Diabetes: glycaemic monitoring: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Diabetes: glycaemic monitoring

Sample item

A 30-year-old man with type 2 diabetes and hereditary spherocytosis has an HbA1c of 5.3%, but his home glucose readings average 230 mg/dL. Which is the most appropriate way to assess his glycaemic control?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Fructosamine or continuous glucose monitoring

HbA1c reflects glycation over the 8 to 12 week lifespan of red cells. In haemolytic anaemias, blood loss or recent transfusion the red cells are younger, giving a falsely low HbA1c. Fructosamine (glycated albumin, 2 to 3 weeks) or glucose monitoring including CGM gives a reliable estimate.

Option by option

  • A. Urine glucose dipstick

    Urine glucose depends on the renal threshold and is a poor index of control.

  • B. Fasting serum insulin

    Insulin concentration does not measure glycaemic control.

  • C. Fructosamine or continuous glucose monitoring (correct)

    Alternative markers do not depend on red cell survival.

  • D. Repeat HbA1c in 3 months

    Repeating the test will not fix the effect of a shortened red cell lifespan.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Fructosamine or continuous glucose monitoring. HbA1c reflects glycation over the 8 to 12 week lifespan of red cells.

Why is "Urine glucose dipstick" not the answer?

Urine glucose depends on the renal threshold and is a poor index of control.

Why is "Fasting serum insulin" not the answer?

Insulin concentration does not measure glycaemic control.

Why is "Repeat HbA1c in 3 months" not the answer?

Repeating the test will not fix the effect of a shortened red cell lifespan.

What concept does this question test?

It tests Diabetes: glycaemic monitoring in General Medicine. In haemolytic anaemias, blood loss or recent transfusion the red cells are younger, giving a falsely low HbA1c. Fructosamine (glycated albumin, 2 to 3 weeks) or glucose monitoring including CGM gives a reliable estimate.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Diabetes: glycaemic monitoring?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.