title: Monitoring HIV-infected Patients with Diabetes: Hemoglobin A1c, Fructosamine, or Glucose?
abstract: 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 mellitus (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 (aAG) 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
  The correlations between HbA1c and aAG and between fructosamine and aAG were weaker than expected, and fructosamine was not more accurate than HbA1c.
authors.affiliation: Department of Medicine, Beth Israel Medical Center, New York, NY, USA.
authors.forename: So-Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Office of Grants and Research Administration, Beth Israel Medical Center, New York, NY, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Friedmann
authors.affiliation: Division of Endocrinology and Friedman Diabetes Institute, Albert Einstein College of Medicine/Beth Israel Medical Center, New York, NY, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Seth
authors.affiliation: Division of Endocrinology and Friedman Diabetes Institute, Albert Einstein College of Medicine/Beth Israel Medical Center, New York, NY, USA.
authors.forename: Adrienne M
authors.initials: AM
authors.lastname: Fleckman
keywords: A1C; HIV; diabetes; fructosamine; glucose