Usefulness of estimated average glucose (eAG) in glycemic control and cardiovascular risk reduction

Correlation between Estimated Average Glucose Levels Calculated from HbA1c Values and Random Blood Glucose Levels in a Cohort of Subjects

Objective Hemoglobin A1c (HbA1c) level remains the gold standard test for the assessment of glycemic control, and it reflects the mean glucose values in the previous 3-month period. HbA1c is expressed as a percentage, whereas the monitoring and treatment of diabetes are based on blood glucose levels expressed as mg/dL. It is appropriate to make it easy for the patient to understand both random blood sugar (RBS) and estimated average glucose (eAG) expressed with the same units. This will enhance the usefulness of eAG. This article determines the statistical correlation between eAG derived from HBA1C with RBS values both in diabetic and prediabetic subjects.

Methods The RBS and HbA1c levels of 178 males and 283 females (12–90 years) were obtained and the eAG levels were calculated using Nathan's regression equation. The samples were divided into four groups based on HbA1c levels—group 1: HbA1c greater than 9%, group 2: HbA1c 6.5 to 9%, group 3: HbA1c 5.7 to 6.4%; and group 4: HbA1c less than 5.7%.

Results There was a statistically significant positive correlation between RBS and eAG values for the study group 1 and 2. Also, the median values of RBS and eAG showed a significant difference (p < 0.001).

Conclusion As the association between the RBS and eAG levels is strong in a fairly and poorly controlled diabetic population, reporting the eAG level together with the HbA1c level at no additional cost may assist in effective blood glucose control in clinical care. However, eAG and RBS values cannot be used interchangeably.

Relationship Between Estimated Average Glucose (eAG) and Fasting Plasma Glucose in a Cohort of Pakistani Diabetic Subjects

Introduction Scientific literature is scarce on the utility of estimated average glucose (eAG) from Pakistan. Hence, there is a dire need to evaluate the relationship between eAG and fasting plasma glucose (FPG), in order to enhance our understanding of eAG and its usefulness. This study aims to investigate the relationship between FPG and eAG in diabetic patients calculated using HbA1C. Materials and methods A retrospective study was conducted at the Aga Khan University, Karachi, Pakistan. The medical records of both genders in the age range of 18-60 years, presenting as outpatients at the endocrine clinic, labeled as DM, were reviewed from January 2013 to December 2019. The subjects were divided into three groups A (<130 mg/dL), B (130-179 mg/dL), and C (>180 mg/dL) based on FPG levels. A correlation was compared using Spearman's correlation. Box, whisker plots, and scatter plots were computed by R studio. Results After excluding those with missing values for either serum Cr, FPG, and HbA1c and sub-optimal renal function based on estimated glomerular filtration rate (eGFR) a total of 4,673 cases were analyzed. Subgroup A showed good glycemic control, whereas subgroup C showed poor glycemic control. The difference between eAG and FPG was significant (p < 0.0001). eAG values were found to be elevated than FPG values in groups A and B and almost the same in group C, whereas a moderately significant correlation with eAG and FPG in all three groups. Conclusion The correlation between eAG and FPG varies with blood glucose control and was significantly higher in the poorly controlled diabetes group. As the association between the FPG and eAG levels varies with the extent of blood glucose control, reporting eAG with HbA1c by a simple formula, at no additional cost will prove to be beneficial for clinical care.

Pediatric data of the usefulness of estimated average glucose (eAG) in glycemic control and cardiovascular risk reduction

The Estimated Average Glucose (eAG) is assumed to provide patients a better understanding of their recent average blood sugar levels comparing to HbA1c, therefore better control their glycemic levels. However, since its inception, debates on its clinical utility have been over several years leading to an unpopular laboratory and clinical practice of adoption; and there is no evidence to support or against the usefulness of eAG in real world medical practice.

Data set presented in this article is related to our research paper entitled “Usefulness of Estimated Average Glucose (eAG) in glycemic Control and Cardiovascular Risk Reduction”, available in Clinical Biochemistry [1]. In this article, we compared population lipid and glycemic controls in pediatric diabetic patients of the regional health authority (RHA) zone 1.1 in New Brunswick, Canada, before and after the eAG implementation in January 2010, and with other 7 zones that do not report the parameter. Data (7,355 HbA1c values and 2,062 LDL-c values) was extracted from all pediatric diabetic patients in the Provincial Diabetes Registry from 2008 to 2014. The proportions of patients achieving therapeutic targets (HbA1c<53 mmol/mol (7.0%) and LDL-c<2.6 mmol/L) and the distributions of HbA1c and LDL-c values pre/post the eAG implementation in RHA Zone 1.1 were assessed. Additionally, to investigate whether the glycemic and cholesterol control in pediatric diabetic patients in RHA Zone 1.1 after the implementation of eAG was better than in other zones, we also compared the medians and inter quartile ranges of HbA1c and LDL-c from different zones from 2010 to 2014.