A comparison of effect of Iron Deficiency Anemia on HbA1c levels in controlled diabetics and non-diabetics: A cross sectional analysis of 300 cases
Keywords:
HbA1C, Iron deficiency Anemia, Diabetics, Non-diabetics
Abstract
BACKGROUND: Diabetes Mellitus (DM) has become a major health problem worldwide. American Diabetes Association has considered HbA1C levels ≤ 6.5 % as the prime target for glycemic control and as a diagnostic criterion for DM. Anemia is common in DM (8-66%).Studies on alteration of HbA1C in IDA have conflicting results.OBJECTIVES:To identify and compare the effect of IDA on HbA1C levels among controlled diabetics (Fasting plasma glucose (FPG) <126mg/dl since last 6 months) and non-diabetics and its variation according to the degree of anemia.METHODS: This cross-sectional study done in SRM Medical College Hospital and Research Centre, Chennai includes 150 Controlled diabetics (75 with IDA and 75 without IDA) and 150 non diabetics (75 with IDA and 75 without IDA). HbA1C, complete hemogram, iron profile and FPG were tested. Medical history was recorded.RESULTS:The mean HbA1C in controlled diabetics with and without IDA were 8.81±0.13 & 5.79±0.01 respectively (P<0.05) and in non-diabetics with and without IDA were 6.84±0.07 & 5.12±0.04 respectively (P<0.05).The difference between no, mild, moderate and severe anemia in both diabetics and non-diabetics was statistically significant (p< 0.05). Mean HbA1C% was highest in groups with severe anemia.CONCLUSION:IDA falsely elevates HbA1C level independent of blood glucose concentration in both controlled diabetics and non-diabetics. Hence prior to alteration of treatment regimen based on HbA1C for diabetes, IDA should be diagnosed and corrected. Concurrent evaluation for anemia is critical to correctly interpret glycemic status in Indian population with prevalent IDA. DOI: 10.21276/APALM.1276References
1. American Diabetes Association. Classification and diagnosis of diabetes. Diabetes care. 2015;38:S8-16
2. World Health Organization. Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation.
3. Cavagnolli G, Comerlato J, Comerlato C, Renz P, Gross JL, Camargo JL. HbA1c measurement for the diagnosis of diabetes: is it enough?. Diabetic Medicine. 2011;28(1):31-5.
4. Thomas MC, MacIsaac RJ, Tsalamandris C, Power D, Jerums G. Unrecognized Anemia in Patients With Diabetes A cross-sectional survey. Diabetes care. 2003;26(4):1164-9.
5. Tong PC, Kong AP, So WY, Ng MH, Yang X, Ng MC, et al. Hematocrit, independent of chronic kidney disease, predicts adverse cardiovascular outcomes in Chinese patients with type 2 diabetes. Diabetes care. 2006;29(11):2439-44.
6. Joss N, Patel R, Paterson K, Simpson K, Perry C, Stirling C. Anaemia is common and predicts mortality in diabetic nephropathy. QJM. 2007;100(10):641-7.
7. Christy AL, Manjrekar PA, Babu RP, Hegde A. Influence of Iron Deficiency Anemia on Hemoglobin A1C Levels in Diabetic Individuals with Controlled Plasma Glucose Levels. Iran Biomed J. 2014;18(2):88.
8. Lapolla A, Traldi P, Fedele D. Importance of measuring products of non-enzymatic glycation of proteins. Clin biochem. 2005;38(2):103-15.
9. Bain BJ, Lewis SM. Dacie and Lewis Practical Haematology. 11th ed. Edinburgh: Elsevier Churchill Livingstone, 2012. Print.
10. Hong JW, Ku CR, Noh JH, Ko KS, Rhee BD, Kim DJ. Association between the presence of iron deficiency anemia and hemoglobin A1c in Korean adults: the 2011–2012 Korea National Health and Nutrition Examination Survey. Medicine. 2015 May 1;94(20):e825.
11. 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.
12. 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.
13. 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.
14. 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.
15. 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.
16. El‐Agouza I, Abu Shahla A, Sirdah M. The effect of iron deficiency anaemia on the levels of haemoglobin subtypes: possible consequences for clinical diagnosis. Clin Lab Haematol. 2002;24(5):285-9.
17. Zoppini G, Targher G, Chonchol M, Negri C, Stoico V, Pichiri I, et al. Anaemia, independent of chronic kidney disease, predicts all-cause and cardiovascular mortality in type 2 diabetic patients. Atherosclerosis. 2010;210(2):575-80.
18. Tarim ÖM, Küçükerdogan AY, Günay ÜN, Eralp ÖZ, Ercan I. Effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus. Pediatr Int. 1999;41(4):357-62.
19. Ng JM, Cooke M, Bhandari S, Atkin SL, Kilpatrick ES.The effect of iron and erythropoietin treatment on the A1C of patients with diabetes and chronic kidney disease. Diabetes Care. 2010;33(11):2310–3.
20. Sharif F, Sazandeh SH. Serum ferritin in type 2 diabetes mellitus and its relationship withHbA1c. Acta Medica iranica. 2004;42(2):142-5.
21. 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.
22. 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.
23. Silva JF, Pimentel AL, Camargo JL. Effect of iron deficiency anaemia on HbA1c levels is dependent on the degree of anaemia. Clinical Biochemistry. 2016;49(1):117-20.
24. 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.
25. Raj S, Rajan GV; Correlation between elevated serum ferritin and HbA1c in type 2 diabetes mellitus. Int J Res Med Sci. 2013; 1(1): 12-15.
2. World Health Organization. Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation.
3. Cavagnolli G, Comerlato J, Comerlato C, Renz P, Gross JL, Camargo JL. HbA1c measurement for the diagnosis of diabetes: is it enough?. Diabetic Medicine. 2011;28(1):31-5.
4. Thomas MC, MacIsaac RJ, Tsalamandris C, Power D, Jerums G. Unrecognized Anemia in Patients With Diabetes A cross-sectional survey. Diabetes care. 2003;26(4):1164-9.
5. Tong PC, Kong AP, So WY, Ng MH, Yang X, Ng MC, et al. Hematocrit, independent of chronic kidney disease, predicts adverse cardiovascular outcomes in Chinese patients with type 2 diabetes. Diabetes care. 2006;29(11):2439-44.
6. Joss N, Patel R, Paterson K, Simpson K, Perry C, Stirling C. Anaemia is common and predicts mortality in diabetic nephropathy. QJM. 2007;100(10):641-7.
7. Christy AL, Manjrekar PA, Babu RP, Hegde A. Influence of Iron Deficiency Anemia on Hemoglobin A1C Levels in Diabetic Individuals with Controlled Plasma Glucose Levels. Iran Biomed J. 2014;18(2):88.
8. Lapolla A, Traldi P, Fedele D. Importance of measuring products of non-enzymatic glycation of proteins. Clin biochem. 2005;38(2):103-15.
9. Bain BJ, Lewis SM. Dacie and Lewis Practical Haematology. 11th ed. Edinburgh: Elsevier Churchill Livingstone, 2012. Print.
10. Hong JW, Ku CR, Noh JH, Ko KS, Rhee BD, Kim DJ. Association between the presence of iron deficiency anemia and hemoglobin A1c in Korean adults: the 2011–2012 Korea National Health and Nutrition Examination Survey. Medicine. 2015 May 1;94(20):e825.
11. 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.
12. 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.
13. 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.
14. 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.
15. 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.
16. El‐Agouza I, Abu Shahla A, Sirdah M. The effect of iron deficiency anaemia on the levels of haemoglobin subtypes: possible consequences for clinical diagnosis. Clin Lab Haematol. 2002;24(5):285-9.
17. Zoppini G, Targher G, Chonchol M, Negri C, Stoico V, Pichiri I, et al. Anaemia, independent of chronic kidney disease, predicts all-cause and cardiovascular mortality in type 2 diabetic patients. Atherosclerosis. 2010;210(2):575-80.
18. Tarim ÖM, Küçükerdogan AY, Günay ÜN, Eralp ÖZ, Ercan I. Effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus. Pediatr Int. 1999;41(4):357-62.
19. Ng JM, Cooke M, Bhandari S, Atkin SL, Kilpatrick ES.The effect of iron and erythropoietin treatment on the A1C of patients with diabetes and chronic kidney disease. Diabetes Care. 2010;33(11):2310–3.
20. Sharif F, Sazandeh SH. Serum ferritin in type 2 diabetes mellitus and its relationship withHbA1c. Acta Medica iranica. 2004;42(2):142-5.
21. 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.
22. 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.
23. Silva JF, Pimentel AL, Camargo JL. Effect of iron deficiency anaemia on HbA1c levels is dependent on the degree of anaemia. Clinical Biochemistry. 2016;49(1):117-20.
24. 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.
25. Raj S, Rajan GV; Correlation between elevated serum ferritin and HbA1c in type 2 diabetes mellitus. Int J Res Med Sci. 2013; 1(1): 12-15.
Published
2017-04-19
Issue
Section
Original Article
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
