Tip 2 Diyabet ve Demir Eksikliği: Oral ve İntravenöz Demir Tedavisinin HbA1c Üzerindeki Etkisi

Öz

Amaç: Demir eksikliği anemisinin (IDA) HbA1c ile ilişkisini incelemek, yakın zamana kadar birçok çalışmanın konusunu olmuştur. Fakat bu çalışmalar arasında ciddi tutarsızlıklar mevcuttur. Amacımız IDA tanılı diyabetik hastalarda, tedavi önecesi ve sonrası HbA1c düzeylerinin nasıl etkilendiğinin incelenmesi ve aydınlatılmamış bu konunun açıklığa kavuşturulmasıdır. Metod: Bu retrospektif analiz, IDA ve T2DM tanısına sahip 899 hasta üzerinde gerçekleştirilmiştir. Dahil edilme kriterlerini karşılayan toplam 166 hasta çalışmaya alınmıştır. Katılımcılar intravenöz demir tedavisi alanlar, oral demir tedavisi alanlar ve tedavi almayanlar olmak üzere üç gruba ayrılmıştır. Bulgular: Çalışmaya 104’ü kadın (%62,7) ve 62’si (%37,3) erkek olmak üzere toplam 166 hasta dahil edilmiştir. Hastaların yaş ortalaması 59,10±13,31dir. Hem IV grubunda, hem oral grubunda hem de tedavi almayan grupta ikinci glukoz ölçümü birinciye göre anlamlı şekilde artış göstermiştir (p<0,001). Tedavi almayan grupta ikinci HbA1c ölçümü birinciye göre anlamlı şekilde artış göstermiştir (p=0,01). HbA1c düzeylerini gruplar arası kıyasladığımızda ise hem tedavi öncesi hemde tedavi sonrası anlamlı bir fark bulamadık. Sonuç: Bu çalışmada, IDA ve T2DM’li hastalarda demir tedavisi alan gruplarda HbA1c düzeyleri genel olarak stabil seyrederken, tedavi almayan grupta ferritin düzeylerindeki azalma ile birlikte HbA1c ve glukoz değerlerinde artış gözlendi. Bu bulgular, demir eksikliğinin giderilmediği olgularda HbA1c’nin gerçek glisemik durumu olduğundan daha yüksek yansıtabileceği yönündeki hipotezle uyumludur. Anemi varlığında HbA1c’nin değerlendirilmesinde literatürdeki tutarsızlıklar ve HbA1c düzeylerinin normalden hem yüksek hem de düşük olabileceği olasılığı göz önünde bulundurulmalı, diyabet yönetiminde bu parametre dikkatle yorumlanmalıdır.

Anahtar Kelimeler

• Demir eksikliği anemisi
• HbA1c
• oral demir
• parenteral demir
• Tip 2 Diyabet Mellitus

Type 2 Diabetes and Iron Deficiency: The Effect of Oral and Intravenous Iron Therapy on HbA1c

Öz

Objective: The relationship between iron deficiency anemia (IDA) and HbA1c has been the subject of many recent studies. However, there are serious inconsistencies among studies in the literature. Our aim is to investigate how HbA1c levels are affected before and after treatment in diabetic patients diagnosed with IDA and to clarify unresolved issue. Methods: This retrospective analysis was conducted on 899 patients diagnosed with IDA and Type 2 Diabetes Mellitus (T2DM). A total of 166 patients who met the inclusion criteria were included in the study. Participants were divided into three groups: those receiving intravenous iron therapy, those receiving oral iron therapy, and those not receiving any treatment. Results: The study included 166 patients, 104 of whom were female (62.7%) and 62 were male (37.3%). The average age of the patients was 59.10 ± 13.31 years. In all groups—IV, oral, and no treatment—the second glucose measurement showed a significant increase compared to the first (p<0.001). In the no-treatment group, the second HbA1c measurement showed a significant increase compared to the first (p<0.01). When comparing HbA1c levels between groups, we found no significant difference either before or after treatment. Conclusion: In this retrospective cohort of patients with T2DM and IDA, HbA1c levels remained largely stable in iron-treated patients, while increases in HbA1c and glucose levels were observed in the untreated group, paralleling a decrease in ferritin. These findings are consistent with the hypothesis that unresolved iron deficiency may lead to higher HbA1c values. Clinicians should interpret HbA1c values cautiously in the presence of anemia, as iron status may cause HbA1c values to be artificially higher or lower than expected.

Anahtar Kelimeler

• Iron deficiency anemia
• HbA1c
• oral iron
• parenteral iron
• Type 2 Diabetes Mellitus

Kaynakça

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