Within-subject variation of HbA1c: A systematic review and meta-analysis
Alex Gough1, Alice Sitch1, Erica Ferris1
1Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
Plos One
|August 2, 2023
Summary
Glycosylated haemoglobin (HbA1c) variability is higher in individuals with diabetes than in healthy subjects. This within-subject variation increases with higher average HbA1c levels, impacting clinical interpretation.
Area of Science:
- Endocrinology and Metabolism
- Clinical Chemistry
- Biostatistics
Background:
- Glycosylated haemoglobin (HbA1c) is crucial for diagnosing and managing diabetes mellitus.
- Understanding within-subject variability of HbA1c is essential for accurate clinical interpretation and utility.
- Previous comprehensive reviews on HbA1c within-subject variability are lacking.
Approach:
- Conducted a systematic review and meta-analysis of studies reporting HbA1c within-subject variability.
- Searched multiple databases from inception to November 2022 for relevant follow-up studies.
- Assessed risk of bias using a modified COSMIN tool and pooled ICC results; described CV by median and range.
Key Points:
- Analyzed 111 studies, with data from healthy individuals, type 1 diabetes, and type 2 diabetes patients.
- Median within-subject coefficient of variation (CV) for HbA1c was 0.070.
- HbA1c CV was significantly higher in patients with diabetes (Type 1: 0.084, Type 2: 0.083) compared to healthy subjects (0.017) and increased with mean population HbA1c.
Conclusions:
- Within-subject HbA1c variability is greater in individuals with diabetes than in healthy individuals.
- Increased HbA1c variability may confound associations between variability and health outcomes.
- Further research is needed to refine estimates and understand factors influencing HbA1c variability for improved clinical decision-making.
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