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Cited by 987Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes Management and Education

Defining the Relationship Between Plasma Glucose and HbA1c

Rohlfing, Curt L., Wiedmeyer, Hsiao-Mei, Little, Randie R., England, Jack D., Tennill, Alethea, Goldstein, David E.·2002·Diabetes Care
DOI 10.2337/diacare.25.2.275
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Abstract

OBJECTIVE— To define the relationship between HbA1c and plasma glucose (PG) levels in patients with type 1 diabetes using data from the Diabetes Control and Complications Trial (DCCT). RESEARCH DESIGN AND METHODS— The DCCT was a multicenter, randomized clinical trial designed to compare intensive and conventional therapies and their relative effects on the development and progression of diabetic complications in patients with type 1 diabetes. Quarterly HbA1c and corresponding seven-point capillary blood glucose profiles (premeal, postmeal, and bedtime) obtained in the DCCT were analyzed to define the relationship between HbA1c and PG. Only data from complete profiles with corresponding HbA1c were used (n = 26,056). Of the 1,441 subjects who participated in the study, 2 were excluded due to missing data. Mean plasma glucose (MPG) was estimated by multiplying capillary blood glucose by 1.11. Linear regression analysis weighted by the number of observations per subject was used to correlate MPG and HbA1c. RESULTS— Linear regression analysis, using MPG and HbA1c summarized by patient (n = 1,439), produced a relationship of MPG (mmol/l) = (1.98 ○1 HbA1c) - 4.29 or MPG (mg/dl) = (35.6 ○1 HbA1c) - 77.3, r = 0.82). Among individual time points, afternoon and evening PG (postlunch, predinner, postdinner, and bedtime) showed higher correlations with HbA1c than the morning time points (prebreakfast, postbreakfast, and prelunch). CONCLUSIONS— We have defined the relationship between HbA1c and PG as assessed in the DCCT. Knowing this relationship can help patients with diabetes and their healthcare providers set day-to-day targets for PG to achieve specific HbA1c goals.

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  • To exclude invalid self-reported HbA1c data, users with a greater or less than 2.0% difference between self-reported HbA1c and 90-day mean blood glucose were excluded (n=44).

    “To exclude invalid self-reported HbA1c data, we used the formula HbA1c=(90-day mean blood glucose + 77.3)/35.6 [11] to compare self-reported HbA1c to 90-day mean blood glucose, and excluded users with a greater or less than 2.0% difference (n=44 were excluded).”

    From One drop | Mobile on iPhone and apple watch: an evaluation of hbA1c improvement associated with tracking self-care (2017) · cites this paper as [11]

  • Glycosylated hemoglobin reflects long-term glycemic control and is a more accurate and stable measure than fasting plasma glucose.

    “Glycosylated hemoglobin reflects long-term glycemic control and is a more accurate and stable measure than FPG levels [13,14].”

    From A Novel Testing Model for Opportunistic Screening of Pre-Diabetes and Diabetes among U.S. Adults (2015) · cites this paper as [14]

  • The optimal cutoff values for HbA1c have been intensively reported in previous studies and discussed in several review papers.

    “The optimal cutoff values for HbA1c has been intensively reported in previous studies and discussed in several review papers [4,14,15,38,41,42,43,44,45].”

    From A Novel Testing Model for Opportunistic Screening of Pre-Diabetes and Diabetes among U.S. Adults (2015) · cites this paper as [14]

  • There is substantial interindividual variation in A1C at the same levels of glycemia.

    “Moreover, there is substantial interindividual variation in A1C at the same levels of glycemia (20,21), reflecting differences in red cell penetration, glycation, hemoglobin species, red cell half-life, vitamin and medication status, and others factors (22).”

    From Screening for Diabetes and Pre-Diabetes With Proposed A1C-Based Diagnostic Criteria (2010) · cites this paper as [21]

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Authors
Rohlfing, C. L., Wiedmeyer, H.-M., Little, R. R., England, J. D., Tennill, A., & Goldstein, D. E.
Affiliations
University of Missouri (US)
ORCID
Little, Randie R.
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2002-02-01
Volume
25
Issue
2
Pages
275-278
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.25.2.275
OpenAlex
W2110590807
Cited by
987
References
19
Citations by year
2026: 11 · 2025: 19 · 2024: 32 · 2023: 33 · 2022: 24 · 2021: 27 · 2020: 33 · 2019: 30 · 2018: 45 · 2017: 32 · 2016: 33 · 2015: 41 · 2014: 60 · 2013: 58 · 2012: 45
FWCI
18.45
Type
journal article
Language
en
Open access
closed
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • George Washington University
  • Max-Planck-Gesellschaft
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
HbA1c, plasma glucose, type 1 diabetes, glycemic control, capillary blood glucose, glycemic targets, Diabetes Control and Complications Trial
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Linear Models

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