Effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus

Tarım, Ömer; Kucukerdogan, Aygun; Günay, Ülgen; Eralp, Oya; Ercan, I.

doi:10.1046/j.1442-200x.1999.01083.x

Cited by 108 publications

(57 citation statements)

References 9 publications

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“…Limitations imposed by nonglycemic nutritional influences should invite further research into the application of HbA 1c in the diagnosis of prediabetes and diabetes in undernourished populations. Similar associations between iron deficiency and elevated HbA 1c concentrations have been shown in other studies in nondiabetic as well as type 1 diabetic patients (5,7,18,22). A causal role for iron deficiency in elevating HbA 1c concentration is supported by a fall in levels after iron supplementation (5).…”

Section: Discussionsupporting

confidence: 88%

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Spuriously High Prevalence of Prediabetes Diagnosed by HbA1c in Young Indians Partly Explained by Hematological Factors and Iron Deficiency Anemia

et al. 2012

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OBJECTIVETo examine the influence of glycemic and nonglycemic parameters on HbA1c concentrations in young adults, the majority of whom had normal glucose tolerance.RESEARCH DESIGN AND METHODSWe compared the diagnosis of normal glucose tolerance, prediabetes, and diabetes between a standard oral glucose tolerance test (OGTT; World Health Organization 2006 criteria) and HbA1c concentrations (American Diabetes Association [ADA] 2009 criteria) in 116 young adults (average age 21.6 years) from the Pune Children’s Study. We also studied the contribution of glycemic and nonglycemic determinants to HbA1c concentrations.RESULTSThe OGTT showed that 7.8% of participants were prediabetic and 2.6% were diabetic. By ADA HbA1c criteria, 23.3% were prediabetic and 2.6% were diabetic. The negative predictive value of HbA1c was 93% and the positive predictive value was 20% (only 20% had prediabetes or diabetes according to the OGTT; this figure was 7% in anemic participants). Of participants, 34% were anemic, 37% were iron deficient (ferritin <15 ng/mL), 40% were vitamin B12 deficient (<150 pmol/L), and 22% were folate deficient (<7 nmol/L). On multiple linear regression analysis, HbA1c was predicted by higher 2-h glucose (R2 = 25.6%) and lower hemoglobin (R2 = 7.7%). When hematological parameters were replaced by ferritin, vitamin B12, and folate, HbA1c was predicted by higher glycemia (R2 = 25.6%) and lower ferritin (R2 = 4.3%).CONCLUSIONSThe use of HbA1c to diagnose prediabetes and diabetes in iron-deficient populations may lead to a spuriously exaggerated prevalence. Further investigation is required before using HbA1c as a screening tool in nutritionally compromised populations.

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Section: Discussionsupporting

confidence: 88%

“…These were small studies in nondiabetic subjects. There is one similar report in type 1 diabetic patients (7). WHO and ADA have acknowledged this limitation of using HbA 1c in the diagnosis of prediabetes and diabetes in nutritionally compromised populations, but not the magnitude of the effect.…”

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confidence: 75%

Spuriously High Prevalence of Prediabetes Diagnosed by HbA1c in Young Indians Partly Explained by Hematological Factors and Iron Deficiency Anemia

et al. 2012

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“…Moreover, there have been acknowledged challenges using HbA1C in childhood to characterize abnormal glucose metabolism, as the ideal cut point to capture those at greatest risk for prediabetes, diabetes and diabetic sequelae is controversial 35, 36 . In addition, HbA1c has had a heterogeneous diagnostic performance among different racial/ethnic populations 37 and can be inaccurate when nonglycemic test factors such as hemoglobinopathies, iron deficient anemia or impaired renal function are present 38, 39 . Despite this, HbA1C parameters chosen in this study were consistent with most recent American Diabetes Association recommendations for screening 19 and are regarded as effective in screening for prediabetes and diabetes in overweight and obese populations 40 .…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Prediabetes and Type 2 Diabetes in Children With Nonalcoholic Fatty Liver Disease

et al. 2016

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“…Thus, if serum glucose is accepted to remain constant, a decrease in the hemoglobin concentration might lead to an increase in the glycated fraction. Tarim et al [13]speculated that the emergence of young erythrocytes in the circulation after iron therapy could have led to dilution and lowering the concentration of previously formed HbA1c. Future studies may address the mechanism of increased HbA1c levels in IDA.…”

Section: Discussionmentioning

confidence: 99%

Effect of Iron Deficiency Anemia on the Levels of Hemoglobin A1c in Nondiabetic Patients

Özdoğan²,

2004

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The major form of glycohemoglobin is hemoglobin A1c (HbA1c). The HbA1c fraction is abnormally elevated in chronic hyperglycemic diabetic patients and correlates positively with glycemic control. Previous studies suggest that iron deficiency anemia (IDA) affects the levels of HbA1c. The aim of this study was to determine the effect of IDA on HbA1c levels in nondiabetic patients. The population studied consisted of 50 patients (30 women, 20 men, mean age 35.7 ± 11.9 years) with IDA and 50 healthy subjects that were matched for age and sex. Patients who had glucose tolerance abnormalities (impaired glucose tolerance or diabetes mellitus), hemoglobinopathies, hemolytic anemia, chronic alcohol ingestion and chronic renal failure were excluded from the study. Hematologic investigations, fasting and postprandial glucose and HbA1c levels were measured in all subjects before iron therapy. All patients with IDA were treated with iron 100 mg/day for 3 months. We repeated the laboratory investigation after iron therapy. Before iron treatment, the mean HbA1c (7.4 ± 0.8%) level in patients with IDA was higher than in a healthy group (5.9% ± 0.5) (p < 0.001). In patients with IDA, HbA1c decreased significantly after iron treatment from a mean of 7.4% ± 0.8 to 6.2% ± 0.6 (p < 0.001). Iron deficiency must be corrected before any diagnostic or therapeutic decision is made based on HbA1c.

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Effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus

Cited by 108 publications

References 9 publications

Spuriously High Prevalence of Prediabetes Diagnosed by HbA1c in Young Indians Partly Explained by Hematological Factors and Iron Deficiency Anemia

Spuriously High Prevalence of Prediabetes Diagnosed by HbA1c in Young Indians Partly Explained by Hematological Factors and Iron Deficiency Anemia

Prevalence of Prediabetes and Type 2 Diabetes in Children With Nonalcoholic Fatty Liver Disease

Effect of Iron Deficiency Anemia on the Levels of Hemoglobin A1c in Nondiabetic Patients

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