Monitoring HIV-infected patients with diabetes: Hemoglobin A1c, fructosamine, or glucose?

So Young Kim, Patricia Friedmann, Amit Seth, Adrienne M. Fleckman

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


BACKGROUND: Published studies report inappropriately low hemoglobin A1C (HbA1c) values that underestimate glycemia in HIV patients.

METHODS: We reviewed the charts of all HIV patients with diabetes m ell it us (DM) at our clinic. Fifty-nine patients had HbA1c data, of whom 26 patients also had fructosamine data. We compared the most recent HbA1c to finger-stick (FS) glucose averaged over three months, and fructosamine to FS averaged over six weeks. Predicted average glucose (pAG) was calculated as reported by Nathan et al: pAG (mg/dL) = 28.7 × A1C% – 46.7. Data were analyzed using the Statistical Analysis System (SAS) and Kruskal–Wallis test.

RESULTS: HbA1c values underestimated (UE) actual average glucose (a AG) in 19% of these patients and overestimated (OE) aAG in 27%. HbA1c estimated aAG within the established range in only 54% of the patients. There were no statistical differences in the types of HIV medication used in patients with UE, OE, or accurately estimated (AE) glycemia. A Spearman correlation coefficient between HbA1c and aAG was r = 0.53 (P < 0.0001). Correlation between fructosamine and aAG was r = 0.47 (P = 0.016).

CONCLUSIONS: Te correlations between HbA1c and aAG and between fructosamine and aAG were weaker than expected, and fructosamine was not more accurate than HbA1c.

Original languageEnglish (US)
Pages (from-to)41-45
Number of pages5
JournalClinical Medicine Insights: Endocrinology and Diabetes
StatePublished - Dec 4 2014
Externally publishedYes


  • A1C
  • Diabetes
  • Fructosamine
  • Glucose
  • HIV

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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