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Cited by 64Clinical Laboratory Practices and Quality ControlDiabetes Management and ResearchHemoglobinopathies and Related Disorders

Factors affecting A1C in non-diabetic individuals: review and meta-analysis

Cavagnolli, Gabriela, Pimentel, Ana Laura, Freitas, Priscila Aparecida Correa, Gross, Jorge Luiz, Camargo, Joíza Lins·2015·Clinica Chimica Acta
DOI 10.1016/j.cca.2015.03.024
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Abstract

We carried out a systematic review and meta-analyses of studies that evaluated the possible effects of anemia, variant hemoglobin, and uremia on A1C levels in individuals without diabetes (DM). Medline and Embase were searched for studies that measured A1C values in groups with and without iron deficiency anemia (IDA) and/or iron deficiency (ID), variant hemoglobin and/or uremia by standardized methods. The difference between A1C levels in the groups with and without interferences was obtained by using random-effects meta-analysis and the effect size was presented as absolute difference of means (95% CI). Ten studies fulfilled the inclusion criteria, providing data from 11,176 participants without DM. There were no statistically significant differences in A1C in the presence of IDA/ID, HbS, and uremia by HPLC and uremia by immunoassay [0.79% (95% IC -0.39; 1.97), -0.13% (95% IC -0.51; 0.26), 0.15% (95% CI -0.58; 0.88) and -0.19% (95% CI -0.78; 0.40), respectively]. The effects of HbAS and uremia on A1C levels are within the expected individual variation and should not affect A1C results to diagnose DM. However, the effects of IDA/ID remain inconclusive and further studies are needed to clarify the glycation mechanisms in individuals with IDA/ID without diabetes.

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  • A1C has disadvantages including inaccuracies in the presence of increased red blood cell turnover and hemoglobinopathies (usually reads lower) and higher values with anemia and reduced red blood cell turnover.

    “Disadvantages include inaccuracies in the presence of increased red blood cell turnover and hemoglobinopathies (usually reads lower) and higher values with anemia and reduced red blood cell turnover (199).”

    From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [199]

  • A1C is not reliable for screening for GDM or for preexisting diabetes at 15 weeks of gestation or later in part from the higher red blood cell turnover in pregnancy but also from the unknown diabetes status prior to pregnancy, which could help distinguish new-onset diabetes from preexisting diabetes.

    “A1C is not reliable for screening for GDM or for preexisting diabetes at 15 weeks of gestation or later in part from the higher red blood cell turnover in pregnancy but also from the unknown diabetes status prior to pregnancy, which could help distinguish new-onset diabetes from preexisting diabetes.”

    From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [181]

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References 52 · Cited by 64

Authors
Cavagnolli, G., Pimentel, A. L., Freitas, P. A. C., Gross, J. L., & Camargo, J. L.
Affiliations
Universidade Federal do Rio Grande do Sul (BR)
Corresponding author
Camargo, Joíza Lins
ORCID
Venue
Clinica Chimica Acta
Publisher
Elsevier BV
Published
2015-05
Volume
445
Pages
107-114
ISSN
0009-8981 (ISSN-L)
DOI
10.1016/j.cca.2015.03.024
OpenAlex
W2070340796
Cited by
64
References
52
Citations by year
2026: 4 · 2025: 5 · 2024: 2 · 2023: 5 · 2022: 7 · 2021: 10 · 2020: 7 · 2019: 6 · 2018: 6 · 2017: 8 · 2016: 2 · 2015: 2
FWCI
0.73
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Clinica Chimica Acta (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Hospital de Clínicas de Porto Alegre (PQG/1015019)
  • Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul
  • Conselho Nacional de Desenvolvimento Científico e Tecnológico
Topics
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
Keywords
HbA1c, iron deficiency anemia, iron deficiency, hemoglobin variants, hemoglobin S, uremia, non-diabetic individuals, sickle cell trait, HbS, glycation, diabetes diagnosis
MeSH terms
Adult, Diabetes Mellitus, Female, Glycated Hemoglobin, Hemoglobin, Sickle, Humans, Male, Regression Analysis, Uremia, Anemia, Iron-Deficiency

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