{"title":"When HbA1c Lies: Recognizing and Managing HbA1c-Glucose Discordance in Clinical Practice.","authors":"Brian Burroughs","doi":"10.14423/SMJ.0000000000002002","DOIUrl":null,"url":null,"abstract":"<p><p>Hemoglobin A1c (HbA1c) remains a cornerstone of glycemic assessment in diabetes mellitus care, yet discordance between HbA1c and measured glucose values is common in clinical practice. Failure to recognize this discordance can lead to inappropriate treatment escalation, increased hypoglycemia risk, and patient distress. This article reviews the biological and clinical factors that contribute to HbA1c-glucose discordance and translates these findings into practical strategies for routine care. Common causes include iron deficiency, chronic kidney disease, altered red blood cell turnover, hemoglobin variants, and rapid changes in glycemia. A stepwise, practice-oriented framework is presented to guide clinicians in evaluating discordant glycemic data using targeted laboratory testing and continuous glucose monitoring metrics. Emphasis is placed on avoiding reflexive medication intensification and using glucose monitoring data to individualize treatment decisions. The role of interdisciplinary care and patient-centered communication is also highlighted.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 8","pages":"524-528"},"PeriodicalIF":0.9000,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Southern Medical Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.14423/SMJ.0000000000002002","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Hemoglobin A1c (HbA1c) remains a cornerstone of glycemic assessment in diabetes mellitus care, yet discordance between HbA1c and measured glucose values is common in clinical practice. Failure to recognize this discordance can lead to inappropriate treatment escalation, increased hypoglycemia risk, and patient distress. This article reviews the biological and clinical factors that contribute to HbA1c-glucose discordance and translates these findings into practical strategies for routine care. Common causes include iron deficiency, chronic kidney disease, altered red blood cell turnover, hemoglobin variants, and rapid changes in glycemia. A stepwise, practice-oriented framework is presented to guide clinicians in evaluating discordant glycemic data using targeted laboratory testing and continuous glucose monitoring metrics. Emphasis is placed on avoiding reflexive medication intensification and using glucose monitoring data to individualize treatment decisions. The role of interdisciplinary care and patient-centered communication is also highlighted.
期刊介绍：
As the official journal of the Birmingham, Alabama-based Southern Medical Association (SMA), the Southern Medical Journal (SMJ) has for more than 100 years provided the latest clinical information in areas that affect patients'' daily lives. Now delivered to individuals exclusively online, the SMJ has a multidisciplinary focus that covers a broad range of topics relevant to physicians and other healthcare specialists in all relevant aspects of the profession, including medicine and medical specialties, surgery and surgery specialties; child and maternal health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices. Each month, articles span the spectrum of medical topics, providing timely, up-to-the-minute information for both primary care physicians and specialists. Contributors include leaders in the healthcare field from across the country and around the world. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine.
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