Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

Which of the following does not affect the accuracy of A1C tests?

1. Sickle cell anemia

2. Iron deficiency

3. Iron supplementation

4. Low albumin

The correct answer is: Low albumin

Low albumin levels do not affect the accuracy of A1C tests because A1C measurements reflect average blood glucose levels over the past two to three months by analyzing the percentage of hemoglobin that is glycated. While conditions such as sickle cell anemia, iron deficiency, and iron supplementation can interfere with hemoglobin's structure or function, potentially leading to inaccurate A1C readings, low albumin levels generally do not influence the hemoglobin itself or its ability to bind glucose. Sickle cell anemia causes changes to the shape and function of red blood cells, leading to shorter lifespan of these cells and can skew results. Similarly, iron deficiency can alter the production of hemoglobin, which affects A1C levels. Iron supplementation can complicate this as well, sometimes causing a rise in hemoglobin levels independent of glycemic control. In contrast, low albumin primarily affects the plasma proteins but does not modify the integrity of the hemoglobin molecule used in A1C testing.