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Background: Adecreasing erythrocyte life-span is associated with lower HbA1c level. This research aims to study the fault of HbA1c level in poor control of diabetes in endemic area of hemoglobinopathy.
Methods: This cross-sectional study was conducted from 2009 to 2016. Patient’s clinical information, fasting plasma glucose (FPG), and HbA1c levels were collected and divided into three groups which arecontrol group, hemoglobin E heterozygous (HbEA) and homozygous group(HbEE). Each group was further divided into six strata according to HbA1c level. The hypothesis, at the same level of HbA1c, FPG would not higher if there is no effect in hemoglobin E disorder.
Results: As a result of 1947 test, there were 1222 diabetic patients, in cludes hemoglobin E disorder and 725 diabetic patients with negative dichlorophenol-Indolephenol(DCIP) test. There was no significant dif-ference regarding age, HbA1c, FPG, and serum creatinine which were found between the study and the control group. When there was a comparison between the study and the control group, anemia was more prevalent among diabetic patients with hemoglobin E homozyg-ous (p<0.05). Furthers, HbA1c level was divided into six strata which were5.0-5.4, 5.5-5.9, 6.0-6.4, 6.4-6.9, 7.0-7.4, and 7.5-7.9%.The ANOVA test revealed that HbA1c levels in each stratum wasnot significantly different among these three groups. FPG level was significantly differ-ent in 6.0-6.4, 6.5-6.9, and 7.0-7.4%; as well as, HbA1c stratum with FPG was higher in HbEE than the control group. In HbEA group, FPG was still higher in 6.0-6.4 and 6.5-6.9 strata.
Conclusion: Diabetic patients with hemoglobins E disorder should carefully use HbA1c level as an indicator for long-term glycemic control. At HbA1c 6.0-7.5%, FPG is higher than expected because of the fault of low HbA1c measurement.
Key words: Diabetes mellitus, Hemoglobinopathy, Hemoglobin E disorder, Glyco-hemoglobin, HbA1c
2. Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004;141:421-31.
3. Rohlfing CL, Wiedmeyer HM, Little RR, England JD, Tennill A, Goldstein DE: Defining the relationship between plasma glucose and HbA(1c): analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care. 2002;25:275-8.
4. American Diabetes Association: Standards of medical care in diabetes 2017. Diabetes care. 2017;9:320-24.
5. Schulz KF, Grimes DA. Multiplicity in randomised trials. Endpoints and treatments. Lancet. 2005;365:1591-95.
6. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M: Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2002;48:436-72.
7. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545-59.
8. Bunn HF, Haney DN, Kamin S, Gabbaj KH, Gallop PM. The biosynthesis of human he-moglobin A1c. J Clin Invest. 1976;41:1652-9.
9. Fitzgibbons JF, Koler RD, Jones RT. Red-cell age-related changes of hemoglobins A1a+b and A1c in normal and diabetic subjects. J Clin Invest. 1976;41:820-4.
10. Weykamp CW, Penders TJ, Muskiet FA, van der Slik W: Influence of hemoglobin va-riants and derivatives on glycohemoglobin determinations, as investigated by 102 la-boratories using 16 methods. Clin Chem. 39;1993:1717-23.
11. Sueyunyongsiri P. Effect of Hemoglobin E disorder on Hemoglobin A1c in Diabetic patients. Med J Srisaket Surin Buriram Hosp. 2008;23:637-43.
12. Schneider RG, Hightower B, Hosty TS, Ryder H, Tomlin G, Atkins R, Brimhall B, Jones R. Abnormal hemoglobins in a quarter million people. Blood. 1976;48:629-37.
13. Weatherall DJ, Clegg JB. Inherited haemoglobin disorders: an increasing global health problem. Bulletin of the World Health Organization. 2001;79:704-12.
14. Fucharoen S, Winichagoon P. Hemoglobinopathies in Southeast Asia. Hemoglobin. 1987;11:65-88.
15. Na-Nakorn S, Wasi P. The distribution of hemoglobin E : hemoglobin E triangle in Southeast Asia. J Med Assoc Thai. 1972;61:65-8.
16. Sattarattanamai C, Thongsuk S, Sutjaritchep P, Thuengsang D, Chomchuen S: Preva-lence of thalassemia and hemoglobinopathies in pregnant women at Surin Hospital. Med J Srisaket Surin Buriram Hosp. 2000;15:1-12.
17. Srisurin W. Prevalence and effect of hemoglobin E disorders on Hba1c and lipid pro-file of diabetic patients at Surin Hospital. J Med Assoc Thai. 2011;94:36-41.
18. Fucharoen G, Sanchaisuriya K, Sae-ung N, Dangwibul S, Fucharoen S. A simplified screening strategy for thalassaemia and haemoglobin E in rural communities in south-east Asia. Bull World Health Organ. 2004;82:364-72.