Impact of Iron Deficiency Anemia on Glycated Hemoglobin (HbA1c) Levels in Diabetics with Controlled Plasma Glucose Levels
Keywords:
HbA1C, Iron deficiency Anemia, Diabetes
Abstract
BACKGROUND: Glycated hemoglobin (HbA1C) is used as a gold standard for monitoring glycemic control. American Diabetes Association (ADA) has certified HbA1C ≥ 6.5% as a diagnostic criterion for diabetes mellitus (DM). Recent studies suggest that conditions affecting erythrocyte turnover like Iron deficiency anemia (IDA) alters HbA1C levels but their results are conflicting. However the effect of IDA on HbA1C is rarely reported. To determine the impact of IDA on HbA1C levels among controlled diabetics [Fasting plasma glucose (FPG) <126mg/dl since last 6 months] independent of blood glucose concentration and its variation according to the degree of anemia.METHODS: This cross-sectional study carried out in SRM Medical College Hospital and Research Centre, Chennai includes totally 300 controlled diabetic patients –Type 2 DM (150 with IDA and 150 without IDA). Medical history recorded. HbA1C, complete hemogram and FPG were tested.RESULT: The mean HbA1C among controlled diabetics with IDA (7.86 ± 0.11%) was significantly higher than those without IDA (5.45 ± 0.038%) (P<0.05). HbA1C results were higher with the reduction of total hemoglobin (p< 0.05)CONCLUSION: IDA spuriously elevates HbA1C levels independent of blood glucose concentration in controlled-diabetics.HbA1C increases significantly as severity of anemia worsens. Thereby this study insists on the utter importance to exclude IDA and to correct it before any diagnostic or therapeutic decision is made based solely on HbA1C level.References
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15. Koga M, Saito H, Mukai M, Matsumoto S, Kasayama S. Influence of iron metabolism indices on glycated haemoglobin but not glycated albumin levels in premenopausal women. Acta diabetologica. 2010;47(1):65-9.
16. Shanthi B, Revathy C, Manjula Devi AJ, et al. Effect of iron deficiency on glycation of haemoglobin in nondiabetics. J Clin Diagn Res. 2013;7(1):15–17.
17. Ford ES, Cowie CC, Li C, Handelsman Y, Bloomgarden ZT. Iron‐deficiency anemia, non‐iron deficiency anemia and HbA1c among adults in the US. J Diabetes. 2011;3(1):67-73.
18. Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab. 2008;93(7):2447-53.
19. Sinha N, Mishra TK, Singh T, Gupta N. Effect of iron deficiency anemia on hemoglobin A1c levels. Ann Lab Med. 2012;32(1):17-22.
2. Wolffenbuttel BH, Herman WH, Gross JL, Dharma lingam M, Jiang HH, Hardin DS. Ethnic differences in glycemic markers in patients with type 2 diabetes. Diab care. 2013;36:2931-6.
3. Herman WH, Ma Y, Uwaifo G, Haffner S, Kahn SE, Horton ES, et al. Differences in A1C by race and ethnicity among patients with impaired glucose tolerance in the Diabetes Prevention Program. Diab care. 2007;30:2453-7.
4. Nathan DM, International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diab Care. 2009;32:e160.
5. Soulimane S, Simon D, Herman WH, Lange C, Lee CM, Colagiuri S,et al. HbA1c, fasting and 2 h plasma glucose in current, ex-and never-smokers: a meta-analysis. Diabetologia. 2014;57:30-9.
6. Kalasker V, Kodliwadmath MV, Bhat H. Effect of iron deficiency anemia on glycosylated hemoglobin levels in non-diabetic Indian adults. Int J Med Hlth Sci. 2014;3(1):40-3.
7. Coban E, Ozdogan M, Timuragaoglu A. Effect of iron deficiency anemia on the levels of hemoglobin A1C in nondiabetic patients. Acta Haematol. 2004;112(3):126-8.
8. World Health Organization, Worldwide prevalence of anaemia 1993–2005. WHO global database on anaemia, WHO, 2008
9. Kilpatrick ES, Bloomgarden ZT, Zimmet PZ. Is haemoglobin A1c a step forward for diagnosing diabetes. BMJ. 2009;339:b4432.
10. Thomas MC, MacIsaac RJ, Tsalamandris C, Power D, Jerums G. Unrecognized Anemia in Patients With Diabetes A cross-sectional survey. Diab care. 2003;26(4):1164-9.
11. Cawood TJ, Buckley U, Murray A, Corbett M, Dillon D, Goodwin B, et al. Prevalence of anaemia in patients with diabetes mellitus. Irish J Med Sci. 2006;175(2):25-7.
12. Stevens PE, O'Donoghue DJ, Lameire NR. Anaemia in patients with diabetes: unrecognised, undetected and untreated? Current medical research and opinion. 2003;19(5):395-401.
13. Hosseini MS, Rostami Z, Saadat A, Saadatmand SM, Naeimi E. Anemia and microvascular complications in patients with type 2 diabetes mellitus. Nephro-urol. 2014;6(4).
14. Wu AC, Lesperance L, Bernstein H. Screening for iron deficiency. Pediatrics in Review. 2002;23(5):171-8.
15. Koga M, Saito H, Mukai M, Matsumoto S, Kasayama S. Influence of iron metabolism indices on glycated haemoglobin but not glycated albumin levels in premenopausal women. Acta diabetologica. 2010;47(1):65-9.
16. Shanthi B, Revathy C, Manjula Devi AJ, et al. Effect of iron deficiency on glycation of haemoglobin in nondiabetics. J Clin Diagn Res. 2013;7(1):15–17.
17. Ford ES, Cowie CC, Li C, Handelsman Y, Bloomgarden ZT. Iron‐deficiency anemia, non‐iron deficiency anemia and HbA1c among adults in the US. J Diabetes. 2011;3(1):67-73.
18. Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab. 2008;93(7):2447-53.
19. Sinha N, Mishra TK, Singh T, Gupta N. Effect of iron deficiency anemia on hemoglobin A1c levels. Ann Lab Med. 2012;32(1):17-22.
Published
2017-04-07
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