Discrepancies in assessment of metabolic regulation in insulin-dependent diabetes mellitus--can we do without measurements of glycated haemoglobin?

Our purpose was to compare physicians' assessment of metabolic control in insulin-dependent diabetes mellitus (IDDM) with measurements of glycated haemoglobin HbA1c. One hundred and twenty diabetics were evaluated by physicians without access to HbA1c. Simultaneously HbA1c was measured by a highly precise isoelectric focusing method (interval of non-diabetics 5.2-6.8%). A comparison between physicians' classification into good, acceptable or poor control, and a biochemical classification by HbA1c showed a considerable discrepancy. Identity between classifications was seen in 52%, but 30% of the diabetics were considered in good or acceptable control despite HbA1c values above 10.0%. Mean HbA1c was significantly higher in women than in men (p less than 0.01). Among patients, overrated by the physicians, were relatively more women, whereas no other differences could be demonstrated. Home blood glucose monitoring did not lead to better agreement between classifications. We conclude that measurements of HbA1c is presently the most accurate single assay of metabolic control in insulin-dependent diabetics.