Abstract

BackgroundHemoglobin A1c (HbA1c) is the product of a non-enzymatic chemical reaction between hemoglobin (Hb) and glucose. However, the association between Hb and HbA1c remains to be fully elucidated in view of the controversial findings reported to date. Therefore, our aim in this study was to evaluate the association between Hb levels within the normal range and HbA1c levels among Chinese non-diabetes adults using cross-sectional data from the China Health and Nutrition Survey 2009.MethodsOur analysis was based on the data of 1659 non-diabete adults 20–49 years of age. Multivariable linear models were applied to examine the association between Hb and HbA1c levels. Subgroup analyses stratified by age and sex were also performed.ResultsThe association between Hb and HbA1c levels was positive in the unadjusted model (β =0.020, 95% CI: 0.008, 0.032). However, this association did not remain significant when the regression model was minimally adjusted for age and sex (β =0.006, 95% CI: − 0.014, 0.024); this association became negative when the model was further adjusted for covariates whose effect estimates of HbA1c levels more than 10% (β = − 0.042, 95% CI: − 0.064, − 0.020). The association remained negative on subgroup analyses stratified by age (20–34 years: β = − 0.052, 95% CI: − 0.091, − 0.013; 35–49 years: β = − 0.041, 95% CI: − 0.068, − 0.014) and sex (men: β = − 0.042, 95% CI: − 0.074, − 0.010; women: β = − 0.042, 95% CI: − 0.073, − 0.012) when controlling for covariates.ConclusionsOur findings revealed that Hb levels within the normal range were negatively associated with HbA1c levels among Chinese non-diabetes adults. Confounding factors, such as red blood cell counts can affect the association between Hb and HbA1c levels.

Highlights

  • Hemoglobin A1c (HbA1c) is the product of a non-enzymatic chemical reaction between hemoglobin (Hb) and glucose

  • Our aim in this study was to evaluate the association between Hb levels within the normal range and HbA1c levels among Chinese non-diabetes adults using cross-sectional data from the China Health and Nutrition Survey (CHNS)

  • Data on the following covariates were extracted for inclusion in our analysis: age, sex, ethnicity, education level, activities, smoking behavior, alcohol consumption, body mass index (BMI), total protein, total cholesterol, blood glucose, alanine aminotransferase (ALT), uric acid, serum creatinine, white blood cell (WBC) count, red blood cell (RBC) count, and platelet (PLT) count

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Summary

Introduction

Hemoglobin A1c (HbA1c) is the product of a non-enzymatic chemical reaction between hemoglobin (Hb) and glucose. Our aim in this study was to evaluate the association between Hb levels within the normal range and HbA1c levels among Chinese non-diabetes adults using cross-sectional data from the China Health and Nutrition Survey 2009. Diabetes is one of the most prevalent diseases globally. Almost 10% of the world’s adult population (nearly 500 million individuals) live with diabetes, with the prevalence expected to increase to 700 million by 2045 [1]. The prevalence of diabetes is high, nearly half of the individuals living with diabetes are unaware of their disease status [2]. Diabetes is associated with devastating short- and long-term complications [3]. As early interventions might delay or even prevent full-blown diabetes, it is important to identify individuals at high risk of diabetes. Ongoing studies are assessing the utility of novel and less studied biomarkers of diabetes [4]

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