Thyroid hormones have a catabolic effect on bone homeostasis. Hence, this study aimed to evaluate serum vitamin D, calcium, and phosphate and bone marker levels and bone mineral density (BMD) among patients with different thyroid diseases. This cross-sectional study included patients with underlying thyroid diseases (n = 64, hyperthyroid; n = 53 euthyroid; n = 18, hypothyroid) and healthy controls (n = 64). BMD was assessed using z-score and left hip and lumbar bone density (g/cm2). The results showed that the mean serum vitamin D Levels of all groups was low (<50 nmol/L). Thyroid patients had higher serum vitamin D levels than healthy controls. All groups had normal serum calcium and phosphate levels. The carboxy terminal collagen crosslink and procollagen type I N-terminal propeptide levels were high in hyperthyroid patients and low in hypothyroid patients. The z-score for hip and spine did not significantly differ between thyroid patients and control groups. The hip bone density was remarkably low in the hyperthyroid group. In conclusion, this study showed no correlation between serum 25(OH)D levels and thyroid diseases. The bone markers showed a difference between thyroid groups with no significant difference in BMD.

Glycated hemoglobin (HbA1c) is used to monitor the long-term management of diabetes and reflects the average blood glucose level over the past three months. Hb J is an alpha-globin gene variant that occurs less commonly but can interfere with the HbA1c result. This case report presents two cases of abnormally high HbA1c in patients with Hb J using the high-performance liquid chromatography (HPLC) method and repeated value using the capillary electrophoresis (CE) method. The first case was a 26 years old female Malay patient, presenting at 25 weeks gestation with diabetes mellitus (DM). Her HbA1c results from HPLC showed persistently high level (> 18.5%, > 179 mmol/mol) despite optimum diabetic control (fasting blood sugar (FBS) range 4.0–6.1 mmol/L). The second case was a 62-year-old female Malay with type 2 DM. Her HbA1c results from HPLC was also persistently high (> 18.5%, > 1;79 mmol/mol) despite good diabetic control (FBS average 5.0–7.0 mmol/L). Both patients’ hemoglobin analysis reports were suggestive of Hb J. Repeated HbA1c using CE were 6.0% (42 mmol/mol) and 8.1% (65 mmol/mol), respectively, and supported the presence of the Hb J variant peak. HbA1c measurement in patients with a variant should be interpreted with caution to avoid misdiagnosis and mismanagement in these kinds of patients.

Utilization of glycated haemoglobin (HbA1c) in diagnosis and monitoring of diabetes mellitus is accepted and validated worldwide. Standardisation between various methods available is no longer an issue. However, knowledge of HbA1c interference by various haemoglobin (Hb) fractions presence in the patient’s sample must be taken into account during HbA1c analysis and interpretation. Carbamylated Hb (cHb) is one of Hb fractions, formed when Hb condensed at the N-terminal valine by cyanate derived from spontaneous decomposition of urea which usually raised in patients with renal impairment. This study aimed to compare the level of HbA1c in patient with high urea measured using High Performance Liquid Chromatography (HPLC) and Capillary Electrophoresis (CE). After analysis using the laboratory’s routine method, or HPLC, the patient’s samples with concurrent urea level of >25 mmol/L were re-analyzed within 2 hours using the comparative method or CE.  A cut off cHb of 2% on HPLC considered as no interference. The mean level of urea was 31.37±5.09 mmol/L (range 25.2-43.1mmol/L). Out of 68 samples, only 24 cHb were detected by HPLC but only less than 2% and none cHb detected on CE.  Correlation between HPLC and CE showed no significant different in HbA1c measurement (r= p>0.05). Therefore, we propose that both HPLC and CE can be used to determine HbA1c level in patient with high urea.

Haemoglobin A1c (HbA1c) is used to monitor glycaemic control and predict diabetic complications. Measurement of HbA1c can be interfered by haemoglobin (Hb) variant and other Hb derivatives include carbamylated Hb and elevated labile A1c. This study is to determine the percentages and type of interferences during HbA1c analysis and the percentages of non- reportable HbA1c results. This is a cross-sectional study using retrospective data of HbA1c. The HbA1c is measured on Biorad D10 using the ion-exchange high-performance liquid chromatography method. The data were analyzed using descriptive statistics. A total of 26,560 patients were included. The result showed the presence of interferences of 2269 (8.56%). The most common causes of the interferences were the Hb variant (8.48%) followed by carbamylated Hb and labile A1c (0.03% each). The non-reportable HbA1c results were 0.46% with the Hb variant contributed most of the causes. By knowing the presence of interferences particularly the Hb variant, the HbA1c results hopefully are interpreted with caution and correct management can be given to the patients.

Insulin resistance increases the risk of developing diabetes, and the degree of resistance influences the glycemic control of patients with diabetes. Numerous researchers have focused on improving insulin sensitivity in order to prevent diabetes-related complications and other chronic diseases. Several studies have also linked vitamin D levels to insulin secretion and resistance, given that both vitamin D and its receptor complex play important roles in regulating pancreatic β-cells. It has been suggested that vitamin D supplementation improves vitamin D levels, but further research is needed to confirm this as neither insulin function nor glycemic control improves when vitamin D levels increase. Magnesium is a cofactor for many enzymes. Although the role of magnesium in the management of diabetes has long been evaluated, it has not yet been determined whether magnesium supplements improve insulin function. However, several researchers have found that patients with good glycemic control have high magnesium levels. Magnesium is closely related to vitamin D and is necessary for the transport and activation of vitamin D in humans. Combined supplementation with vitamin D and magnesium improves glycemic control in patients with diabetes.