Abel Joseph Profile picture
Jan 21 7 tweets 3 min read
Do you interpret/rely on HbA1c often? ⚖️

Sometimes it may not truly represent glucose control.

Here are a few alternative methods to assess long-term glycemic control #MedTwitter.

A thread🧵
1/
Serum Fructosamine 🪢

This circulating glycated protein provides a 7 to 21-day estimate of glucose levels.

317 μmol/L -> HbA1c 7%
375 μmol/L -> HbA1c 8%

Limited use in nephrotic syndrome, liver disease, PLE, and pregnancy.
2/
Glycated Albumin 🪢

Glycemic control in the previous 14 to 21 days.

➗Divide by 3 for an approximate HbA1c.

Limited use in nephrotic, thyroid, and liver disease.
3/
Capillary blood glucose 🤌

Requires strict adherence but is very accurate.

Find ADA's calculator here professional.diabetes.org/diapro/glucose…
4/
Continuous glucose monitoring 📱📱

Measures interstitial glucose levels. Fancy mobile-based applications to curate data.

Personal monitors (~3k$/yr) - Nutrisense, Veri

Professional monitors (covered by insurance)
DexCom ~$4k/yr,
FreeStyle Libre ~$2k/yr,
Eversense ~$6k/y
5/
1,5-Anhydroglucitol

A dietary polyol that competes with glucose for reabsorption in the renal tubules.

High glucosuria -> Lower 1,5 AHG in the previous 14 to 21 days.

Limited use with SGLT2 inhibitors and altered renal perfusion. 💊
6/
Consider these alternative approaches to glycemic monitoring in
🩸Hemoglobinopathies
◽️Anemia
🫄 Pregnancy
🫘 Advanced Liver and Kidney disease

Check out this 1-minute consult:
ccjm.org/content/88/2/81

#MedTwitter #Diabetes

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