Low HbA1c in poorly controlled type 1 diabetes mellitus in a child

Area of Science:

• Clinical Chemistry
• Endocrinology
• Hematology

Background:

• Glycosylated haemoglobin (HbA1c) is a key biomarker for assessing long-term glycemic control in diabetes mellitus.
• HbA1c also aids in predicting the risk of microvascular complications associated with diabetes.
• Accurate HbA1c interpretation is essential for effective diabetes management and patient outcomes.

Observation:

• This report details a case of an uncontrolled diabetic child presenting with an unexpectedly low HbA1c level.
• The discrepancy between clinical presentation and HbA1c value prompted further investigation.
• The presence of an underlying condition affecting HbA1c measurement was suspected.

Findings:

• Haemoglobin variants and disorders are known to interfere with the accuracy of HbA1c assays.
• Such interference can lead to misinterpretation of glycaemic control, particularly in diverse patient populations.
• The child's low HbA1c was attributed to a condition affecting haemoglobin, not actual glycaemic control.

Implications:

• Misleading HbA1c results due to haemoglobin variants can significantly alter clinical management strategies.
• It is crucial for clinicians to be aware of factors that can affect HbA1c accuracy.
• Consideration of haemoglobin variants is important for appropriate diagnosis and treatment of diabetic patients.