Glycosylated Hemoglobin Levels in Sudanese Sickle Cell Anemia Patients

Atabani, G.; Hassan, Doaa; Rahman, Abdul Malek Abdul; Saeed, B. O.

doi:10.1159/000205546

Cited by 11 publications

(6 citation statements)

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“…They found a strong linear correlation between A1c levels and red blood cell survival ( r 2 = 0.88, P < 0.001) and suggested the use of A1c levels to estimate the degree of haemolysis in patients without diabetes [6]. Low A1c levels that are discrepant with high plasma glucose measures have been reported in diabetic patients with haemolysis of various aetiologies, such as autoimmune haemolytic anaemia [7], sickle cell anaemia [8], malaria [9], or haemolysis following cardiac surgery [10]. Unexpectedly low A1c levels were also found in three patients with haemolysis induced by medication (dapsone, trimethoprim–sulfamethoxazole, and IFN + RBV in one case) [11].…”

Section: Discussionmentioning

confidence: 99%

Decline in haemoglobin A1c values in diabetic patients receiving interferon‐alpha and ribavirin for chronic hepatitis C*

Greenberg

Rosman

Eldeiry

et al. 2006

Journal of Viral Hepatitis

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Haemoglobin A1c (A1c) levels are lower during haemolysis because of the shorter exposure of haemoglobin (Hb) to plasma glucose. Ribavirin (RBV) used in combination with interferon-alpha (IFN) for chronic hepatitis C causes reversible haemolytic anaemia. This study examined the extent to which RBV treatment influences A1c levels in diabetic patients. A retrospective analysis identified 32 diabetic patients who underwent hepatitis C treatment with IFN and RBV. Each subject had at least three measures of A1c, Hb and glucose: before, during and after therapy. A1c values decreased from a mean pretreatment level of 7.2% to an on-treatment A1c level of 5.2% [mean paired difference -2.01%; 95% confidence interval (CI) -1.59% to -2.43%; P < 0.001]. During therapy, mean Hb levels decreased from 15.1 g/dL at baseline to a nadir of 11.7 g/dL (P < 0.001) with a rise in lactose dehydrogenase levels and reticulocyte counts, and unchanged mean corpuscular volume values confirming haemolysis. At the same time, glucose levels declined by a mean of 38.4 mg/dL (95% CI 13.4-63.5 mg/dL; P = 0.002) as did body weights by a mean of 3.15 kg (P < 0.001). According to published glucose-A1c correlation tables, this decline of glucose concentration by 38.4 mg/dL correlates to a decline in A1c level of 1.08%. In conclusion, reductions of A1c levels by a mean of 2.01% during hepatitis C therapy with IFN + RBV are due to a combination of decreased glucose levels (1.08%) and RBV-induced haemolysis (0.93%). A1c levels should not be measured during hepatitis C treatment with IFN + RBV because they do not adequately reflect glycaemic control.

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Section: Discussionmentioning

confidence: 99%

Decline in haemoglobin A1c values in diabetic patients receiving interferon‐alpha and ribavirin for chronic hepatitis C*

Greenberg

Rosman

Eldeiry

et al. 2006

Journal of Viral Hepatitis

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“…Thus, GHb percentage can be used as a time-averaged index of the blood glucose concentration to which the Hb has been exposed. However, unusually low GHb percentages are observed in subjects with hemolytic anemia (3)(4)(5)(6)(7). Thus, GHb concentration also is a function of the duration of exposure of Hb to blood glucose, i.e., the life span of the erythrocyte.…”

mentioning

confidence: 99%

Relationship Between GHb Concentration and Erythrocyte Survival Determined From Breath Carbon Monoxide Concentration

Virtue¹,

Furne²,

Nuttall³

et al. 2004

Diabetes Care

127

102

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OBJECTIVE -Subjects with decreased erythrocyte survival have an unusually low GHb percentage. The goal of this study was to determine whether hyperglycemia, as reflected by GHb percentage, is associated with decreased erythrocyte survival.RESEARCH DESIGN AND METHODS -Erythrocyte survival was quantitated in 23 subjects with type 2 diabetes, and these values were correlated with the subjects' GHb percentage. Erythrocyte survival was determined from the difference between the subjects' alveolar carbon monoxide (CO) concentration and atmospheric CO concentration. Reticulocyte counts were obtained in 16 subjects.RESULTS -Although the vast majority of the subjects had erythrocyte life spans that fell within the normal range (123 Ϯ 23 days), there was a highly significant inverse correlation (r ϭ Ϫ0.66, P Ͻ 0.01) between life span and GHb percentage, with an average decline in life span of 6.9 days for each 1% rise in GHb. The reticulocyte count inversely correlated with erythrocyte life span (r ϭ Ϫ0.77, P Ͻ 0.01).CONCLUSIONS -Hyperglycemia, as evidenced by high GHb percentage, is associated with an appreciable decrease in erythrocyte life span. Because GHb appears to be formed over the lifetime of the erythrocyte, this decreased erythrocyte survival suggests that high GHb percentages may systematically underestimate the true degree of hyperglycemia.

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“…For instance, a study done in Sudan by Atabani et al (10) revealed lower levels of HbA1c in children with SCA compared to children without SCA. Another study involving adults African-Americans by Lacy et al (6) also revealed lower levels of HbA1c in patients with SCT compared to those without SCT.…”

Section: Discussionmentioning

confidence: 99%

“…Considering the wide availability of immunoassay methods in our settings, using standard cut-offs of HbA1c levels to diagnose DM in children with SCA can cause missed opportunity for interventions. Some of the patients could be missed because of the possibly false low values (10).…”

Section: De Nition Of Key Terms Introductionmentioning

confidence: 99%

Glycosylated Hemoglobin Levels Among Non-Diabetic Children With Sickle Cell Anemia At Muhimbili National Hospital. A Case For Establishing Normal Values

Mugyabuso

Muze

Manji

2021

Preprint

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BackgroundImprovement in the management of children with SCA, has led to increase in their lifespan. However, the increased lifespan, has been accompanied with emergence of various endocrinopathies such as Diabetes mellitus (DM).Glycosylated Hemoglobin (HbA1c) levels have been found to be lower in children with SCA compared to children without SCA in various studies. This can lead to missed children with DM hence delaying their treatment. There is a need to establish normal ranges of HbA1c levels corresponding to children with SCA.ObjectiveTo determine normal range of HbA1c levels among non-diabetic children with SCA attending clinics at Muhimbili National Hospital in Dar-es-salaamMethodologyThis was a hospital-based cross sectional study conducted at Paediatric clinics in Muhimbili National Hospital involving children from 9 months to 14 years. The study was approved by Institutional review Board of MUHAS. A written informed consent was obtained.120 children with SCA and 40 children without SCA were recruited. Data was reported as median and IQR or as mean ± standard deviation. Chi-square was used for categorical data while independent t-test and Mann Whitney test were used for continuous data. ResultsThe reference range of HbA1c levels in children with SCA was from 3.4% to 5.2%. Median HbA1c level in children with SCA was 4.2% with IQR of (4.1% - 4.6%) while for children without SCA median HbA1c levels was 5.3% with IQR of (4.9% - 5.5%). The median HbA1c level was significantly lower in children with SCA than children without SCA.Conclusion and RecommendationThe reference range of HbA1c levels in children with SCA was from 3.4% to 5.2%. Children with SCA had lower levels of HbA1c compared to children without SCA. Health personnel are advised to use HbA1c reference ranges obtained from this study when screening for Diabetes mellitus in children with SCA.

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Glycosylated Hemoglobin Levels in Sudanese Sickle Cell Anemia Patients

Cited by 11 publications

References 6 publications

Decline in haemoglobin A1c values in diabetic patients receiving interferon‐alpha and ribavirin for chronic hepatitis C*

Decline in haemoglobin A1c values in diabetic patients receiving interferon‐alpha and ribavirin for chronic hepatitis C*

Relationship Between GHb Concentration and Erythrocyte Survival Determined From Breath Carbon Monoxide Concentration

Glycosylated Hemoglobin Levels Among Non-Diabetic Children With Sickle Cell Anemia At Muhimbili National Hospital. A Case For Establishing Normal Values

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