Author + information
- Received May 4, 2016
- Revision received August 19, 2016
- Accepted August 23, 2016
- Published online December 6, 2016.
- M. Odette Gore, MD, MSCS∗ ( and )
- Darren K. McGuire, MD, MHSc
- ↵∗Reprint requests and correspondence:
Dr. M. Odette Gore, University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, 5323 Harry Hines Boulevard, Dallas, Texas 75390.
Measurement of glycated hemoglobin (HbA1c), the most widely accepted indicator of long-term glycemic exposure, is central for the diagnosis and management of diabetes mellitus. Levels of HbA1c track epidemiologically with diabetic complications, and glycemic control, as reflected by HbA1c reduction, results in decreased risk of microvascular complications, including diabetic kidney disease, neuropathy, and retinopathy. The relationship between HbA1c reduction and cardiovascular disease prevention in patients with diabetes is more complex, with data from large randomized trials published over the past decade providing clear evidence that lowering of HbA1c per se is an inadequate marker for a therapeutic regimen’s impact on cardiovascular outcomes and patient survival. Recent revisions in professional society guidelines moved away from uniform recommendations and toward a more nuanced, patient-centered approach to HbA1c therapeutic targets. The context and key evidence underpinning these recent changes are discussed in this paper, alongside a brief overview of HbA1c contemporary assays and their limitations.
Dr. McGuire has received honoraria for clinical trial leadership from Boehringer-Ingelheim, Janssen Research and Development LLC, Merck Sharp and Dohme, Lilly USA, Novo Nordisk, GlaxoSmithKline, Takeda Pharmaceuticals North America, AstraZeneca, Lexicon, and Eisai; and personal consulting fees from Sanofi, Boehringer Ingelheim, Merck Sharp and Dohme, Novo Nordisk, Lilly USA, and Regeneron. Dr. Gore is uncompensated principal or co-investigator for randomized trials sponsored by GlaxoSmithKline and AstraZeneca; and is supported by a career development award from the National Heart, Lung, and Blood Institute (K23-HL131939).
- Received May 4, 2016.
- Revision received August 19, 2016.
- Accepted August 23, 2016.
- American College of Cardiology Foundation
- Central Illustration
- Definition and Relationship With Blood/Plasma Glucose
- Analytical Methods and Standardization
- HbA1c and Clinical Outcomes in T1DM
- HbA1c and Clinical Outcomes in T2DM
- HbA1c Treatment Targets: Recent Changes in Professional Guidelines