A Study on Influence of Iron Deficiency Anemia Over Hba1c Levels
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Nalini Jeyaprakash, Sudha M. A study on influence of iron deficiency anemia over HbA1c levels. IAIM, 2020; 7(12): 25-33. Original Research Article A study on influence of iron deficiency anemia over HbA1c levels Nalini Jeyaprakash1*, Sudha M2 1Associate Professor, Department of Physiology, Madha Medical College and Research Institute, Kovur, Thandalam Chennai, Tamil Nadu, India 2Professor, Department of Physiology, Rajah Muthiah Medical College and Hospital Annamalai University, Chidambaram, Tamil Nadu, India *Corresponding author email: [email protected] International Archives of Integrated Medicine, Vol. 7, Issue 12, December, 2020. Available online at http://iaimjournal.com/ ISSN: 2394-0026 (P) ISSN: 2394-0034 (O) Received on: 14-11-2020 Accepted on: 24-11-2020 Source of support: Nil Conflict of interest: None declared. How to cite this article: Nalini Jeyaprakash, Sudha M. A study on influence of iron deficiency anemia over HbA1c levels. IAIM, 2020; 7(12): 25-33. Abstract Background: Iron deficiency anemia is the commonest nutritional anemia worldwide. HbA1c, which is a valuable tool in monitoring glycemic control, has been recently recommended for diagnosing diabetes. HbA1c can be affected by other non-glycemic parameters like hemoglobin variants, anemia, uremia, pregnancy, and acute blood loss. Reports on the effects of iron deficiency anemia on HbA1c levels were inconsistent. Aim of study: To study the levels of HbA1c in iron deficiency anemia patients and to study the changes in HbA1c levels after the correction of anemia. Materials and methods: 120 patients confirmed to have iron deficiency were enrolled in this study. Complete blood count, anemia profile including serum ferritin and HbA1c levels were measured at baseline and after treatment of anemia. These values were compared with those in the control population. Results: The mean HbA1c level in iron deficiency anemia patients (4.619 ± 0.308%) was significantly lower than the control group (5.446 ± 0.281%). A significant increase (5.816 ± 0.323%) was observed in the mean HbA1c of the anemia group after treatment. Conclusion: Our study showed that HbA1c levels were affected by iron deficiency anemia. The HbA1c levels are lower in iron deficiency anemia patients and it increases after treatment with iron supplements. So iron deficiency anemia has to be kept in mind before using the HbA1c to diagnose diabetes. Key words Iron deficiency anemia, HbA1c, Ferritin. Page 25 Nalini Jeyaprakash, Sudha M. A study on influence of iron deficiency anemia over HbA1c levels. IAIM, 2020; 7(12): 25-33. Introduction Madha Medical College and Hospital, were Iron deficiency anemia is the commonest form of included in the study in the year 2017-2018. nutritional anemia worldwide. WHO (World Health Organization) reported that globally there Inclusion criteria: All consented Iron deficiency are 2.1 billion cases of iron deficiency anemia, anemia patients attending Medical OPD and which is approximately 30% of the world medical wards in our hospital, aged between 18 population [1]. Anemia is a late indicator of iron to 60 years. deficiency. It is estimated that iron deficiency is Exclusion criteria: Age <18 years or >60 years, 2.5 times more common than anemia [2]. Anemia patients with diabetes/IFG/IGT, patients with and iron deficiency leads to significant chronic renal failure/ liver disease, patients with productivity losses in adults. Iron deficiency in hemolytic anemia, pregnancy, chronic pregnant women is associated with increased alcoholism, known case of malignancy. maternal mortality, preterm labor, low birth weight, and increased infant mortality. Iron A detailed history was recorded along with a deficiency in children leads to defective cognitive complete clinical examination. The provisional and motor development and increases diagnosis was made and this was subsequently susceptibility to infections [3]. Hemoglobin A1c revised after completion of the investigations. (HbA1c) or glycated hemoglobin is the predominant fraction of hemoglobin A. It is used Laboratory investigations: Samples were as the gold standard method for assessing collected from all the participants to estimate glycemic control. It reflects the glycemic status complete blood count, blood urea, serum of the individual over the past 3 months [4]. In creatinine, serum electrolytes, blood sugar- addition to blood glucose level, HbA1c is FBS/PPBS/GTT, urine R/E, HbA1c level, affected by multiple factors like genetic, anemia profile including serum ferritin, vitamin hematologic, and illness-related factors. Initial B12, and folic acid levels, based on standard studies suggested a relationship between HbA1c tests available in our hospital. Also, ECG, chest levels and iron deficiency anemia [5]. They tried x-ray, and ultrasonogram abdomen were done in to explain that based on structural modifications necessary cases. The final data was entered onto and alterations in HbA1c levels in old and new the Microsoft excel sheet 2007 version. Study red blood cells. Few studies reported no protocol: Patients with iron deficiency anemia differences in the HbA1c levels of anemic based on WHO criteria cut off point and age, patients compared to healthy controls [6]. Few sex-matched control patients were assigned for studies stated that higher HbA1c levels were seen study. History, clinical assessment, and in iron deficiency anemia patients and it investigations including serum ferritin, HbA1c decreased significantly after treatment. The were done. results of various studies on the relationship between HbA1c and iron deficiency anemia were Statistical analysis conflicting. Only fewer studies have been The clinical parameters were compared and conducted in the Indian population on this topic analyzed using the Pearson chi-square method. [7]. The diagnostic accuracy of all the parameters was then compared and interpreted concerning Materials and methods clinical data. In the present study, the statistical methods for quantitative data, descriptive This cross-sectional study included 240 patients. statistics were presented by N, Mean, Standard In the group – A was a control group of 120 Deviation, and Range. For qualitative data, patients and in the group – B, 120 patients frequency count, N, and percentage were put in a diagnosed with iron deficiency anemia, who tabular manner. To analyze the data, appropriate were attending the outpatient Department of statistical tests were applied. The significance of Page 26 Nalini Jeyaprakash, Sudha M. A study on influence of iron deficiency anemia over HbA1c levels. IAIM, 2020; 7(12): 25-33. the difference between means in the two groups Mean (±SD) in the control group was 88.508 was calculated using the student t-test and the (5.312) and in the study group was 88.525 significance of the difference in proportions (5.231). P-value was 0.98 which is not using a chi-square test. 2 x 2 tables were significant i.e. FBS distribution among the constructed for each variable and the chi-square control and study groups were the same (Table – value for the degree of freedom calculated. 2). Results Table – 3: PPBS distribution. Mean age (±SD) in the control group was 32.1 PPBS CONTROL STUDY (8.34) and in the study group was 34.1 (8.398). mg/dl GROUP N (%) GROUP N (%) P-value was 0.064 which was not significant i.e. ≤110 48(40) 57(47.5) the age distribution among the control and study 111-120 29(24.1) 21(17.5) group were equal. About 67% of study subjects 121-130 32(26.7) 32(26.7) were in the age group of 21-40 years while 28% 131-140 11(9.2) 10(8.3) were aged 41-60 years. Minimum age was 19 N 120 120 years, maximum age was 49 years. The majority Mean 114.65 112.352 of the study subjects were females (68.3%) while SD 12.522 13.725 the remaining 31.7% were males. It confirmed P value 0.185 Not significant the fact that iron deficiency anemia was more common in females. P-value was 0.146 which Table – 4: Distribution of hemoglobin between was not significant i.e. sex distribution among control and study group pre-correction. the control group and study group was equal HB (g/dl) CONTROL STUDY (Table – 1). GROUP GROUP PRE ≤13 03 120 Table – 1: Age distribution. >13 97 0 Age (years) Control Study group N 120 120 group N (%) N (%) Mean 13.408 6.778 ≤20 12(10) 5(4.2) SD 0.354 1.085 21-30 51(42.5) 40(33.3) P value <0.001 Significant 31-40 28(23.3) 41(34.2) >40 29(24.2) 34(28.3) Table – 5: Distribution of hemoglobin in study Total 120(100) 120(100) group pre and post correction. Mean 32.06 34.067 HB (g/dl) STUDY STUDY SD 8.34 8.398 GROUP PRE GROUP POST P value 0.064 Not Significant ≤13 120 82 >13 0 38 Table – 2: FBS distribution. N 120 120 FBS CONTROL STUDY Mean 6.778 12.659 mg/dl GROUP N (%) GROUP N (%) SD 1.085 0.446 ≤80 11(9.2) 10(8.3) P value <0.001 Significant 81-90 66(55) 68(56.7) 91-110 43(35.8) 42(35) Mean (±SD) in the control group was 114.65 N 120 120 (12.522) and in the study group was 112.352 Mean 88.508 88.525 (13.725). P-value was 0.185 which was not SD 5.312 5.231 significant i.e. PPBS distribution among the P value 0.98 not significant control and study groups were the same (Table – 3). Page 27 Nalini Jeyaprakash, Sudha M. A study on influence of iron deficiency anemia over HbA1c levels. IAIM, 2020; 7(12): 25-33. Table – 6: Distribution of MCV. MCV (fl) CONTROL GROUP STUDY GROUP STUDY GROUP POST N(%) PRE N(%) N(%) <80 0(0) 120(100) 0(0) 80-90 45(37.5) 0(0) 44(36.7) 91-100 75(62.5) 0(0) 76(63.3) N 120 120 120 Mean 91.316 64.46 91.349 SD 2.851 6.674 2.81 P value <0.001 Significant <0.001 Significant Table – 7: Distribution of MCH.