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Glycated Hemoglobin A1c Levels Are Not Affected by Critical Illness

Nora Luethi1, Luca Cioccari, Aiko Tanaka

  • 11Department of Intensive Care, Austin Hospital, The University of Melbourne, Melbourne, VIC, Australia.2Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.3Discipline of Acute Care Medicine, Department of Intensive Care, University of Adelaide, Adelaide, SA, Australia.4Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.5Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

Critical Care Medicine
|March 16, 2016
PubMed

Insights

Glycated hemoglobin A1c (HbA1c) measured in the ICU reliably reflects patients' long-term glycemic control. Critical illness does not significantly alter HbA1c levels, validating its use for guiding diabetes treatment.

Area of Science:

  • Endocrinology
  • Critical Care Medicine
  • Clinical Chemistry

Background:

  • Glycated hemoglobin A1c (HbA1c) is a key indicator of long-term glycemic control in diabetic patients.
  • Concerns exist that critical illness may affect HbA1c levels, potentially misrepresenting a patient's usual glycemic status upon ICU admission.

Purpose of the Study:

  • To evaluate the relationship between HbA1c levels measured at ICU admission and premorbid HbA1c levels.
  • To determine if critical illness alters HbA1c measurements.

Main Methods:

  • Retrospective observational cohort study involving 69 diabetic patients admitted to two tertiary ICUs in Australia.
  • HbA1c levels were measured upon ICU admission and from records within the preceding 30 days.

Main Results:

  • Mean (SD) HbA1c was 7.5% (1.8%) on ICU admission and 7.8% (2.0%) pre-admission.
  • A strong correlation (r = 0.89, p < 0.001) was observed between admission and premorbid HbA1c levels.
  • No significant correlation was found between the change in HbA1c and the time elapsed between measurements.

Conclusions:

  • Glycated hemoglobin A1c levels are not significantly altered by the acute onset of critical illness.
  • HbA1c measured at ICU admission serves as a reliable estimate of chronic glycemic control.
  • Admission HbA1c values can be effectively utilized to guide acute glycemic management in critically ill diabetic patients.
Abstract

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