Abstract
Objectives:Diabetes is prevalent in the Indian population, to the extent that the diabetes burden matches that of nutritional anemia. We aimed to determine the effects of iron and vitamin B12 deficiency anemia on glycated haemoglobin (HbA1c) concentrations in individuals without diabetes.Material and methods:The study comprises 100 patients with iron deficiency anemia, 100 with vitamin B12 deficiency anemia, and 100 healthy volunteers as a control group. Each of the first two groups was subdivided into two groups depending on the severity of anemia based on Hb levels. We treated with iron replenishment in the iron deficiency group and B12 replenishment in the B12 deficiency group for three months. We noted HbA1c levels before and after the therapy. Data were entered into the SPSS package. For comparing pre and post-therapy levels, we used the Paired 't' test.Results:The mean HbA1c before treatment were 6.1% ± 0.23% and 5.5% ± 0.24%, and the values after treatment were 5.1% ± 0.14% and 4.6% ± 0.2% in severe iron deficiency anemia subgroup and mild to moderate subgroup, respectively. The mean HbA1c in the iron-deficiency anemia control group was 5.2% ± 0.2%. The mean HbA1c levels before treatment were 5.9% ± 0.3% and 5.6% ± 0.19%, and after treatment were 5.0% ± 0.15% and 4.9% ± 0.16% in severe and mild to moderate B12 deficiency anemia, respectively. The mean HbA1c in the vitamin B12 deficiency anemia control group was 5.1% ± 0.2%.Conclusion:HbA1c in both types of anemia subjects showed a significant decrease with appropriate therapy. Physicians should consider rechecking patient haemoglobin values and correcting a patient's anemia before determining the patient's glycemic status using HbA1c to avoid misinterpretation of their diabetes status.
Highlights
Glycated haemoglobin (HbA1c) is defined as haemoglobin (Hb) that is irreversibly glycated at one or both Nterminal valines of the beta chains and remains in the red blood cell (RBC) for the rest of its lifespan [1,2]
The mean age of patients with iron deficiency anemia was 38 years, whereas patients in the vitamin B12 deficiency anemia had a mean age of 45 years
A study by Silva et al obtained similar results [16]. Our findings contradicted those reported by Sinha et al, who reported a subsequent rise in glycated haemoglobin (HbA1c) with iron supplementation (4.6% to 5.9%) in 50 iron deficiency anemia patients and 50 controls [2]
Summary
Glycated haemoglobin (HbA1c) is defined as haemoglobin (Hb) that is irreversibly glycated at one or both Nterminal valines of the beta chains and remains in the red blood cell (RBC) for the rest of its lifespan [1,2]. HbA1c concentrations are altered by blood glucose levels [4], but they vary significantly in a few diseases and pathological states, such as hypoproliferative anemia and hemoglobinopathies [5,6]. Conditions that prolong the erythrocyte lifespan or conditions related to decreased RBC turnover will lead to prolonged exposure of the cell to glucose, resulting in higher HbA1c [7]. States that reduce the lifespan of RBCs or conditions where RBC exposure to glucose is shortened (i.e., from an increase in RBC turnover) will result in reduced HbA1c concentrations. Iron deficiency anemia and vitamin B12 deficiency anemia fall into the former scenario
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