Personalized Hemoglobin A1c Shows Better Correlation with Mean Glucose than Laboratory Hemoglobin A1c in Ugandan Youth with Type 1 Diabetes, but Mean Glucose Is Not Clinically Useful in This Population Due to Extreme Glucose Variability

Neither the measured A1c nor the calculated pA1c provided reliable guidance for insulin adjustment in this population. No matter how accurately MG is measured or estimated, it is just an average, with limited clinical application in individuals with wide glycemic variation. These measures cannot replace the information available from CGM about glycemic excursion, daily glucose patterns, or percent time in various glucose ranges. Our data suggest that it is essential to find a way to make CGM at least periodically affordable in low-resource settings.