Ann Lab Med.  2012 Jan;32(1):17-22. 10.3343/alm.2012.32.1.17.

Effect of Iron Deficiency Anemia on Hemoglobin A1c Levels

• Sinha N
• Mishra TK
• Singh T
• Gupta N

• KMID: 1781433
• DOI: http://doi.org/10.3343/alm.2012.32.1.17

Abstract

BACKGROUND
Iron deficiency anemia is the most common form of anemia in India. Hemoglobin A1c (HbA1c) is used in diabetic patients as an index of glycemic control reflecting glucose levels of the previous 3 months. Like blood sugar levels, HbA1c levels are also affected by the presence of variant hemoglobins, hemolytic anemias, nutritional anemias, uremia, pregnancy, and acute blood loss. However, reports on the effects of iron deficiency anemia on HbA1c levels are inconsistent. We conducted a study to analyze the effects of iron deficiency anemia on HbA1c levels and to assess whether treatment of iron deficiency anemia affects HbA1c levels.
METHODS
Fifty patients confirmed to have iron deficiency anemia were enrolled in this study. HbA1c and absolute HbA1c levels were measured both at baseline and at 2 months after treatment, and these values were compared with those in the control population.
RESULTS
The mean baseline HbA1c level in anemic patients (4.6%) was significantly lower than that in the control group (5.5%, p<0.05). A significant increase was observed in the patients' absolute HbA1c levels at 2 months after treatment (0.29 g/dL vs. 0.73 g/dL, p<0.01). There was a significant difference between the baseline values of patients and controls (0.29 g/dL vs. 0.74 g/dL, p<0.01).
CONCLUSIONS
In contrast to the observations of previous studies, ours showed that HbA1c levels and absolute HbA1c levels increased with treatment of iron deficiency anemia. This could be attributable to nutritional deficiency and/or certain unknown variables. Further studies are warranted.

Keyword

Iron deficiency anemia; Hemoglobin A1c; HbA1c; Glycated hemoglobin

MeSH Terms

Adolescent
Adult
Anemia, Iron-Deficiency/*blood/drug therapy
Child
Female
Ferritins/blood
Hemoglobin A, Glycosylated/*analysis
Hemoglobins/analysis
Humans
Iron/therapeutic use
Male
Time Factors

Figure

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  Fig. 1 Correlation between hemoglobin and HbA1c levels in patients at baseline. Abbreviation: HbA1c, hemoglobin A1c.

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  Fig. 2 Correlation between hemoglobin and HbA1c levels in patients after 1 month of treatment Abbreviation: HbA1c, hemoglobin A1c.

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  Fig. 3 Correlation between hemoglobin and HbA1c levels in patients after 2 months of treatment. Abbreviation: HbA1c, hemoglobin A1c.

Reference

1. Telen MJ, Kaufman RE. Greer JP, Forester J, editors. The mature erythrocyte. Wintrobe's clinical hematology. 2004. 11th ed. Lippincot: Williams and Wilkins;230.

2. American Diabetes Association. Position statement: Standards of medical care in diabetes-2007. Diabetes Care. 2007. 30:S1. S9.

3. Horton BF, Huisman TH. Studies on the heterogeneity of hemoglobin. VII. Minor hemoglobin components in haematological diseases. Br J Haematol. 1965. 11:296–304.

4. Eberentz-Lhomme C, Ducrocq R, Intrator S, Elion J, Nunez E, Assan R. Haemoglobinopathies: a pitfall in the assessment of glycosylated haemoglobin by ion-exchange chromatography. Diabetologia. 1984. 27:596–598.

5. Bernstein RE. Glycosylated hemoglobins: hematologic considerations determine which assay for glycohemoglobin is advisable. Clin Chem. 1980. 26:174–175.

6. Starkman HS, Wacks M, Soeldner JS, Kim A. Effect of acute blood loss on glycosylated hemoglobin determinations in normal subjects. Diabetes Care. 1983. 6:291–294.

7. Lind T, Cheyne GA. Effect of normal pregnancy upon the glycosylated haemoglobins. Br J Obstet Gynaecol. 1979. 86:210–213.

8. Hanson U, Hagenfeldt L, Hagenfeldt K. Glycosylated hemoglobins in normal pregnancy: sequential changes and relation to birth weight. Obstet Gynecol. 1983. 62:741–744.

9. Phelps RL, Honig GR, Green D, Metzger B, Frederiksen MC, Frienkel N. Biphasic changes in hemoglobin A1c concentrations during normal human pregnancy. Am J Obstet Gynecol. 1983. 147:651–653.

10. de Boer MJ, Miedema K, Casparie AF. Glycosylated haemoglobin in renal failure. Diabetologia. 1980. 18:437–440.

11. Flückiger R, Harmon W, Meier W, Loo S, Gabbay KH. Hemoglobin carbamylation in uremia. N Engl J Med. 1981. 304:823–827.

12. Paisey R, Banks R, Holton R, Young K, Hopton M, White D, et al. Glycosylated haemoglobin in uraemia. Diabet Med. 1986. 3:445–448.

13. Shendurnikaref N, editor. Iron deficiency is preventable. Updated on Apr 2007. http://www.indiaparenting.com/raisingchild/data/raisingchild063.shtml.

14. Brooks AP, Metcalfe J, Day JL, Edwards MS. Iron deficiency and glycosylated haemoglobin A. Lancet. 1980. 2:141.

15. Sluiter WJ, van Essen LH, Reitsma WD, Doorenbos H. Glycosylated haemoglobin and iron deficiency. Lancet. 1980. 2:531–532.

16. Mitchell TR, Anderson D, Shepperd J. Iron deficiency, haemochromatosis, and glycosylated haemoglobin. Lancet. 1980. 2:747.

17. van Heyningen C, Dalton RG. Glycosylated haemoglobin in iron-deficiency anaemia. Lancet. 1985. 1:874.

18. Gram-Hansen P, Eriksen J, Mourits-Andersen T, Olesen L. Glycosylated haemoglobin (HbA1c) in iron- and vitamin B12 deficiency. J Intern Med. 1990. 227:133–136.

19. Rai KB, Pattabiraman TN. Glycosylated haemoglobin levels in iron deficiency anaemia. Indian J Med Res. 1986. 83:234–236.

20. El-Agouza I, Abu Shohla A, Sirdah M. The effect of iron deficiency anaemia on the levels of haemoglobin subtypes: possible consequences for clinical diagnosis. Clin Lab Haematol. 2002. 24:285–289.

21. Coban E, Ozdogan M, Timuragaoglu A. Effect of iron deficiency anemia on the levels of hemoglobin A1c in nondiabetic patients. Acta Haematol. 2004. 112:126–128.

22. Rastogi T, Mathers C, editors. Global burden of iron deficiency anaemia in the year 2000. Updated on Apr 2007. http://www.who.int/entity/healthinfo/statistics/bod_irondeficiencyanaemia.pdf .

23. Conrad ME, editor. Iron deficiency. Updated on Apr 2007. http://www.emedicine.com/med/topic1188.htm.