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Vitamin D and glycated hemoglobin levels in non-diabetic anemic patients

Kanchana R, Pushpa K.

Background: Glycated hemoglobin (HbA1c) is a form of hemoglobin that indicates average plasma glucose concentration over months formed due to non-enzymatic glycation. According to the previous studies, HbA1c levels have been found to be increased in anemic patients despite the shortened life span of the erythrocytes. Decreased Vitamin D may be an independent risk factor for type 2 diabetes mellitus (T2DM) with higher HbA1c levels. Studies have also demonstrated that in children, decreased Vitamin D levels are associated with increased risk for anemia.

Aim and Objective: The aim of this study is to estimate and analyze HbA1c, Hb, and Vitamin D among non-diabetic anemic patients and age- and sex-matched normal subjects.

Materials and Method: A case–control study was carried out with inclusion of 50 anemic patients as cases and 50 normal subjects as controls. The patients, who had diabetes, hemolytic anemia, worm infestation, chronic alcohol ingestion, and renal disease, were excluded from the study. Routine blood investigations, the fasting and postprandial glucose and HbA1c, Hb, and Vitamin D levels were measured in all the subjects. Vitamin D was estimated by ELISA. Fasting and postprandial blood glucose levels were determined by GOD-POD method. Hemoglobin (Hb) was estimated by Drabkin’s method. HbA1c was determined by immunoturbidimetry.

Results: The mean HbA1c (7.4 ± 0.5%) level in the patients with iron deficiency anemia (IDA) was higher than that in the control group (5.2% ± 0.8) (P < 0.05). There was no difference in the levels of FBS and PPBS between the two groups (P > 0.05). The Hb, serum ferritin, FBS, PPBS, and the HbA1c levels were normal in the control group (P > 0.05). The study found negative correlation between Vitamin D and HbA1c in both males and females (r = –0.4, r = –0.3, P ≤ 0.001), HbA1c and hemoglobin (r = –0.4, r = –0.3 P ≤ 0.002). Furthermore, there was a significant positive correlation between the Vitamin D and hemoglobin (r = 0.5, r = 0.3 P ≤ 0.001) values in the study population.

Conclusion: HbA1c is not affected by the blood sugar levels alone, and there are many factors to be considered when HbA1c is measured, especially that of presence of iron deficiency. It is essential to rule out IDA before making any decision, based on the HbA1c levels.

Key words: Anemia; Glycated Hemoglobin; Non-diabetic; Vitamin D

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