HbA1c levels in hemoglobin H disease

Background

Patients with beta-thalassemia have been shown to exhibit lower HbA1c levels, often correlating with reduced hemoglobin (Hb) concentrations. Similarly, individual with alpha-thalassemia, particularly those with hemoglobin H (HbH) disease, experience chronic hemolytic anemia, which may also influence HbA1c measurements. This study aimed to investigate the effect of alpha-thalassemia on HbA1c levels.

Methods

This cross-sectional study was conducted between September 2022 and April 2024 at the Tertiary care University Hospital. Non-diabetic patients with alpha-thalassemia (hemoglobin H disease) were enrolled and compared with age- and sex-matched control without thalassemia. Statistical analysis was performed using independent t-tests based on distribution of data. Linear regression analysis was used to assess the association between HbH disease and HbA1c levels.

Results

A total of 92 participants were enrolled, comprising 46 patients with HbH disease and 46 matched controls. The mean ± SD HbA1c levels were significantly lower in the HbH group (4.09 ± 0.64 %) compared to the control group (5.39 ± 0.50 %) (P < 0.001). The mean difference in HbA1c levels between the two groups was −1.31 ± 0.12 % [95 % CI -1.54 to −1.07](P < 0.001).

Conclusion

Patients with HbH exhibit significantly lower HbA1c levels compared to control group. These finding highlight the need to establish specific HbA1c reference ranges for patients with thalassemia to avoid misinterpretation in the diagnosis and management of diabetes mellitus.