Page 32 - Delaware Medical Journal - July/August 2019
P. 32
Colon Cancer Diagnosed
by Falsely Low Hemoglobin A1c
Ronak M. Patel, MD; M. James Lenhard, Jr., MD; Prakash Seshadri, MD
OBJECTIVE: The objective of this case report is to describe the conditions under which hemoglobin A1c (A1c) may not be reliable.
METHODS: We present clinical context and laboratory results related to the case and review of relevant literature.
RESULTS: A 65-year-old with history of insulin-dependent type 2 diabetes with improvement in A1c from 6.9% to
5.6% without any changes in lifestyle or medication regimen. Further evaluation of his fingerstick glucose log revealed no hypoglycemia and did not correlate with his measured A1c. Thus, further workup with complete blood count demonstrated anemia. Subsequently, patient was found to have colon cancer on colonoscopy. Following treatment of his colon cancer and improvement in his anemia, his A1c returned to previous level of 6.9%.
CONCLUSION: The case report demonstrates the importance of evaluating fingerstick glucose log in addition to checking A1c, especially when there is an unexpected change in A1c, for the assessment of diabetes control. Various causes of falsely elevated or reduced A1c are outlined as well. The case also highlights the association between diabetes and increased risk of developing certain cancers, such as colon cancer.
KEYWORDS: diabetes, false hemoglobin A1c, diabetes-associated cancers
176 Del Med J | July/August 2019 | Vol. 91 | No. 4
Abstract
