A1c can be misleading

[skb]

We've always known that people with anemia can show lower A1c results which can lead to a misdiagnosis. Particularly sickle cell anemia is a condition that is quite common and the usual culprit. I have the live case of a friend who is a confirmed diabetic (he doesn't believe so) but his A1c levels are always low, to the point that a number of times the machines are unable to give out a reading. Finally, here's a study that proves the point;

http://www.npr.org/sections/health-shots/2017/02/07/513891129/the-a1c-blood-sugar-test-may-be-less-accurate-in-african-americans 

[BobIA41]

Thank you for your comment before the link.  Also affecting the A1c is blood transfusion and dialysis to name two other cases that cause errors in A1c results.

[walkerwally1]

I have wondered about A1c results for some time.  I had blood work done Monday 2/6 and my A1c was 4.4.  I believe that is lower than it should be.  I am on the borderline of anemic since my hip fracture and when I was in the hospital after the surgery the doctor had me given a transfusion of two pints of whole blood.  He said that I was just on the border and he felt that a transfusion was a precaution.  On my last tests my HBC and RBC are still on the low side so my doctor wants to keep an eye on it.  As a result I am not sure what to think of my A1c results.  I test fairly often, usually about 4 times a day,  and my 30 day average on my meter is 94 which according to a chart I have is equal to an A1c of 4.9.  Comparing my meter to lab results they are pretty close, meter the morning of test 88mg/dl and lab test 86 mg/dl, so I feel that my home readings are at least close to reality. 
I brought this up to my doctor and she agreed that anemia can have an effect on A1c results but she doesn't think that what I am seeing is enough to skew the results.  Still I think that 4.4 is not really accurate.    That would be an average of 80 mg/dl and I can't believe that.  Interesting that I had blood work done the last day I was in the hospital on 1/4 before being transferred to another facility for rehab and my A1c then was 5.0 which seems more in line.

[rocky]

Thank you very much all for another enlightening article and discussion. 

[Grammabear]

In 2015 I was hospitalized for very low electrolyte levels and since I am type 1 diabetic, they did regular blood sugar checks at every shift change of the nurses.  One night the nurse came in, did the bg check and left to bring the sample to the lab.  About 15 min later she returns with her 'equipment' to do yet another blood test.  When I asked her 'why', she said "because the lab says your blood sugar is 950 (52.7). 

I pulled my CGM out and told her "No way is my bg that high."  "My CGM says my blood sugar is approximately 164 (9.1)."  After she did the second blood test and returned with the results, the lab admitted they made a mistake in how they processed the first test.  The results of the second test from the lab were more in keeping with what my CGM told me at the time.

I think that a number of things can influence the A1C.  I know in my case that it was my low electrolytes that really screwed up my readings both before and after the lab mistake. 

[skb]

I test fairly often, usually about 4 times a day,  and my 30 day average on my meter is 94 which according to a chart I have is equal to an A1c of 4.9. Comparing my meter to lab results they are pretty close, meter the morning of test 88mg/dl and lab test 86 mg/dl, so I feel that my home readings are at least close to reality.

Our site's Converter gives a figure of 4.81 for an average BG of 94. And if your meter is accurate and you test 4-5 times a day, then you have the full spectrum covered and there is no doubt about the result.
The 4.4 could be a machine calibration error. I had a few of the Bayer's home A1c test kits which always gave me lower results of 0.5 or thereabouts, as compared to the labs. Always made me happy, as they were closer to my own average BG. And I wouldn't put it beyond Indian labs to deliberately give a higher number. The doctor / lab nexus here is very apparent. Doctors get as much as 65% lab fees back as kickbacks. Rotten, isn't it  ?