Fault Low of HbA1c Value in Hemoglobin E Disorder

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Passorn Sueyanyongsiri

Abstract

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

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