Decline in haemoglobin A1c values in diabetic patients receiving interferon‐alpha and ribavirin for chronic hepatitis C*

Abstract

Haemoglobin A1c (A1c) levels are lower during haemolysis because of the shorter exposure of haemoglobin (Hb) to plasma glucose. Ribavirin (RBV) used in combination with interferon-alpha (IFN) for chronic hepatitis C causes reversible haemolytic anaemia. This study examined the extent to which RBV treatment influences A1c levels in diabetic patients. A retrospective analysis identified 32 diabetic patients who underwent hepatitis C treatment with IFN and RBV. Each subject had at least three measures of A1c, Hb and glucose: before, during and after therapy. A1c values decreased from a mean pretreatment level of 7.2% to an on-treatment A1c level of 5.2% [mean paired difference -2.01%; 95% confidence interval (CI) -1.59% to -2.43%; P < 0.001]. During therapy, mean Hb levels decreased from 15.1 g/dL at baseline to a nadir of 11.7 g/dL (P < 0.001) with a rise in lactose dehydrogenase levels and reticulocyte counts, and unchanged mean corpuscular volume values confirming haemolysis. At the same time, glucose levels declined by a mean of 38.4 mg/dL (95% CI 13.4-63.5 mg/dL; P = 0.002) as did body weights by a mean of 3.15 kg (P < 0.001). According to published glucose-A1c correlation tables, this decline of glucose concentration by 38.4 mg/dL correlates to a decline in A1c level of 1.08%. In conclusion, reductions of A1c levels by a mean of 2.01% during hepatitis C therapy with IFN + RBV are due to a combination of decreased glucose levels (1.08%) and RBV-induced haemolysis (0.93%). A1c levels should not be measured during hepatitis C treatment with IFN + RBV because they do not adequately reflect glycaemic control.

Low Hemoglobin A1c and Risk of All-Cause Mortality Among US Adults Without Diabetes

“…ALT was positively associated with HbA1c levels among participants with and without diabetes in the British Women’s Heart and Health Study, with a stronger association noted among women without diabetes. 28 Certain combination therapies for hepatitis C have been reported to temporarily lower HbA1c levels 29 ; however, the low HbA1c-mortality association observed in the present study was still evident after excluding participants with hepatitis C. The overall biomarker profile of the participants without diabetes and an HbA1c < 4.0% is suggestive of red blood cell markers, inflammation, and liver function as part of the biological underpinning for the association noted in this study. However, the low HbA1c and all-cause mortality association observed in this study persisted after adjustment for lifestyle, cardiovascular, metabolic, red blood cell, iron storage, and liver function indices.…”

Improvement of glycemic state among responders to Sofosbuvir‐based treatment regimens: Single center experience

“…HbA1c could not be used to guide diabetes therapy during the previous era of treatment with peg‐IFN plus ribavirin. Ribavirin induced hemolytic anemia was previously known to cause false reduction in HbA1c without a change in the fasting glucose levels in diabetic patients who were treated with peg‐IFN plus ribavirin Also the decreased lifespan of the RBC may provide an inaccurate HbA1c with falsely low values. In the current study, Sofosbuvir‐based treatment regimens caused a significant decline in HbA1c values with decline in FPG levels at SVR24 and it seems that ribavirin had no role in reduction of HbA1c values.…”

Pitfalls in Hemoglobin A1c Measurement: When Results may be Misleading

“…Vitamin E, at doses of 600-1200 mg per day, can reduce protein glycation, 10,36 whereas Ribavirin and interferon-alpha can cause a reversible hemolytic anemia. 37,38 Table 2 summarizes conditions associated with falsely lowered A1c.…”