrations is not completely understood. The purpose of this Diabetes Research in Children Network (DirecNet) study was to use continuous glucose monitoring data to examine the relationship between A1C and glucose in type 1 diabetes. RESEARCH DESIGN AND METHODS: Forty-eight youth enrolled in studies of the Navigator continuous glucose monitor were encouraged to wear the Navigator sensor at home continuously. A1C was measured at baseline, at 3 months, and at 6 months. Sensor glucose data were directly transmitted via the Internet, assuring that essentially all glucose values were analyzed. RESULTS: Subjects had a median of 112 h/week of Navigator data in the first 3 months and 115 h/week in the second 3 months. The slope of mean glucose over the previous 3 months versus A1C was only 18 mg/dl per 1.0% A1C. Individually, there was substantial variation in the relationship between mean glucose and A1C. A1C was not associated with glucose lability after controlling for mean glucose. Measures of an individual's rate of glycation were moderately correlated at the 3- and 6-month visits. CONCLUSIONS: As the chemistry of glycation would predict, we found no evidence to contradict the simple hypothesis that A1C directly reflects mean glucose over time. There is, however, substantial variability in individual mean glucose concentrations for a given A1C. Transforming reliable A1C values into calculated mean glucose values would, when applied to an individual, introduce substantial error.

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A small study comparing A1C to CGM data in children with type 1 diabetes found a highly statistically significant correlation between A1C and mean blood glucose, although the correlation (r = 0.7) was significantly lower than that in the ADAG trial.
“A small study comparing A1C to CGM data in children with type 1 diabetes found a highly statistically significant correlation between A1C and mean blood glucose, although the correlation (r = 0.7) was significantly lower than that in the ADAG trial (21).”
From 6. Glycemic Targets: Standards of Care in Diabetes—2023 (2023) · cites this paper as [21]
A recent study comparing A1C to CGM data in 48 type 1 children found a highly statistically significant correlation between A1C and mean blood glucose, although the correlation (r = 0.7) was significantly lower than in the ADAG trial.
“A recent study comparing A1C to CGM data in 48 type 1 children found a highly statistically significant correlation between A1C and mean blood glucose, although the correlation (r = 0.7) was significantly lower than in the ADAG trial (44).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [44]

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Authors: Diabetes Research in Children Network (DirecNet) Study Group
Affiliations: Jaeb Center for Health Research (US)
Corresponding author: Diabetes Research in Children Network (DirecNet) Study Group
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2008-03-01
Volume: 31
Issue: 3
Pages: 381-385
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc07-1835
PMC: PMC2274897
OpenAlex: W1674375000
Cited by: 115
References: 17
Citations by year: 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 1 · 2018: 6 · 2017: 10 · 2016: 4 · 2015: 4 · 2014: 4 · 2013: 9 · 2012: 8
FWCI: 12.78
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Center for Research Resources (M01 RR 00059, M01RR006022, M01RR000059, M01 RR00069, M01 RR00070-41, M01 RR-06022, M01RR000070, M01RR000069)
NIH Clinical Center
Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD041919, U01HD041890, U10HD041908, HD 041890, U10HD041918, U10HD041890, U10HD041915, U10HD041906)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords: HbA1c, mean blood glucose, type 1 diabetes, children, continuous glucose monitoring, glycemic control, glycemic variability
MeSH terms: Adolescent, Blood Glucose, Child, Child, Preschool, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Biosensing Techniques

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Relationship of A1C to Glucose Concentrations in Children With Type 1 Diabetes

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