Sunday, December 4, 2011

Teenagers- great home test results - elevated A1c

Teenagers with diabetes – great home glucose test- high A1c

Teenage children with diabetes present a number of issues for parents and their doctors. I would like to stress the word children because they are. They may have a grown up looking body and developing independence but still have many of the thought processes of a child.
This combination often presents some delicate issues for their parents and health care providers.

The mismatch of A1c and home glucose test results is not unusual. Teen agers may bring in great looking home glucose test results and then the lab. finds an elevated A1c result.

The desire to believe the home glucose results is very strong with parents and doctors. I have been fooled more times than I would like to remember by sweet young girls. The girls would often bring in neat clean glucose records with what appeared to be expected variation. we would discuss and make management plans based on their results .Then the A1c would come back at 12 or 14. This resulted in phone calls and disbelief by the parents . It is common to first think that the A1c test is incorrect or that the child has some other problem causing the elevation.
My ability to deal with this issue improved after we started doing office testing of A1c and had immediate results.

I cannot think of many causes for false elevations of the A1c. Lab error is rare and ruled out by a repeat test. Iron deficiency may cause a very slight elevation, but generally when you hear hoof beats coming you can expect to see a horse

There are also subtle clues to made up numbers. Girls will often have very neat results all written with the same pen. if you look at the last digit of the results there will be a pattern of using the same number such as 0 or 5. Boys were often a little different with less desire to please their parents or doctor with good results. Some kids would provide sloppy unreadable test results or no results at all.

How to manage this problem is a problem for parents and healthcare providers .

I will give you my opinion tomorrow. Dr. Calder

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Your comments and questions are appreciated. David Calder,MD