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Iron-deficiency anemia, non-iron-deficiency anemia and HbA1c among adults in the US
Open accessAbstract
BACKGROUND: Conditions that affect erythrocyte turnover affect HbA1c concentrations. Although many forms of anemia are associated with lowering of HbA1c, iron deficiency tends to increase HbA1c. We examined the effect of iron and hemoglobin (Hb) status on HbA1c and on the relationship between concentrations of fasting glucose and HbA1c in a national sample of adults in the US. METHODS: Cross-sectional data from 8296 adults aged ≥ 20 years who participated in NHANES 1999-2002 were used. RESULTS: The prevalence of low Hb (defined as <120 and < 118 g/L in women aged 20-69 and ≥ 70 years, respectively, and <137, <133, and < 124 g/L in men aged 20-49, 50-69, and ≥ 70 years, respectively) was 5.5%. There was a significant positive correlation between Hb concentrations and HbA1c concentrations after adjusting for age, gender, and race or ethnicity, with HbA1c rising from a mean of 5.28% among participants with Hb < 100 g/L to 5.72% among participants with Hb ≥ 170 g/L. The adjusted mean concentrations of HbA1c were 5.56% and 5.46% among participants with and without iron deficiency, respectively (P = 0.095). However, there was no evidence of differences in the relationship between fasting glucose and HbA1c when groups of anemic and non-anemic individuals with and without iron deficiency were examined individually. CONCLUSIONS: Caution should be used when diagnosing diabetes and prediabetes among people with high or low Hb when the HbA1c level is near 6.5% or 5.7%, respectively, as changes in erythrocyte turnover may alter the test result. However, the trend for HbA1c to increase with iron deficiency does not appear to require screening for iron deficiency in ascertaining the reliability of HbA1c in the diagnosis of diabetes and prediabetes in a given individual.
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Body Composition, Anemia, and Kidney Function among Guatemalan Sugarcane Workers
Krisher, L. K., Butler-Dawson, J., Schlosser, K., Asensio, C., Sinibaldi, E. M., Yoder, H. A., Dexter, L., Dally, M. J., Pilloni, D., Cruz, Á., et al. (2021) · Nutrients · doi:10.3390/nu13113928 · Cited by 12
Saltevo, J. T., Kautiainen, H., NISKANEN, L. K., Oksa, H. H., Puolijoki, H., Sundvall, J., Keinanen-Kiukaanniemi, S. M., Peltonen, M., Tuomilehto, J., Uusitupa, M. I. J., et al. (2011) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2011.05.006 · Cited by 12
Gulshan, & Arora, A. S. (2024) · Biomedical Physics & Engineering Express · doi:10.1088/2057-1976/ad2479 · Cited by 11
Effect of iron deficiency anemia on glycosylated hemoglobin levels in non diabetic Indian adults.
Kalasker, V., Sudhamadhuri, Kodliwadmath, M. V., & Bhat, H. (2014) · International journal of medical and health sciences · Cited by 11
Hodel, N. C., Hamad, A., Reither, K., Mwangoka, G., Kasella, I. M., Praehauser, C., Abdulla, S., Hatz, C., & Mayr, M. (2020) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2019-000939 · Cited by 11
Rao, L. V., Pratt, G. W., Bi, C., & Kroll, M. H. (2022) · Clinica Chimica Acta · doi:10.1016/j.cca.2022.02.005 · Cited by 13
Sheng, X., Li, T., Hu, Y., Xiong, C.-S., & Hu, L. (2023) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s418224 · Cited by 10
“Emerging Continuous glucose monitoring (CGM) equipment, the flash glucose monitoring system (FGMS), has broad clinical application prospects.(3) CGM can retrospectively provide 24-h blood glucose monitoring data, which can help doctors understand the trend of glycemic excursion and detect latent hyperglycemia and hypo…”
BackgroundMethodInfluentialZhang, J.-B., Wang, L., Chen, J., Wang, Z., Cao, M., Yie, S.-M., Yang, H., Yao, X., Zeng, Y., Yang, Y.-C., et al. (2018) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2017.09.010 · Cited by 9
Quality of care to institutionalized patients with diabetes in Italy: a national survey
Porto, A. D., Coracina, A., Fiore, V., Masi, S., Fontana, L., Marnini, P., Felace, G., AMD Italian Study Group “Diabetes care in older people”, Ferrari, G. M. D., Biason, A., et al. (2020) · European Geriatric Medicine · doi:10.1007/s41999-020-00329-8 · Cited by 8
A prospective observational prevalence study of elevated HbA1c among elective surgical patients
Teo, L. M., Lim, W. Y., Ke, Y., Sia, I. K. L., Gui, C. H., & Abdullah, H. R. (2020) · Scientific Reports · doi:10.1038/s41598-020-76105-2 · Cited by 8
Time in range is a tool for assessing the quality of glycemic control in diabetes
Суплотова, Л. А., Сергеевна, С. А., Романова, Н. В., & Shestakova, M. V. (2021) · Diabetes Mellitus · doi:10.14341/dm12703 · Cited by 9
Bondarenko, V., Løkke, C. R., Dobrowolski, P., Mentzel, C. M. J., Castro-Mejía, J. L., Hansen, C. H. F., Sørensen, D. B., Nielsen, D. S., Krych, Ł., & Hansen, A. K. (2022) · Scientific Reports · doi:10.1038/s41598-022-17242-8 · Cited by 9
Rajagopal, L., Arunachalam, S., Ganapathy, S., & Ramraj, B. (2017) · Annals of Pathology and Laboratory Medicine · doi:10.21276/apalm.1126 · Cited by 8
“[6,17,18] Few studies by Horton BF & Huisman TH, Rau et al and Sinha et al reported that HbA1C level decrease in IDA patients and this contradicts with our study result.”
ResultEffect of chronic kidney disease on A1C in individuals being screened for diabetes
Shipman, K. E., Jawad, M., Sullivan, K. M., Ford, C., & Gama, R. M. (2014) · Primary care diabetes · doi:10.1016/j.pcd.2014.05.001 · Cited by 8
Dong, J., Yin, X., Zhang, X., & Chen, Z. (2025) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2025.103068 · Cited by 7
“Transferrin saturation was categorized as either 15 % or ≥ 15 % based on previously established thresholds (Ford et al., 2011).”
Haemoglobin A1c and Iron Deficiency Anaemia our Understanding Through the Decades
Hussain, N. (2015) · Romanian Journal of Diabetes Nutrition and Metabolic Diseases · doi:10.1515/rjdnmd-2015-0035 · Cited by 7
“[46] analyzing the influence of iron-deficiency anemia and noniron-deficiency anemia on HbA1c levels among adults in the US revealed a significant positive correlation between Hb concentrations and HbA1c.”
BackgroundMethodInfluentialMean blood glucose‐independent HbA1c racial disparity and iron status in youth with Type 1 DM
Hamdan, M. A. A., Gómez, R., & Chalew, S. A. (2020) · Pediatric Diabetes · doi:10.1111/pedi.13002 · Cited by 7
“It should be pointed out that although some prior studies have reported that HbA1c can be higher in individuals with iron deficiency(14-17) other investigators have not found such a relationship.(24,25) Our study findings would support this latter group.”
ResultLai, Y. C., Lin, Z., & Zhu, Z. (2021) · BMC Endocrine Disorders · doi:10.1186/s12902-021-00704-x · Cited by 7
“While several studies have reported that HbA1c level was significantly higher in individuals with anemia [16–18], others did not identify a difference in HbA1c levels between individuals with anemia and healthy controls [19], or found a lower HbA1c level in patients with anemia [20].”
ResultAddendum 1: Forum for Injection Technique and Therapy Expert Recommendations, India
Kalra, S., Unnikrishnan, A., KUMAR, K. M. P., Sahay, R. K., Chandalia, H. B., Saboo, B., Sundaram, A., Kesavadev, J., Shukla, R., WANGNOO, S. K., et al. (2022) · Diabetes Therapy · doi:10.1007/s13300-022-01332-x · Cited by 7
Diagnosis and Management of Diabetes and the Relationship of dGlucose to Kidney Function
Mandal, A. K., & Hiebert, L. M. (2015) · Current Diabetes Reviews · doi:10.2174/1573399811666150302111453 · Cited by 7
Fırat, A., Katlan, D. C., & Uzunay, N. (2024) · Clinical and Experimental Obstetrics & Gynecology · doi:10.31083/j.ceog5101024 · Cited by 5
Shabani, M., Pishgar, F., Akhtarkhavari, S., Quinaglia, T., Budoff, M. J., Bluemke, D. A., Barr, R. G., Post, W. S., Wu, C. O., Arbab‐Zadeh, A., et al. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.785957 · Cited by 7
“In addition, disorders such as iron deficiency anemia which affect red blood cells turnover can negatively impact the interpretation of HbA1c (8).”
BackgroundInfluentialAnderson, P., Grills, N., Singh, R. P., Singh, R., Evans, R. G., Sengupta, P., & Thrift, A. G. (2019) · BMC Public Health · doi:10.1186/s12889-019-7184-4 · Cited by 6
Veeramalla, V., & Madas, S. (2017) · International Journal of Current Microbiology and Applied Sciences · doi:10.20546/ijcmas.2017.612.308 · Cited by 6
Mott, J., Dolan, J. K., Gilor, C., & Gilor, S. (2023) · Veterinary Clinical Pathology · doi:10.1111/vcp.13257 · Cited by 7
The impact of ferritin on the disassociation of HbA1c and mean plasma glucose
Li, Y., Zhang, F., Zhang, X., Fu, Z., Wang, L., Zhao, C., Guo, G., Zhou, X., & Ji, L. (2020) · Journal of Diabetes · doi:10.1111/1753-0407.13138 · Cited by 5
“Furthermore, several studies showed iron deficiency, with or without the existence of anemia, are related to increasing HbA1c levels regardless of glycemia levels.(21,23) It is well revealed that excess iron is associated with increased diabetes risk, that this relationship is causal, TABLE 5 (Continued)”
BackgroundResultYafi, M., Shah, A., & Vélez, K. (2023) · Translational Pediatrics · doi:10.21037/tp-23-145 · Cited by 5
“The use of insulin pump therapy has increased dramatically in the past decade to include infants, toddlers and pre-school children (37), with many studies demonstrating improvement of metabolic control and HbA1c (38,39).”
InfluentialA Population‐Based Correlation Analysis Between Hemoglobin A1c and Hemoglobin Levels
Zhang, T., Shi, T., Cao, M., Ji, Y., Xue, Y., Yao, H., Yin, Q., Cui, B., Xie, Z., & He, P. (2025) · Journal of Diabetes · doi:10.1111/1753-0407.70057 · Cited by 4
Metadata
- Authors
- FORD, E. S., COWIE, C. C., LI, C., HANDELSMAN, Y., & BLOOMGARDEN, Z. T.
- Affiliations
- Centers for Disease Control and Prevention (US)
- National Institutes of Health (US)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- FORD, Earl S.
- Venue
- Journal of Diabetes
- Publisher
- Wiley
- Published
- 2011-03
- Volume
- 3
- Issue
- 1
- Pages
- 67-73
- ISSN
- 1753-0393 (ISSN-L)
- OpenAlex
- W1629736006
- Cited by
- 165
- References
- 19
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 9 · 2023: 13 · 2022: 10 · 2021: 18 · 2020: 21 · 2019: 10 · 2018: 16 · 2017: 16 · 2016: 7 · 2015: 10 · 2014: 8 · 2013: 6 · 2012: 3
- FWCI
- 2.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Genetics (clinical) › Hemoglobinopathies and Related Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- iron deficiency anemia, HbA1c, hemoglobin, erythrocyte turnover, fasting blood glucose, diabetes diagnosis, prediabetes, anemia prevalence, NHANES
- MeSH terms
- Adult, Aged, Anemia, Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Female, Glycated Hemoglobin, Hemoglobins, Humans, Iron, Male, Middle Aged, Nutrition Surveys, Sensitivity and Specificity, United States, Anemia, Iron-Deficiency, Young Adult
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