North Florida Regional Medical Center, Department of Medicine and Graduate Medical Education, Gainesville, FL, United States; University of Central Florida, College of Medicine, Orlando, FL, United States.
North Florida Regional Medical Center, Department of Medicine and Graduate Medical Education, Gainesville, FL, United States; University of Central Florida, College of Medicine, Orlando, FL, United States.
Prim Care Diabetes. 2019 Aug;13(4):316-323. doi: 10.1016/j.pcd.2019.01.002. Epub 2019 Feb 1.
Previous study showed A1C was affected by hemoglobin and gender in non-anemic Koreans. However, there was no other data to support those important findings.
Participants from National Health and Nutrition Examination Survey (NHANES) - 1999 to 2014 with age over 12 years were examined. After excluding participants with hypoglycemia and moderate to severe anemia, 22,974 participants were included in analysis. Both female and male were divided into three groups based on their hemoglobin level. Linear regression and multivariate regression analyses were conducted to assess the relationship between A1C and hemoglobin in three fasting plasma glucose (FPG) intervals.
For both female and male, A1C was significantly negatively correlated with hemoglobin in the FPG interval range between 80 to 126mg/dl, p<0.0001. A1C was not significantly associated with hemoglobin over the other two intervals (70≤FPG<80mg/dl and FPG≥126mg/dl, p>0.05). In addition, over FPG interval between 80 to 126mg/dl, after adjusting age and fasting glucose level, A1C still significantly negatively correlated with hemoglobin (regression coefficient=-0.052, p<0.0001 in females, regression coefficient=-0.050, p<0.0001 in males).
A1C would decrease by 0.05% (about 0.5mmol/mol) as a result of each 1g/dl increase in total hemoglobin count when plasma glucose level in normal or prediabetes range. The mechanism behind this finding is unclear. Further study should be conducted and hemoglobin count may need be taken into consideration when applying A1C for the diagnosis of diabetes or to screen for prediabetes.
先前的研究表明，在非贫血的韩国人群中，糖化血红蛋白（A1C）受到血红蛋白和性别因素的影响。然而，没有其他数据支持这些重要发现。
研究对象来自于 1999 年至 2014 年的全国健康和营养检查调查（NHANES），年龄均在 12 岁以上。排除低血糖和中重度贫血患者后，共纳入 22974 名参与者进行分析。根据血红蛋白水平，将女性和男性分为三组。采用线性回归和多元回归分析评估了三个空腹血糖（FPG）区间内 A1C 与血红蛋白之间的关系。
对于女性和男性，A1C 与 FPG 80-126mg/dl 区间内的血红蛋白呈显著负相关（p<0.0001）。A1C 与其他两个区间（70≤FPG<80mg/dl 和 FPG≥126mg/dl，p>0.05）内的血红蛋白无显著相关性。此外，在 FPG 80-126mg/dl 区间内，调整年龄和空腹血糖水平后，A1C 仍与血红蛋白呈显著负相关（女性的回归系数为-0.052，p<0.0001；男性的回归系数为-0.050，p<0.0001）。
在正常或糖尿病前期血糖范围内，血红蛋白每增加 1g/dl，A1C 会降低 0.05%（约 0.5mmol/mol）。其背后的机制尚不清楚。需要进一步研究，在应用 A1C 诊断糖尿病或筛查糖尿病前期时，可能需要考虑血红蛋白计数。
