A 76-year-old man presented to his physician’s office, requesting assistance managing his type 2 diabetes. He was diagnosed 18 months previously, based on a fasting blood glucose level of 200 mg/dL (11 mmol/L), and was prescribed metformin. The metformin was discontinued 12 months later, when his hemoglobin A1c (HbA1c) was 6.4% (46 mmol/mol). He had a history of hypertension, hereditary spherocytosis, and cholecystectomy. Medications included aspirin, atorvastatin, and lisinopril-hydrochlorothiazide. His body mass index was 38 (calculated as weight in kilograms divided by height in meters squared), blood pressure was 126/64 mm Hg, and clinical examination results were normal. He reported polyuria and polydipsia. His fingerstick blood glucose diary showed consistent recordings of greater than 350 mg/dL. His laboratory data are shown in Table 1.
Derek T. O’Keeffe, Spyridoula Maraka, Robert A. Rizza. HbA1c in the Evaluation of Diabetes Mellitus. JAMA. 2016;315(6):605–606. doi:10.1001/jama.2015.16561