QJM Advance Access originally published online on June 29, 2006
QJM 2006 99(7):489; doi:10.1093/qjmed/hcl066
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Correspondence |
Single measurements of glycaemic markers may lack stability over time
Sir,
Timmer et al.1 studied the relation between single measurements of HbA1c and random blood glucose and mortality in patients. The deaths occurred several months after these measurements were made, and unfortunately there were no data on the glycaemic status of these patients during the follow-up period. Did glycaemic control improve in the group of patients with HbA1c 
6.2%, after discharge from the hospital? Did it worsen? How did the subgroup with diabetes fare?
The United Kingdom Prospective Diabetes Study (UKPDS) clearly demonstrated a significant association between HbA1c and cardiovascular outcomes in diabetic subjects.2 The updated mean of several annual measurements of HbA1c (over a 10-year period) was used in the UKPDS, and this made the data more robust. It might have been more appropriate if Timmer et al. had aimed to study the relation between glycaemic markers on admission and in-hospital mortality. Single measurements of metabolic variables lack stability over time, and expecting them to be able to predict events occurring several months later may be unrealistic.
School of Clinical Medical Sciences
University of Newcastle
Newcastle upon Tyne
email: arun.matarajan1{at}newcastle.ac.uk
References
1. Timmer JR, Ottervanger JP, Bilo HJG, Dambrink JHE, Miedema K, Hoorntje JCA, Zijlstra F. Prognostic value of admission glucose and glycosylated haemoglobin levels in acute coronary syndromes. Q J Med 2006; 99:237–43.
2. Stratton IM, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Br Med J 2000; 321:405–12.
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