Glycemic control of diabetic patients with iron deficiency anemia, HbA1c or Fructosamine, which marker should we use?

Abstract

Glycemic control is very important for the management of the risk of long-term complications in diabetic patients. The HbA1c is the most commonly used marker but its rate is a ected by numerous physiological and pathological variations as seen during renal failure, hemolyse, hemoglobinopathies

and also iron deficiency anemia during which levels are falsely higher.In this case, particular interest is given to fructosamine which is independent of the fluctuations incurred by hemoglobin.Our present study aims to determine the impact of iron deficiency anemia on glycated hemoglobin determination and the place of fructosamine in this situation.

We

conducted a case-control study at the central laboratory of medical analysis. We realize di erent biochemical parameters in cases and controls such as: glycaemia, HbA1C, Fructosamine, iron, ferritin, hemoglobin and others, the statistical study was done with excel and SPSS So ware Our study focused on a series of 100 type 2 diabetic patients, 50 of whom were anemic (cases) with a sex ratio of 0.21 and 50 non anemic (controls)with a sex ratio of 0.72. The mean HbA1c in cases (no iron treated)is 8.83% (SD=2.6) and 7.77 %( SD=1) in controls. The average fructosamine in cases (no iron treated) is 395.50 umol/dl (SD=118.03) and 449.11 umol/dl (SD=146,43)in controls. The student test demonstrated significant di erence of HbA1c levels between cases and controls independently of glycaemia nevertheless no di erence in fructosamine rates. In

anemic diabetics we found no significant correlation between glycated hemoglobin and Glycaemia while fructosamine was well correlated, also no correlation between HbA1c and fructosamine while this two parameters were correlated in patients without anemia. Our results confirm that fructosamine values evolve in parallel with those of glycated hemoglobin, but are not subject to variations in hemoglobin hence the usefulness of this parameter in these situations