Correlation of Anemia with Glycated Hemoglobin among Euglycemic Type 2 Diabetic Patients

Diabetes mellitus (DM) and anemia are both prevalent in India. Glycated hemoglobin (HbA1c) is the gold standard test for the diagnosis of DM and monitoring of glycemic status. Hemoglobin (Hb) being the integral component of HbA1c, there is a possibility that anemia can also affect the level of HbA1c apart from the various other factorsObjectives: To study the prevalence, type of anemia, and correlation between HbA1c and anemia, including red blood cell (RBC) indices in euglycemic type 2 DM patients. The study was conducted with the objective of studying the correlation between HbA1c and anemia in euglycemic diabetic patients having controlled blood glucose over a period of 3 monthsMethodology: This cross-sectional study was conducted between May 2020 and May 2021 at the Department of General Medicine, Government Medical College, Kota, Rajasthan, India. All euglycemic diabetic patients with controlled blood glucose over a period of 3 months attending the outpatient department and fulfilling inclusion and exclusion criteria were enrolled in the studyInclusion criteria: All euglycemic type 2 DM patients with controlled blood glucose having three consecutive normal blood glucose levels [fasting blood sugar (FBS)-80-130 mg/dL and postprandial blood sugar (PP2BS) test-<180 mg/dL] over a period of 3 months from the outpatient departmentExclusion criteria: Type 1 DM and latent autoimmune diabetes of adults, patients with hemolytic anemia, pregnancy, chronic alcoholism, chronic kidney disease, chronic liver disease, combined deficiency anemia, patients with increased FBS and PP2BS, acute and chronic inflammatory state, malignancy, anemia of chronic disease, and vitamin B12 deficiency were excluded from our studyDetailed investigations of diabetes and anemia were conducted. The effect of anemia on HbA1c was assessed, and the correlation of anemia with mean HbA1c was analyzed statistically Results: The prevalence of anemia in diabetic patients is 56.8%. Normocytic normochromic anemia is the most common, which was observed among 48.86% of diabetic patients. The median HbA1c of anemic patients is higher than nonanemic patients (p < 0.01). There is a negative correlation between Hb and HbA1c (p < 0.01). The correlation of RBC indices, that is, mean corpuscular Hb (MCH), mean corpuscular volume (MCV), and MCH with HbA1c, is also negative (p < 0.01). There is a negative correlation between HbA1c and serum ferritin level, as indicated by the Pearson correlation test (p-value of <0.01)Conclusion: Anemia is prevalent in type 2 DM patients without renal involvement, and also normocytic normochromic type is the most common, followed by iron deficiency anemia (IDA). HbA1c levels are significantly affected by the presence of moderate anemia in spite of controlled glycemia.