The Effect of Anemia and the Goal of Optimal HbA1c Control in Diabetes and Non-Diabetes

Katwal, Prakash C; Jirjees, Srood; Htun, Zin Mar; Aldawudi, Israa; Khan, Safeera

doi:10.7759/cureus.8431

“…Hence, monitoring of HbA1c along with iron deficiency anemia patients should be taken with caution. This finding has come to the same conclusion as an interventional study which included a hundred and twenty people by Kalairajan et al in 2019 [16]. The study concluded that HbA1c levels have decreased in iron deficiency anaemia patients.…”

Section: Hba1csupporting

confidence: 70%

Effects of Iron Deficiency Anaemia on HbA1c Levels in Non-Diabetics and Diabetics

Singh

¹

,

Bhake

²

,

Agarwal

³

et al. 2021

JPRI

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Background: Iron deficiency anaemia is one of the most common anaemia striking in our country. The level up to which blood sugar level is regulated is measured by HbA1c. HbA1c represents sugar level in the blood for 120 days. HbA1c could be dependent upon an assemblage of factors like variants of haemoglobinopathies, haemolytic anaemia, other deficiency anaemia, acute loss of blood, uraemia, and pregnancy. Thus, it is crucial to determine the role of HbA1c in iron deficiency anemia in diabetics and non-diabetics before treating the patients. Methods: Total of 58 articles were collected and based on our study objective total of 19 articles were included in this study. Iron deficiency anaemia, HbA1c, diabetics and non-diabetics has been added in pub med advanced searches and Google scholar. Original articles which compare the correlation between these two were taken. All the information was gathered from original and review articles. Articles which were qualified for review, their inclusion criteria, exclusion criteria, quality of assessment and data collections were taken into consideration. Structure of heme particle, basic mechanism of HbA1c formation in RBCs is elaborated. Review articles which were taken include RCT, retrospective analysis and observational studies. The results were all compared and concluded of each articles. Basic mechanism of formation of HbA1c in RBCs is shown. Also necessary conclusions were derived from each study. Results: In a wide range of studies, HbA1c was found to be raised in IDA. After iron supplements, studies showed a decrease in HbA1c. Our study showed there is a need to correct anemia in diabetic patients before starting treatment. Conclusions: Strict HbA1c control is not a prerequisite and prior anaemia correction should be done. Nevertheless, a study which will be conducted in representative population matching to the prevalence and incident of disease in our country also which should be interventional is required for the highest correction value of HbA1c in DM and NDM population.

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“…Both diabetes mellitus (DM) and anemia are common in the elderly population, and both are associated with the severity of the course of many comorbidities (especially cardiovascular diseases) and an increase in the risk of death [1][2][3][4][5]. In 2019, 463 million people worldwide were diagnosed with diabetes and approximately 20% of them were in their 60s [6].…”

Section: Introductionmentioning

confidence: 99%

Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population

Michalak

¹

,

Wolny‐Rokicka²,

Nowakowska

³

et al. 2021

Journal of Diabetes Research

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Diabetes mellitus (DM) and also anemia are common in the elderly and have a negative impact on the clinical outcomes of patients. The coexistence of anemia and DM seems to be insufficiently recognized; therefore, the aim of our study is to analyze the incidence and clinical consequences of this coexistence, including mortality, in the population of people aged ≥60. A retrospective study was conducted on 981 primary care clinic patients aged ≥60 during 2013-2014. The prevalence of coexistence of DM and anemia (defined in accordance with WHO) and data on the incidence of comorbidities, hospitalization, medical procedures, and all-cause mortality were analyzed. In the study population, 25% had DM, while 5.4% had both DM and anemia. Peripheral artery disease (PAD) was found in 48 patients (4.89%) of the entire study population, more often in men ( p < 0.001 ). Diabetic patients with anemia compared to nonanemic diabetics had more comorbidities (median 4 (4, 5) vs. 3 (2–4); p < 0.001 )—PAD more often ( p = 0.004 ), more hospitalization (median 2 (0–11) vs. 0 (0–11); p < 0.001 ), and more frequent medical procedures (e.g., percutaneous coronary intervention ( p < 0.001 ), coronary artery bypass surgery ( p = 0.027 ), arteriography ( p < 0.001 ), and bypass surgery or endovascular treatments of lower limb ischemia ( p < 0.001 )). The cumulative survival of patients with both DM and anemia vs. nonanemic diabetics at 36 months was 86.4% vs. 99.3% ( p < 0.001 ). A multivariate logistic regression model showed anemia to be a significant risk factor for death in diabetic patients ( p = 0.013 ). Patients with both DM and anemia have more comorbidities than nonanemic diabetic patients; they are more often hospitalized, require medical procedures more frequently, and are at a higher risk of death. Effective treatment of anemia in patients with DM is advisable and may well improve the prognosis of patients.

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“…107 Table 2 shows the relationship between the average CGM glucose and the GMI values. 107 Importantly, the GMI value is less influenced by conditions, such as anemia, 102 altered red blood cell lifetime, 100 hemoglobinopathies, 99 iron deficiency, 108 and pregnancy, 103 which can confound A1C measurements. 109 However, because measured A1C results are altered by these conditions, the correlation of the GMI and mean glucose can vary.…”

Section: Recommendations With Evidence Basementioning

confidence: 99%

American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

Grunberger

¹

,

Sherr

²

,

Allende

³

et al. 2021

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automated insulin dosing continuous glucose monitoring continuous subcutaneous insulin infusion diabetes diabetes technology glucose sensors hybrid closed loop insulin pumps sensor-augmented pump low-glucose suspend predictive low-glucose suspend a b s t r a c t Objective: To provide evidence-based recommendations regarding the use of advanced technology in the management of persons with diabetes mellitus to clinicians, diabetes-care teams, health care professionals, and other stakeholders. Methods: The American Association of Clinical Endocrinology (AACE) conducted literature searches for relevant articles published from 2012 to 2021. A task force of medical experts developed evidence-based guideline recommendations based on a review of clinical evidence, expertise, and informal consensus, according to established AACE protocol for guideline development. Main Outcome Measures: Primary outcomes of interest included hemoglobin A1C, rates and severity of hypoglycemia, time in range, time above range, and time below range. Results: This guideline includes 37 evidence-based clinical practice recommendations for advanced diabetes technology and contains 357 citations that inform the evidence base.Recommendations: Evidence-based recommendations were developed regarding the efficacy and safety of devices for the management of persons with diabetes mellitus, metrics used to aide with the assessment of advanced diabetes technology, and standards for the implementation of this technology. Conclusions: Advanced diabetes technology can assist persons with diabetes to safely and effectively achieve glycemic targets, improve quality of life, add greater convenience, potentially reduce burden of Disclaimer: The American Association of Clinical Endocrinology medical guidelines for clinical practice are systematically developed statements to assist health care professionals in medical decision-making for specific clinical conditions. Most of the content herein is based on clinical evidence. In areas of uncertainty, or when clarification is required, expert opinion and professional judgment were applied.This guideline is a working document that reflects the state of the field at the time of publication. Because rapid changes are expected in this area, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made considering local resources and individual patient circumstances.

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The Effect of Anemia and the Goal of Optimal HbA1c Control in Diabetes and Non-Diabetes

Cited by 15 publications

References 20 publications

Effects of Iron Deficiency Anaemia on HbA1c Levels in Non-Diabetics and Diabetics

Effects of Iron Deficiency Anaemia on HbA1c Levels in Non-Diabetics and Diabetics

Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population

American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

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