Glucosuria in Pre-Diabetic Patients on Ozempic

Understanding the Clinical Context

The American Diabetes Association suggests that A1C values range from 5.7-6.4% in pre-diabetes, with this patient having an A1C of 5.6% corresponding to an estimated average glucose of 114 mg/dL 1
The American Diabetes Association indicates that hemoglobinopathies, such as sickle cell trait or thalassemia, can falsely lower A1C 2, 3

Renal tubular dysfunction, including familial renal glycosuria, is a benign inherited condition where the renal threshold for glucose reabsorption is low, typically <140 mg/dL, resulting in persistent glucosuria with normal blood glucose and A1C levels 2, 4

The American Diabetes Association recommends obtaining fasting plasma glucose and 2-hour oral glucose tolerance test to confirm true glycemic status, as A1C alone may be misleading 2, 3
Reviewing complete blood count to assess for anemia or conditions affecting red cell turnover is suggested by the American Diabetes Association 1

If glucosuria is due to Ozempic, it is generally a benign finding and may represent a therapeutic benefit, with no specific intervention required beyond routine monitoring 4
The American Diabetes Association recommends continuing to monitor A1C every 3-6 months given pre-diabetic status 6
If true hyperglycemia with falsely normal A1C is present, relying on glucose-based diagnostic criteria rather than A1C for diagnosis and monitoring is recommended by the American Diabetes Association 2, 3