Impact of Iron Deficiency Anemia on the Measurement of HbA1c in Non-Diabetic Population
Published: 2024-05-02
Page: 75-82
Issue: 2024 - Volume 7 [Issue 2]
Kuldeep Kumar *
Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India.
Aditi Singh *
Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India.
G.S. Ranga *
Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India.
Mrinalini Kotru *
Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India.
Khan Amir Maroof *
Department of Community Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India.
Tidip Bordoloi *
Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Iron deficiency anemia (IDA) is a prevalent condition with significant implications for public health. The impact of IDA on glycated hemoglobin (HbA1c) levels in non-diabetic individuals remains underexplored.
Aims: This study aimed to investigate the effect of IDA on HbA1c levels by comparing the HbA1c levels of non-diabetic patients having IDA and age/sex matched healthy controls. The study also compared the mean HbA1c levels with the severity of anemia, and the correlation between HbA1c and hemoglobin levels.
Study Design: Case-control study.
Place and Duration of Study: The study was conducted in the Medicine Emergency, Outpatient Department, and Medicine wards of the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi from September 2022 to February 2024.
Methodology: We included 100 participants aged 18 to 65 years which comprised 50 lab-confirmed IDA cases and 50 age/sex matched healthy controls, after excluding those with diabetes or on hematinics. Detailed clinical history, examination, and investigations were carried out. Diagnosis of IDA was based on specific hematological parameters and confirmed by using serum iron and ferritin levels. Anemia severity was categorized based on hemoglobin levels into mild, moderate, and severe groups. HbA1c levels were measured using the standard HPLC method. The data was analyzed using SPSS software. The continuous variables were presented as means and standard deviations and the strength of correlation between variables was determined by Spearman's correlation coefficient.
Results: The mean HbA1c level was higher in the case group at 5.07% (SD = 0.42) compared to the control group at 4.68% (SD = 0.49) with (P < .001). A trend of increasing mean HbA1c values with the increasing severity of anemia was observed with mild, moderate, and severe anemia having mean HbA1c of 4.92%, 5.15%, and 5.20% respectively. We found a significant negative correlation between HbA1c and hemoglobin (P < .001).
Conclusion: The effect of IDA should be considered while interpreting HbA1c values.
Keywords: Iron deficiency anemia, anemia, glycated hemoglobin, HbA1c, diabetes mellitus
How to Cite
Downloads
References
World Health Organization. 2011. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Accessed December 4, 2023. Available:http://www.who.int/vmnis/indicators/haemoglobin.pdf.
Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci. 2019; 1450(1):15-31. DOI: 10.1111/nyas.14092. Epub 2019 Apr 22. PMID: 31008520; PMCID: PMC6697587.
International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32 (7):1327-34. DOI: 10.2337/dc09-9033. Epub 2009 Jun 5. PMID: 19502545; PMCID: PMC2699715.
Mayer TK, Freedman ZR. Protein glycosylation in diabetes mellitus: a review of laboratory measurements and of their clinical utility. Clin Chim Acta. 1983; 127(2):147-84. DOI: 10.1016/s0009-8981(83)80002-3. PMID: 6337751.
Gould BJ, Davie SJ, Yudkin JS. Investigation of the mechanism underlying the variability of glycated haemoglobin in non-diabetic subjects not related to glycaemia. Clin Chim Acta. 1997; 260(1):49-64. DOI: 10.1016/s0009-8981(96)06508-4. PMID: 9101100.
Shanthi B, Revathy C, Manjula Devi AJ, Subhashree. Effect of iron deficiency on glycation of haemoglobin in nondiabetics. J Clin Diagn Res. 2013;7(1):15-7. DOI:10.7860/JCDR/2012/4881.2659. Epub 2012 Sep 18. PMID: 23449741; PMCID: PMC3576740.
Bain BJ, Lewis SM. Dacie and Lewis Practical Haematology. 11th ed. Edinburgh: Elsevier Churchill Livingstone; 2012.
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26 Suppl 1:S5-20. DOI: 10.2337/diacare.26.2007.s5. PMID: 12502614.
Haider LM, Schwingshackl L, Hoffmann G, Ekmekcioglu C. The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2018;58(8):1359-1374. DOI:10.1080/10408398.2016.1259210. Epub 2017 Jul 5. PMID: 27880062.
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. DOI: 10.1159/000079722. PMID: 15345893.
Pilla R, Palleti SK, Rayana R, Skss SR, Abdul Razzack A, Kalla S. Glycated Haemoglobin (HbA1c) Variations in Nondiabetics with Nutritional Anemia. Cureus. 2020;12(11):e11479. DOI: 10.7759/cureus.11479. PMID: 33329975; PMCID: PMC7735166.
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. DOI:10.3343/alm.2012.32.1.17. Epub 2011 Dec 20. PMID: 22259774; PMCID: PMC3255499.
Rajagopal L, Ganapathy S, Arunachalam S, Raja V, Ramraj B. Does Iron Deficiency Anaemia and its Severity Influence HbA1C Level in Non Diabetics? An Analysis of 150 Cases. J Clin Diagn Res. 2017;11(2): EC13-EC15. DOI: 10.7860/JCDR/2017/25183.9464. Epub 2017 Feb 1. PMID: 28384869; PMCID: PMC5376870.
Silva JF, Pimentel AL, Camargo JL. Effect of iron deficiency anaemia on HbA1c levels is dependent on the degree of anaemia. Clin Biochem. 2016;49(1-2):117-20. DOI:10.1016/j.clinbiochem.2015.09.004. Epub 2015 Sep 10. PMID: 26365695.
Çetinkaya Altuntaş S, Evran M, Gürkan E, Sert M, Tetiker T. HbA1c level decreases in iron deficiency anemia. Wien Klin Wochenschr. 2021;133(3-4):102-106. DOI: 10.1007/s00508-020-01661-6. Epub 2020 May 6. PMID: 32377869.