Q: How does renal disease affect the eAG-to-HbA1c relationship?

Advanced CKD (eGFR <30) can artefactually lower HbA1c due to anaemia and increased red cell turnover, while carbamylated haemoglobin can interfere with some assays. The eAG derived from HbA1c will be unreliable; use CGM or fructosamine instead.

Q: Is eAG the same as time-in-range?

No. eAG is the mean glucose level, while time-in-range describes the percentage of time spent within the target glucose range (typically 70–180 mg/dL). A normal eAG can coexist with significant hypoglycaemia and hyperglycaemia. Both metrics are complementary.

Q: Should I use eAG or HbA1c for target setting?

Many guidelines recommend using both. The eAG may be more intuitive for patients. Set an eAG target corresponding to the HbA1c target (e.g., eAG <154 mg/dL for HbA1c <7%).

Question 1

Can I use the eAG in patients with haemoglobinopathies?

Accepted Answer

No. HbA1c is unreliable in patients with sickle cell trait, thalassaemia, or other haemoglobin variants. In these cases, use fructosamine or CGM-derived metrics for glycaemic assessment.

Question 2

How does renal disease affect the eAG-to-HbA1c relationship?

Accepted Answer

Advanced CKD (eGFR <30) can artefactually lower HbA1c due to anaemia and increased red cell turnover, while carbamylated haemoglobin can interfere with some assays. The eAG derived from HbA1c will be unreliable; use CGM or fructosamine instead.

Question 3

Is eAG the same as time-in-range?

Accepted Answer

No. eAG is the mean glucose level, while time-in-range describes the percentage of time spent within the target glucose range (typically 70–180 mg/dL). A normal eAG can coexist with significant hypoglycaemia and hyperglycaemia. Both metrics are complementary.

Question 4

Should I use eAG or HbA1c for target setting?

Accepted Answer

Many guidelines recommend using both. The eAG may be more intuitive for patients. Set an eAG target corresponding to the HbA1c target (e.g., eAG <154 mg/dL for HbA1c <7%).