Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What is the most likely explanation for a patient with an A1c of 9.6% while claiming all blood glucose checks are normal?

1. Patient likely has a type of anemia affecting A1c

2. Patient likely has an inaccurate blood glucose meter

3. Patient is likely fabricating blood glucose values

4. Patient is probably using improper testing techniques

The correct answer is: Patient is likely fabricating blood glucose values

The scenario presents a paradox where a patient has a significantly elevated A1c level of 9.6%, which indicates poor blood glucose control over the preceding three months, yet reports normal blood glucose readings. This disparity suggests that the patient may not be accurately or truthfully conveying their blood glucose levels. Fabrication of blood glucose values could stem from various motivations, such as a desire to present themselves in a more favorable light to healthcare providers or a misunderstanding of the condition's seriousness. It is crucial to recognize that an A1c is a well-established measure of average blood glucose exposure, and an elevated level like 9.6% typically reflects consistent high blood glucose readings rather than mere isolated instances of normal readings. While conditions like certain anemias can affect A1c levels, this would not typically present with such a stark discrepancy between A1c and reported glucose levels. Similarly, an inaccurate blood glucose meter or improper testing techniques could contribute to misleading results, but these would not explain why the patient consistently reports normal values. Thus, the reasoning centers around the likelihood that the statement of normal blood glucose is not aligned with the objective lab results, pointing toward fabrication as the explanation for the observed data.