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MMLU / A 12-year-old boy with sickle cell disease and type 1 diabetes mellitus is…

Problem

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question

A 12-year-old boy with sickle cell disease and type 1 diabetes mellitus is brought to the office by his mother for an initial visit. The family recently moved to the area. Type 1 diabetes mellitus was diagnosed in the patient 6 years ago. Since that time, he has been treated with insulin and dietary management. His insulin regimen has not changed during the past year; however, his mother says he has been only marginally compliant with his insulin and dietary regimens. His diabetic diary shows home fingerstick blood glucose concentrations ranging from 140–200 mg/dL during the past 3 months. He admits to checking his glucose concentrations infrequently. Measurement of hemoglobin A1c obtained last week was 5.4%. The patient's vital signs are temperature 36.8°C (98.2°F), pulse 72/min, respirations 24/min, and blood pressure 110/64 mm Hg. Physical examination shows no abnormalities. Which of the following is the most likely explanation for the discrepancy between the patient's home fingerstick blood glucose concentrations and his hemoglobin A1c?

choices

  1. His daily glucose control is better than recorded
  2. His glucometer is reading falsely high and should be replaced
  3. His hemoglobin A1c is likely a result of laboratory error and should be repeated
  4. His sickle cell disease is affecting his hemoglobin A1c

subject

professional_medicine

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