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Glycosylated Hemoglobin in Subjects Affected by Iron-Deficiency Anemia
Jari Intra, Giuseppe Limonta, Fabrizio Cappellini, Maria Bertona, Paolo Brambilla
Diabetes Metab J. 2019;43(4):539-544.   Published online November 28, 2018
DOI: https://doi.org/10.4093/dmj.2018.0072
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  • 8 Web of Science
  • 9 Crossref
AbstractAbstract PDFPubReader   

Previous studies have suggested that iron-deficiency anemia affects glycosylated hemoglobin (HbA1c) measurements, but the results were contradictory. We conducted a retrospective case-control study to determine the effects of iron deficiency on HbA1c levels. Starting with the large computerized database of the Italian Hospital of Desio, including data from 2000 to 2016, all non-pregnant individuals older than 12 years of age with at least one measurement of HbA1c, cell blood count, ferritin, and fasting blood glucose on the same date of blood collection were enrolled. A total of 2,831 patients met the study criteria. Eighty-six individuals were diagnosed with iron-deficiency anemia, while 2,745 had a normal iron state. The adjusted means of HbA1c were significantly higher in anemic subjects (5.59% [37.37 mmol/mol]), than those measured in individuals without anemia (5.34% [34.81 mmol/mol]) (P<0.0001). These results suggest that clinicians should be cautious about diagnosing prediabetes and diabetes in individuals with anemia.

Citations

Citations to this article as recorded by  
  • Fingerprinting hyperglycemia using predictive modelling approach based on low-cost routine CBC and CRP diagnostics
    Amna Tahir, Kashif Asghar, Waqas Shafiq, Hijab Batool, Dilawar Khan, Omar Chughtai, Safee Ullah Chaudhary
    Scientific Reports.2024;[Epub]     CrossRef
  • Implications of Iron Deficiency Anaemia on Glycemic Dynamics in Diabetes Mellitus: A Critical Risk Factor in Cardiovascular Disease
    Eman Elsheikh, Sereen S Aljohani , Munirah M Alshaikhmubarak, Meshari A Alhawl, Alhanouf W Alsubaie, Norah Alsultan, Asmaa F Sharif, Sayed Ibrahim Ali
    Cureus.2023;[Epub]     CrossRef
  • Usefulness of glucose management indicator derived from continuous glucose monitoring to assess glycemic condition in hospitalized patients with diabetic kidney disease treated with insulin pumps
    Yi Lu, Qian Zhang, Xiangyu Wang, Ya Jiang, Yaoming Xue
    Journal of Diabetes and its Complications.2023; 37(11): 108613.     CrossRef
  • Serum Iron Profile in Type 2 Diabetes, A Role Beyond Anemic Marker!
    Happy Chutia, Sungdirenla Jamir, Md Yasir, Gautam Handique
    The Journal of Medical Research.2023; 9(5): 129.     CrossRef
  • Association between Anemia and Myopia in Korean Adults
    Minyi Seo, Sangshin Park
    Journal of Health Informatics and Statistics.2023; 48(4): 314.     CrossRef
  • Large-scale retrospective analyses of the effect of iron deficiency anemia on hemoglobin A1c concentrations
    Lokinendi V. Rao, George W. Pratt, Caixia Bi, Martin H. Kroll
    Clinica Chimica Acta.2022; 529: 21.     CrossRef
  • Integrity loss of glycosylated hemoglobin with deepening anemia
    Bünyamin AYDIN, Aysun GÖNDEREN
    Journal of Health Sciences and Medicine.2022; 5(3): 839.     CrossRef
  • Association between hemoglobin within the normal range and hemoglobin A1c among Chinese non-diabetes adults
    Yi Lai, Zhihong Lin, Zhongxin Zhu
    BMC Endocrine Disorders.2021;[Epub]     CrossRef
  • The Association between Daily Total Dietary Nutrient Intake and Recent Glycemic Control States of Non-Pregnant Adults 20+ Years Old from NHANES 1999–2018 (Except for 2003–2004)
    Yin Bai, Hao Zhang, Jie Yang, Lei Peng
    Nutrients.2021; 13(11): 4168.     CrossRef
Original Articles
The Relationship between Anemia and the Initiation of Dialysis in Patients with Type 2 Diabetic Nephropathy
Sun Hee Kim, Kyung Ae Lee, Heung Yong Jin, Hong Sun Baek, Tae Sun Park
Diabetes Metab J. 2015;39(3):240-246.   Published online April 22, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.3.240
  • 3,757 View
  • 32 Download
  • 6 Web of Science
  • 5 Crossref
AbstractAbstract PDFPubReader   
Background

Anemia is associated with various poor clinical outcomes in chronic kidney disease patients. The aim of this study was to investigate the relationship between anemia and the initiation degree and time of dialysis in type 2 diabetic nephropathy patients.

Methods

This observational retrospective study included 130 type 2 diabetic nephropathy patients in Korea. The existence of anemia, the degree and time of dialysis initiation were reviewed. Clinical characteristics and variables were also compared.

Results

The levels of hemoglobin and serum creatinine were significantly correlated with the dialysis initiation (P<0.05) during the 10-year follow-up period. Patients with anemia showed rapid decline of renal function, causing significantly more dialysis initiation (54.1% vs. 5.4%, P<0.05) compare to the patients without anemia. Average time to initiate dialysis in patients with anemia was 45.1 months (range, 8.0 to 115.8 months), which was significantly faster than that (68.3 months [range, 23.3 to 108.8 months]) in patients without anemia (P<0.01). The risk to dialysis initiation was significantly increased in patients with anemia compared to the patients without anemia (adjusted hazard ratio, 8.1; 95% confidence interval, 2.4 to 27.0; P<0.05).

Conclusion

Anemia is associated with rapid decline of renal dysfunction and faster initiation of dialysis in diabetic nephropathy patients. Therefore, clinicians should pay an earlier attention to anemia during the management of diabetes.

Citations

Citations to this article as recorded by  
  • Microalbuminuria as the Tip of Iceberg in Type 2 Diabetes Mellitus: Prevalence, Risk Factors, and Associated Diabetic Complications
    Sohaib Asghar, Shoaib Asghar, Tayyab Mahmood, Syed Muhammad Hassan Bukhari, Muhammad Habib Mumtaz, Ali Rasheed
    Cureus.2023;[Epub]     CrossRef
  • The Association between Serum Hemoglobin and Renal Prognosis of IgA Nephropathy
    Tae Ryom Oh, Su Hyun Song, Hong Sang Choi, Chang Seong Kim, Seung Hyeok Han, Kyung Pyo Kang, Young Joo Kwon, Soo Wan Kim, Seong Kwon Ma, Eun Hui Bae
    Journal of Clinical Medicine.2021; 10(2): 363.     CrossRef
  • Prevalence of anemia in diabetic adult outpatients in Northeast Ethiopia
    Temesgen Fiseha, Aderaw Adamu, Melkam Tesfaye, Angesom Gebreweld, Jennifer A. Hirst
    PLOS ONE.2019; 14(9): e0222111.     CrossRef
  • Targeted Clinical Metabolite Profiling Platform for the Stratification of Diabetic Patients
    Ahonen, Jäntti, Suvitaival, Theilade, Risz, Kostiainen, Rossing, Orešič, Hyötyläinen
    Metabolites.2019; 9(9): 184.     CrossRef
  • Effect of high density lipoprotein cholesterol on the relationship of serum iron and hemoglobin with kidney function in diabetes
    Ashley N. Williams, Baqiyyah N. Conway
    Journal of Diabetes and its Complications.2017; 31(6): 958.     CrossRef
Hemoglobin A1c May Be an Inadequate Diagnostic Tool for Diabetes Mellitus in Anemic Subjects
Jung Il Son, Sang Youl Rhee, Jeong-taek Woo, Jin Kyung Hwang, Sang Ouk Chin, Suk Chon, Seungjoon Oh, Sung Woon Kim, Young Seol Kim
Diabetes Metab J. 2013;37(5):343-348.   Published online October 17, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.5.343
  • 5,191 View
  • 60 Download
  • 34 Crossref
AbstractAbstract PDFPubReader   
Background

Recently, a hemoglobin A1c (HbA1c) level of 6.5% has been determined to be a criterion for diabetes mellitus (DM), and it is a widely used marker for the diagnosis of DM. However, HbA1c may be influenced by a number of factors. Anemia is one of the most prevalent diseases with an influence on HbA1c; however, its effect on HbA1c varies based on the variable pathophysiology of anemia. The aim of this study was to determine the effect of anemia on HbA1c levels.

Methods

Anemic subjects (n=112) and age- and sex-matched controls (n=217) who were drug naive and suspected of having DM were enrolled. The subjects underwent an oral glucose tolerance test and HbA1c simultaneously. We compared mean HbA1c and its sensitivity and specificity for diagnosing DM between each subgroup.

Results

Clinical characteristics were found to be similar between each subgroup. Also, when glucose levels were within the normal range, the difference in mean HbA1c was not significant (P=0.580). However, when plasma glucose levels were above the diagnostic cutoff for prediabetes and DM, the mean HbA1c of the anemic subgroup was modestly higher than in the nonanemic group. The specificity of HbA1c for diagnosis of DM was significantly lower in the anemic subgroup (P<0.05).

Conclusion

These results suggest that the diagnostic significance of HbA1c might be limited in anemic patients.

Citations

Citations to this article as recorded by  
  • Establishment of a feline glycated hemoglobin reference interval for a novel dried‐blood‐spot assay and the effects of anemia on assay results
    Jocelyn Mott, Jacqueline K. Dolan, Chen Gilor, Shir Gilor
    Veterinary Clinical Pathology.2023; 52(3): 531.     CrossRef
  • Waist circumference and glycaemia are strong predictors of progression to diabetes in individuals with prediabetes in sub-Saharan Africa: 4-year prospective cohort study in Malawi
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    PLOS Global Public Health.2023; 3(9): e0001263.     CrossRef
  • Implications of Iron Deficiency Anaemia on Glycemic Dynamics in Diabetes Mellitus: A Critical Risk Factor in Cardiovascular Disease
    Eman Elsheikh, Sereen S Aljohani , Munirah M Alshaikhmubarak, Meshari A Alhawl, Alhanouf W Alsubaie, Norah Alsultan, Asmaa F Sharif, Sayed Ibrahim Ali
    Cureus.2023;[Epub]     CrossRef
  • Serum Iron Profile in Type 2 Diabetes, A Role Beyond Anemic Marker!
    Happy Chutia, Sungdirenla Jamir, Md Yasir, Gautam Handique
    The Journal of Medical Research.2023; 9(5): 129.     CrossRef
  • Large-scale retrospective analyses of the effect of iron deficiency anemia on hemoglobin A1c concentrations
    Lokinendi V. Rao, George W. Pratt, Caixia Bi, Martin H. Kroll
    Clinica Chimica Acta.2022; 529: 21.     CrossRef
  • Glycemic Abnormalities Assessment on Children and Adolescents with Beta-Thalassemia Major
    Siska Mayasari Lubis, Bidasari Lubis, Nadhira Anindita Ralena
    Open Access Macedonian Journal of Medical Sciences.2022; 10(B): 697.     CrossRef
  • Integrity loss of glycosylated hemoglobin with deepening anemia
    Bünyamin AYDIN, Aysun GÖNDEREN
    Journal of Health Sciences and Medicine.2022; 5(3): 839.     CrossRef
  • Effect of anemia and erythrocyte indices on hemoglobin A1c levels among pregnant women
    Zong-Hui Guo, Huai-Liang Tian, Xiao-Qian Zhang, Deng-Han Zhang, Zhi-Min Wang, Kun Wang, Wen-Wen Su, Fei Chen
    Clinica Chimica Acta.2022; 534: 1.     CrossRef
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    Manju Mamtani, Manisha T. Jaisinghani, Sujeet G. Jaiswal, Kanchan V. Pipal, Ashwini A. Patel, Hemant Kulkarni, Lee-Ling Lim
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    See Ling Loy, Jinjie Lin, Yin Bun Cheung, Aravind Venkatesh Sreedharan, Xinyi Chin, Keith M. Godfrey, Kok Hian Tan, Lynette Pei-Chi Shek, Yap Seng Chong, Melvin Khee-Shing Leow, Chin Meng Khoo, Yung Seng Lee, Shiao-Yng Chan, Ngee Lek, Jerry Kok Yen Chan,
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    Pediatric Diabetes.2019; 20(1): 65.     CrossRef
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    Jari Intra, Giuseppe Limonta, Fabrizio Cappellini, Maria Bertona, Paolo Brambilla
    Diabetes & Metabolism Journal.2019; 43(4): 539.     CrossRef
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The Clinical Characteristics of Anemia in Type 2 Diabetic Patients Without Overt Nephropathy.
Eun Young Ko, Se In Kim, Yong Bum Jang, Kyoung Hun Min, Sung Hun Kim, Kyu Sun Lee, So Ri Kim, Eun Kyoung Choi, Ji Hyun Park, Tae Sun Park, Hong Sun Paek
Korean Diabetes J. 2004;28(5):425-431.   Published online October 1, 2004
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AbstractAbstract PDF
BACKGROUND
It is well known that anemia occurs early in diabetic patients before they reach to end stage renal failure. This anemia is considered to be due to the reduced endogenous erythropoietin synthesis, tubulointerstitial damage, autonomic dysfunction, and to the use of angiotensin-converting- enzyme inhibitors. Because anemia has a significant impact on the quality of life for diabetic patients, we examined the clinical characteristics of anemia in those diabetic patients who did not have overt nephropathy. METHODS: We retrospectively reviewed the medical records of 200 type 2 diabetic patients with anemia who had been followed up from 1998 to 2002 by Chonbuk University Medical School Hospital. We measured the total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein, and the presence of complications (retinopathy or neuropathy) for about 90 diabetic patients who were under the age of 65, they were without other underlying disease and they had a hemoglobin concentration 110g/L, GFR 1.0 mL/s. We excluded the causes of anemia as being from malignancy, liver disease, coexisting iron deficiency, chronic inflammatory disease and chronic infection. RESULTS: The clinical characteristics of the patients are as follows; the mean age was 59.6 +/- 8.4 years, the mean HbA1C was 9.4 +/- 2.3%, and the mean Hb concentration was 96 +/- 12 g/L. Our results showed that an inverse relation existeds between Hb concentration and total cholesterol (p<0.04), LDL cholesterol (p<0.05), age (p<0.02), and the duration of diabetes (p<0.01).Our results also showed that a linear relation existed between the Hb concentration, HDL cholesterol (p<0.02), and the GFR (p<0.01). CONCLUSION: Diabrtic patients with anemia are in need of intensive management for the lipid and GFR that causes thair anemia.
Randomized Controlled Trial
Therapeutic Effect of Recombinant Human Erythropoietin on Anemia with Erythropoietin Deficiency in Early Diabetic Nephropathy.
Dae Jung Kim, Soo Kyung Kim, Hyeung Jin Kim, Yoo Mee Kim, Yong Seok Yun, Chul Woo Ahn, Bong Soo Cha, Young Duk Song, Sung Kil Lim, Kyeong Rae Kim, Hyun Chul Lee, Kap Bum Huh
Korean Diabetes J. 2001;25(5):364-373.   Published online October 1, 2001
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  • 22 Download
AbstractAbstract PDF
BACKGROUND
We have previously reported that reduced erythropoietin (Epo) responsiveness to anemia could explain the anemia in diabetic patients before advanced diabetic nephropathy. Thus, the aim of this randomized prospective study is to investigate the therapeutic effect of recombinant human erythropoietin (rHuEpo) on anemia with Epo deficiency in early diabetic nephropathy. METHODS: Twenty-nine diabetic patients with the normocytic normochromic anemia of Epo deficiency were randomized into Epo-treatment group (n=20, M:F= 8:12, mean age=52.9+/-9.2) and control group (n=9, M:F=4:5, mean age=53.6+/-12.4). Twenty patients of Epo-treatment group were treated with rHuEpo (Epokine (CheilJedang Co.) 4,000unit/day SC., 3 times/week) for 8 weeks. The Epo- treatment group were divided into the responder or non-responder. Patients with increments in Hemoglobin (Hb) during the follow-up duration was above 2 g/dL, or with the final Hb was above 14 g/dL in men or 13g/dL in women were decided the responder. In order to analyze factors affecting the therapeutic effects of rHuEpo, the clinical and biochemical characteristics were compared between the responder and non-responder group. RESULTS: There was no difference in the clinical and biochemical characteristics between the Epo-treatment and the control group at randomization. The responder group (n=14) had significant increments in Hb, compared to the non-responder group (n=6) or the control group (13.6+/-1.0 vs. 10.1+/-1.5 vs 11.2+/-1.2 g/dL, p < 0.001, respectively). The treatment duration of rHuEpo in the responder group was 4.9+/-2.3 weeks. Among the Epo-treatment group, there was no differences between the responder and the non-responder group in sex, age, duration of diabetes, serum creatinine level, 24 hour urinary albumin excretion rates, HbA1C, frequency or severity of microangiopathy, and serum Epo level. However, the responder group had higher serum ferritin (240.3+/-108.4 vs 25.8+/-3.0 g/L, p<0.05) and transferin saturation level (32.7+/-7.9 vs 21.2+/-5.3 %, p<0.05). CONCLUSION: These results concluded that the administration of rHuEpo could be useful in treating anemia with Epo deficiency in early diabetic nephropathy and that the degree of iron storage and functional iron deficiency might affect the therapeutic effects of rHuEpo on this type of anemia.
Original Article
Reduced Erythropoietin Responsiveness to Anemia in Diabetic Patients before Advanced Diabetic Nephropathy.
Yong Seok Yun, Sung Cheol Kim, Nae Chun Yoo, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Jee Sook Hahn, Kap Bum Huh
Korean Diabetes J. 1999;23(5):669-677.   Published online January 1, 2001
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AbstractAbstract PDF
BACKGROUND
We have often encountered some diabetie patients, in whom the causes of anemia were not clearly identified, despite differential hematologic studies. We, therefore, studied the clinical and biochemical characteristics of diabetic patients with anemia of uncertain cause. The study measured erythropoietin levels in diabetic subjects without significant diabetic renal disease. METHODS: Among 62 medical records of diabetic patients with anemia, showing no evidence of advanced diabetic nephropathy (creatinine clearance > 30 mL/min/1.73m2), the causes of the anemia were evaluated. In addition, we recruited 35 diabetic patients with uncertain causes of anemia, in order to evaluate the serum erythropoietin(Epo) responsiveness. Also, we compared their Epo levels to a group of non-diabetie subjects with similar degree of anemia. RESULT: The causes of anemia were not able to be identified in 28 (45.2 %) of 62 patients. The serum Epo levels of diabetic patients with anemia of uncertain cause (17.6+/-8.1), were significantly lower than those of non-diabetic patients with the same degree of decrease in hemoglobin levels (144.9+/-108.0 mIU/mL, p<0.001). The hemoglobin levels of diabetic patients were correlated with creatinine clearance (r=0.34, p=0.03), serum creatinine levels (r=-0.49, p=0.003), and albumin excretion rate (r=-0.44, p=0.009). But, showed no relation with age, duration of diabetes, glycated hemoglobin, presence of retinopathy or neuropathy. CONCLUSION: We concluded that reduced Epo responsiveness to anemia could explain the anemia present in diabetic patient but without advanced diabetic nephropathy. This may reflect early renal interstitial damage.

Diabetes Metab J : Diabetes & Metabolism Journal