Effect of treatment of iron deficiency anemia onhemoglobin A1c in type 2 diabetic patients

An overview of diabetes research achievements during a quarter of a century in Diabetes Research Center

Background

Endocrinology and Metabolism Research Institute (EMRI) is one of the biggest research institutes in Iran that was established to develop research strategies for managing endocrine and metabolic disorders such as diabetes. The aim of this study was to provide an overview of diabetes related research activities and achievements in the EMRI since its foundation.

Method

A comprehensive search was conducted in the PubMed, Scopus, and EMBASE to find out diabetes-related research studies performed in the EMRI. After data extraction, articles were categorized based on their document types, levels of evidence, diabetes types, and subject areas and were presented in various charts.

Result

After removing duplications and screening, 228 remained documents were categorized. The majority of diabetes investigations performed in the Diabetes Research Center (DRC) was on type 2 diabetes (T2D) (37%). Based on document types, most of these publications were original articles. Moreover, clinical studies constituted the greatest amount of evidence in the literature. According to the subject areas, most of the articles were on basic sciences and diabetes-related associated factors, followed by studies related to the management and prevention of diabetes.

Conclusions

As one of the most comprehensive research institute, the EMRI has developed its national and international research activities to improve diabetes management and cure through developing new treatment strategies, improving translational research, and applying new emerging technologies such as regenerative medicine.

The Effect of Iron Replacement Therapy on HbA1c Levels in Diabetic and Nondiabetic Patients: A Systematic Review and Meta-Analysis

BACKGROUND

Several studies have reported that iron-deficiency anemia (IDA) and its treatment might lead to a distorted reading of glycated hemoglobin (HbA1c) value. Hence, this review aims to systematically investigate the effect of iron replacement therapy (IRT) on HbA1c levels, as the literature is deficient in assessing this clinical phenomenon.

METHODS

An electronic search of the Cochrane, MEDLINE, and Embase databases was conducted by four independent authors.

RESULTS

Among the 8332 articles identified using the search strategy, 10 records (with a total of 2113 participants) met the inclusion criteria and were analyzed. In nine of the studies, IRT was found to decrease HbA1c levels; in the remaining study, IRT was found to increase HbA1c levels. The effect size of the pooled standardized mean difference in HbA1c levels between the treatment and control groups with IDA was 1.8 (95% CI = -0.5, 2.31). Heterogeneity was assessed using the I2 and χ2 tests, and the resultant values were 98.46% and p = 0.09, respectively. Additionally, the mean difference between the HbA1c levels (pre-IRT and post-IRT) showed a drop in the HbA1c levels which ranged from 1.20 to 0.43 mg/dL.

CONCLUSIONS

The results suggest that IRT decreases HbA1c levels, and it is helpful in treating IDA patients with poor glycemic control. Accordingly, the results provide an added perspective on antidiabetic medication dosing and physicians' interpretation of initially elevated HbA1c values.

Relationship between glycosylated hemoglobin and iron deficiency anemia: A common but overlooked problem

INTRODUCTION

Both diabetes mellitus (DM) and iron deficiency anemia (IDA) are prevalent in every area of the world, and so, the possibility of these two diseases co-existing is also very high. It is our belief that clinical results of any correlation between iron status of the body and glycosylated haemoglobin (HbA1c) would be beneficial to many patients, therefore in this study, the effect of IDA on HbA1c was investigated.

MATERIALS - METHODS

A total of 146 patients with DM and IDA were evaluated prospectively. While the patients were administered 270 mg/day of ferrous sulphate (80 mg elemental iron) orally for three months for the treatment of IDA, no interventions were made for the treatment of DM. Patient levels of hemoglobin (Hb), hematocrit, red blood cells (RBC), mean corpuscular volume (MCV), platelet, white blood cells (WBC), serum iron, serum iron binding capacity (SIBC), ferritin, fasting plasma glucose (FPG), HbA1c, body mass index (BMI), C-reactive protein (CRP) values were measured at baseline and at the third month of treatment with iron, and were compared.

RESULTS

The median age of our patients was 45 (40-50) and median duration of diabetes was 3 years (1,75-5). While the baseline median Hb was 10.4 (mg/dL) (9.5-11.1), MCV was 74 (fL) (70.8-77), ferritin was 4 (ug/L) (3-6) at three months, Hb was measured at 12.6 (mg/dL) (12.1-13.2), MCV was measured at 82 (fL) (80-86), ferritin was measured at 15 (ug/L) (9-21.2) and was significantly higher compared to baseline values (p < 0.001). The baseline median HBA1c of patients was 7.09 ± 0.51 (%) and three month HBA1c was 6.69 ± 0.53 (%), which was significantly lower than when comparing baseline values with values at third month (p < 0.001). Baseline and three month values for FPG were 118 (mg/dL) (108-132) and 116 (mg/dL) (106-125) respectively, and there was no significant difference (p:0.07). A 2.2 mg/dL (1.5-3.5) increase in median Hb level accompanied a 0.4 % (0.2-0.6) decrease in median HbA1c levels (Spearman rho = -0.362; p < 0.001).

CONCLUSION

Our study has shown conclusivly that IDA is related to increased HbA1c concentrations and HbA1c decreases significantly following treatment with iron. IDA should be considered before making any decisions regarding diagnosis or treatment according to HbA1c.