Integrity loss of glycosylated hemoglobin with deepening anemia

Yıl 2022, Cilt: 5 Sayı: 3, 839 - 843, 30.05.2022

Bünyamin Aydın , Aysun Gönderen

https://doi.org/10.32322/jhsm.1098573

Öz

Introduction: Iron deficiency anemia (IDA) has been shown to cause a false increase in glycosylated hemoglobin (HBA1c), but how much increase in hemoglobin (Hgb) causes a certain decrease in HBA1c remains unknown. Knowledge of this ratio will enable more accurate clinical diagnosis and follow-up of diabetes. This study aimed to investigate whether IDA causes a decrease in HBA1c and if it does, how much of a decrease it causes.
Material and Method: One hundred and twenty-two patients with IDA made up the study group and sixty-two health volunteers formed the control group. 270 mg ferrous sulphate (=80 mg elemental iron) were administered to the study group each day, orally for 3 months, and a control of age/sex matched healthy participants were monitored. Hgb, serum iron, serum iron binding capacity (SIBC), ferritin and HbA1c levels of all participants were measured and compared at baseline and at the third month of the study.
Results: There was a significant decrease in HbA1c and SIBC levels at baseline and 3 months in the study group (p<0.001, p<0.001, p<0.001 respectively) and a significant increase in serum iron, ferritin and Hgb (p<0.001, p<0.001, p<0.001 respectively). It was found that a 1 mg/dl increase in Hgb level resulted in a 0.113% decrease in HbA1c.
Conclusion: As anemia deepens, HBA1c loses its reliability for diagnosis and follow-up of DM. IDA should be considered before any diagnosis or treatment decisions are made according to HbA1c levels.

Anahtar Kelimeler

anemia, diabetes, glycosylated hemoglobin

Kaynakça

• Marton I, Agócs S, Babik B. Az anaemiák epidemiológiája [Epidemiology of anemia]. Orv Hetil 2020; 161: 1569-73.
• Harreiter J, Roden M. Diabetes mellitus-definition, klassifikation, diagnose, screening und prävention (Update 2019) [Diabetes mellitus-Definition, classification, diagnosis, screening and prevention (Update 2019)]. Wien Klin Wochenschr 2019; 131: 6-15.
• Guo W, Zhou Q, Jia Y, Xu J. Increased levels of glycated hemoglobin a1c and iron deficiency anemia: a review. Med Sci Monit 2019; 25: 8371-78.
• Coban E, Ozdogan M, Timuragaoglu A. Effect of iron deficiency anemia on the levels of hemoglobin A1c in nondiabetic patients. Acta Haematol 2004; 112: 126-28.
• Brooks AP, Metcalfe J, Day JL, Edwards MS. Iron deficiency and glycosylated haemoglobin A. Lancet 1980; 2: 141.
• Madhu SV, Raj A, Gupta S, Giri S, Rusia U. Effect of iron deficiency anemia and iron supplementation on HbA1c levels - Implications for diagnosis of prediabetes and diabetes mellitus in Asian Indians. Clin Chim Acta 2017; 468: 225-29.
• Soliman AT, De Sanctis V, Yassin M, Soliman N. Iron deficiency anemia and glucose metabolism. Acta Biomed 2017; 88 :112-18.
• Vikøren TB, Berg JP, Berg TJ. Sources of error when using haemoglobin A1c. Tidsskr Nor Laegeforen 2014; 134: 417-21.
• Intra J, Limonta G, Cappellini F, Bertona M, Brambilla P. Glycosylated hemoglobin in subjects affected by iron-deficiency anemia. Diabetes Metab J 2019; 43 :539-44.
• Aydın B, Özçelik S, Kilit TP, Eraslan S, Çelik M, Onbaşı K. Relationship between glycosylated hemoglobin and iron deficiency anemia: A common but overlooked problem. Prim Care Diabetes 2022; S1751-9918(22)00002-X.
• Skali H, Lin J, Pfeffer MA, et al. Hemoglobin stability in patients with anemia, CKD, and type 2 diabetes: an analysis of the TREAT (Trial to Reduce Cardiovascular Events With Aranesp Therapy) placebo arm. Am J Kidney Dis 2013; 61: 238-46.
• Shanthi B, Revathy C, Manjula Devi AJ, Subhashree. Effect of iron deficiency on glycation of haemoglobin in nondiabetics. J Clin Diagn Res 2013; 7: 15-17.
• Son JI, Rhee SY, Woo JT, et al. Hemoglobin A1c may be an inadequate diagnostic tool for diabetes mellitus in anemic subjects. Diabetes Metab J 2013; 37: 343-48.
• Gram-Hansen P, Eriksen J, Mourits-Andersen T, Olesen L. Glycosylated haemoglobin (HbA1c) in iron- and vitamin B12 deficiency. J Intern Med 1990; 227: 133-6.
• Pilla R, Palleti SK, Rayana R, Skss SR, Abdul Razzack A, Kalla S. Glycated haemoglobin (HbA1c) variations in nondiabetics with nutritional anemia. Cureus 2020; 12: e11479.
• International Expert Committee. International Expert Committee report on the role of A1C assay in the diagnosis of diabetes. Diabetes Care 2009; 32: 1327-34.
• Guo W, Zhou Q, Jia Y, Xu J. Increased levels of glycated hemoglobin A1c and iron deficiency anemia: a review. Med Sci Monit 2019; 25: 8371-78.
• American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020; 43: 14-31.
• Kurban Y, Uyar KI, Alan MM. Evaluation of sialic acid levels in the umbilical cord blood of newborns of diabetic and non-diabetic mothers and the relation with poor neonatal outcome. Int J Gynecol Obstet Reprod Med Res 2021; 27: 79-83.