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Cases of fulminant type 1 and type 2 diabetes mellitus whose HbA1c levels were unmeasurable due to increased labile HbA1c

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Abstract

Although the measurement of hemoglobin A1c (HbA1c) using high-performance liquid chromatography (HPLC) is routinely used to estimate average blood glucose levels, it may not be accurately measured for various reasons, such as alteration of red blood cell lifespan and the existence of hemoglobin variants; including hemoglobin F (HbF). Here, we report cases of fulminant type 1 and type 2 diabetes mellitus in which HbA1c levels were unmeasurable because of increased labile HbA1c levels. Case 1 involved a 73-year-old man with fulminant type 1 diabetes mellitus, who was brought to our hospital with diabetic ketoacidosis. The patient’s blood glucose level was 994 mg/dL, and HbA1c was unmeasurable, which turned out to be 6.2% on the next day when the blood glucose level was normalized. Case 2 involved a 72-year-old man with type 2 diabetes mellitus, whose blood glucose level was 767 mg/dL, and HbA1c was unmeasurable, which turned out to be 17.9% the following day. In both cases, the chromatograms showed that the HbA1c peaks overlapped with large labile HbA1c peaks, which decreased the next day. It is important to keep in mind that HbA1c levels may not be accurately measured in cases of extreme hyperglycemia because of an increase in labile HbA1c, regardless of the absolute HbA1c level.

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Authors and Affiliations

  1. Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan

    Shunsuke Kato, Izumi Otaka, Hanako Toyama, Ryota Kusumi, Kazuyuki Takahashi, Mitsuhiko Nara, Yumi Suganuma, Takehiro Sato, Tsukasa Morii, Hiroki Fujita & Hironori Waki

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  1. Shunsuke Kato
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  2. Izumi Otaka
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  3. Hanako Toyama
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  4. Ryota Kusumi
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  5. Kazuyuki Takahashi
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  6. Mitsuhiko Nara
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  7. Yumi Suganuma
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  8. Takehiro Sato
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  9. Tsukasa Morii
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  10. Hiroki Fujita
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  11. Hironori Waki
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Correspondence to Hironori Waki.

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The authors declare that there is no conflict of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and/or with the Helsinki Declaration of 1964 and later versions. Formal ethics approval was waived for this paper by the ethics committee of Akita University Graduate School of Medicine due to its being a case report.

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Kato, S., Otaka, I., Toyama, H. et al. Cases of fulminant type 1 and type 2 diabetes mellitus whose HbA1c levels were unmeasurable due to increased labile HbA1c. Diabetol Int 13, 698–703 (2022). https://doi.org/10.1007/s13340-022-00593-y

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  • DOI: https://doi.org/10.1007/s13340-022-00593-y

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