Abstract
BackgroundNon-enzymatic glycation increases hemoglobin-oxygen affinity and reduces oxygen delivery to tissues by altering the structure and function of hemoglobin.ObjectivesWe investigated whether an elevated blood concentration of glycosylated hemoglobin (HbA1c) could induce falsely high pulse oximeter oxygen saturation (SpO2) in type 2 diabetic patients during mechanical ventilation or oxygen therapy.MethodsArterial oxygen saturation (SaO2) and partial pressure of oxygen (PO2) were determined with simultaneous monitoring of SpO2 in 261 type 2 diabetic patients during ventilation or oxygen inhalation.ResultsBlood concentration of HbA1c was >7% in 114 patients and ≤ 7% in 147 patients. Both SaO2 (96.2 ± 2.9%, 95% confidence interval [CI] 95.7-96.7% vs. 95.1 ± 2.8%, 95% CI 94.7-95.6%) and SpO2 (98.0 ± 2.6%, 95% CI 97.6-98.5% vs. 95.3 ± 2.8%, 95% CI 94.9-95.8%) were significantly higher in patients with HbA1c >7% than in those with HbA1c ≤ 7% (Data are mean ± SD, all p < 0.01), but PO2 did not significantly differ between the two groups. Bland-Altman analysis demonstrated a significant bias between SpO2 and SaO2 (1.83 ±0.55%, 95% CI 1.73% -1.94%) and limits of agreement (0.76% and 2.92%) in patients with HbA1c >7%. The differences between SpO2 and SaO2 correlated closely with blood HbA1c levels (Pearson’s r = 0.307, p < 0.01).ConclusionsElevated blood HbA1c levels lead to an overestimation of SaO2 by SpO2, suggesting that arterial blood gas analysis may be needed for type 2 diabetic patients with poor glycemic control during the treatment of hypoxemia.
Highlights
Non-enzymatic glycation increases hemoglobin-oxygen affinity and reduces oxygen delivery to tissues by altering the structure and function of hemoglobin
Given that chronic hyperglycemia accelerates the accumulation of advanced glycation end products (AGE) in the skin collagen [14], which poses specific autofluorescence feature, may emit light by absorbing specific wavelengths light [15], and interfere with the accuracy of pulse oximetry, it is pertinent to examine if elevated blood Glycosylated hemoglobin A1c (HbAlc) concentrations could result in an overestimation of Arterial oxygen saturation (SaO2) by Pulse oximeter oxygen saturation (SpO2) with finger probes for type 2 diabetic patients with poor glycemic control
The diagnosis of type 2 diabetes was made according to the criteria of American Diabetes Association, including symptoms of diabetes plus casual plasma glucose concentration beyond 200 mg/dl (11.1 mmol/l), or an increased fasting (126 mg/dl [7.0 mmol/l]) or 2-hour postprandial glucose (2-h PG) level (200 mg/dl [11.1 mmol/l] during an oral glucose tolerance test) [16]
Summary
Non-enzymatic glycation increases hemoglobin-oxygen affinity and reduces oxygen delivery to tissues by altering the structure and function of hemoglobin. Glycohemoglobin is produced via a non-enzymatic reaction between the free aldehyde group of glucose or other sugars and the unprotonated form of free amino groups of hemoglobin [1]. A clinical relationship between blood concentration of HbAlc and status of glycemic control has been elucidated [2], and elevated HbAlc levels accelerates the accumulation of advanced glycation end products (AGE) in the skin collagen [14], which poses specific autofluorescence feature, may emit light by absorbing specific wavelengths light [15], and interfere with the accuracy of pulse oximetry, it is pertinent to examine if elevated blood HbAlc concentrations could result in an overestimation of SaO2 by SpO2 with finger probes for type 2 diabetic patients with poor glycemic control
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
