Comparative assessment of the impact of iron deficiency on HbA1c accuracy in non-anaemic individuals with type 2 diabetes: A secondary data analysis

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PURPOSE: Results from a few studies have been conflicting regarding whether iron deficiency affects HbA1c reliability, and the mechanisms by which iron might influence HbA1c are not fully understood. We aimed to compare the relationship between HbA1c and average glucose levels measured by continuous glucose monitoring, retrospectively, in iron-replete and iron-deplete states among non-anemic type 2 diabetes mellitus (T2DM) patients. METHODS: We compared the differences in HbA1c between iron-replete and iron-deplete groups using the Chi-square test for categorical data and the Mann-Whitney U test for continuous data. We also evaluated the correlation between HbA1c and mean plasma glucose for both iron-replete and iron-deplete individuals using Pearson's correlation and linear regression. RESULTS: A total of 146 of the 213 participants screened had complete data and were included in the final analysis. 43 out of 146 (29.5%) had iron deficiency, and 103 were iron-replete. No significant difference was observed in HbA1c levels between iron-replete and iron-deplete individuals: 69 (51.0, 85.0) vs 62 (46.0, 83.0) mmol/mol, P = 0.291). There was a strong positive correlation between HbA1c and mean plasma glucose concentration for both iron-replete and iron-deplete individuals (Pearson Correlation coefficient: 0.88 (0.83-0.92) and 0.93 (0.88-0.98), respectively). CONCLUSIONS: HbA1c correlates well with mean blood glucose even in the iron-deplete state amongst non-anaemic T2DM individuals. However, larger studies are needed to confirm these findings, particularly at screening and diagnostic thresholds.

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