Abstract
Objective: To differentiate the value of hemoglobin A1c (HbA1c), glycated albumin (GA) and glycosylated serum protein (GSP) in monitoring blood glucose of patients with aplastic anemia.Methods: 42 patients with aplastic anemia (AA) and 30 patients with AA and Type 2 diabetes mellitus (T2DM) were enrolled in the study, in comparison with 114 healthy subjects and 88 subjects with T2DM. HbA1c, GA, GSP, fasting plasma glucose (FPG), hemoglobin (Hb) and albumin (ALB) were measured, and group comparison and correlation analysis were carried out.Results: Compared with the non-diabetes patients while ALB were <30 g/l or 30–40 g/l, the HbA1c and GSP values in AA, T2DM and AA+T2DM patients were significantly higher while the GA values were lower. Moreover, no differences in FPG levels. The AA+T2DM patients with ALB >40 g/l had higher HbA1c level, with no difference in GA, GSP and FPG levels. There was a positive correlation between HbA1c and GA in healthy group (ALB ≥ 40 g/l), AA patients (ALB 30–40 g/l and ≥40 g/l), T2DM patients (ALB 30–40 g/l and ≥40 g/l) and AA+T2DM patients (ALB 30–40 g/l and ≥40 g/l) but not in those with ALB < 30 g/l.Conclusion: The HbA1c results were affected by moderate-to-severe anemia, but not mild anemia. HbA1c is not recommended to detect blood glucose levels in AA patients (Hb < 90 g/l) or AA patients (ALB < 30 g/l). FPG and GSP are not suitable for AA patients.
Highlights
Since the 1990s, World Health Organization (WHO) and the diabetes associations or societies in many countries have recommended hemoglobin A1c (HbA1c) as the preferred diagnostic index for monitoring diabetes but more recently has been advocated as a diagnostic tool for Type 2 diabetes mellitus (T2DM) [1,2,3,4,5], while HbA1c is generally recognized as the “gold standard” for blood glucose testing
AA group Patients diagnosed of AA, according to the AA diagnostic criteria set forth by the Fourth National Conference on Aplastic Anemia of China (1987): (1) Whole blood cell decreased, the absolute value of reticulocytes decreased; (2) Generally no splenomegaly; (3) Bone marrow examination showed at least one site of hyperplasia or severe reduction
The results indicated that the blood glucose levels were high correlation in the two groups of patients
Summary
Since the 1990s, World Health Organization (WHO) and the diabetes associations or societies in many countries have recommended HbA1c as the preferred diagnostic index for monitoring diabetes but more recently has been advocated as a diagnostic tool for T2DM [1,2,3,4,5], while HbA1c is generally recognized as the “gold standard” for blood glucose testing. Glycated serum protein (GSP) is a product of non-enzymatic reaction between blood glucose and plasma protein (approximately 70% of which is albumin). The determination of glycosylated serum protein (GSP) is called fructosamine determination. Glycosylated serum protein (GSP) measurement reflects the total glycosylated plasma protein in plasma, its value is susceptible to the influence of protein concentration, bilirubin, chyle and low molecular weight substances in blood, especially in patients with hypoproteinemia and abnormal albumin transformation. Non-specific reducing substances in serum can react with glycation sites. The specificity of glycosylated serum protein (GSP) assay is poor because of the different reaction rates
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