Israel Ariel, Raz Itamar, Green Ilan, Golan-Cohen Avivit, Berkovitch Matitiahu, Magen Eli, Vinker Shlomo, Merzon Eugene
Leumit Research Institute, Leumit Health Services, Tel-Aviv, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medical & Health Sciences, Tel Aviv University, Tel-Aviv, Israel.
Diabetes Unit, Hadassah Medical Center, Jerusalem, Israel.
Diabetes Res Clin Pract. 2025 Jan;219:111965. doi: 10.1016/j.diabres.2024.111965. Epub 2024 Dec 20.
To assess the impact of Glucose-6-phosphate dehydrogenase (G6PD) deficiency, an enzymatic deficiency prevalent in individuals of African or Asian descent, on Hemoglobin A1c (HbA1c) levels, diabetes medication purchases, and the cumulative incidence of diabetes related complications.
A large cohort study was conducted within a national health organization, comparing 3,913 G6PD-deficient patients to a matched control group without G6PD deficiency over two decades. The main measures and outcomes were the HbA1c levels, patterns of diabetes medication purchases, and the incidence of severe diabetes-related complications.
HbA1c levels significantly underestimated blood glucose concentrations in G6PD-deficient individuals. Individuals with diabetes and G6PD deficiency had lower rates of treatment with most diabetes medications, notably GLP-1 receptor agonists and SGLT2 inhibitors. Severe diabetes-related complications were more frequent among G6PD-deficient patients, with adjusted hazards ratios [95% confidence intervals] of 1.44 [1.16-1.81] for severe kidney insufficiency, 1.75 [1.23-2.49] for myocardial infarction, and 1.27 [1.02-1.58] for neuropathy.
This research highlights serious gaps in the management of G6PD-deficient patients with diabetes, who suffer from insufficient medication management and higher rates of complications. These findings underscore the need to account for G6PD deficiency in diabetes treatment to ensure equitable and effective healthcare for this vulnerable population.
评估葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症（一种在非洲或亚洲血统个体中普遍存在的酶缺乏症）对糖化血红蛋白（HbA1c）水平、糖尿病药物购买情况以及糖尿病相关并发症累积发生率的影响。
在一个国家卫生组织内进行了一项大型队列研究，在二十年的时间里，将3913名G6PD缺乏症患者与一个匹配的无G6PD缺乏症对照组进行比较。主要测量指标和结果是HbA1c水平、糖尿病药物购买模式以及严重糖尿病相关并发症的发生率。
HbA1c水平显著低估了G6PD缺乏症个体的血糖浓度。患有糖尿病且G6PD缺乏的个体使用大多数糖尿病药物的治疗率较低，尤其是胰高血糖素样肽-1（GLP-1）受体激动剂和钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂。G6PD缺乏症患者中严重糖尿病相关并发症更为常见，严重肾功能不全的调整后风险比[95%置信区间]为1.44[1.16 - 1.81]，心肌梗死为1.75[1.23 - 2.49]，神经病变为1.27[1.02 - 1.58]。
本研究突出了G6PD缺乏症糖尿病患者管理方面的严重差距，这些患者药物管理不足且并发症发生率较高。这些发现强调了在糖尿病治疗中考虑G6PD缺乏症的必要性，以确保为这一弱势群体提供公平有效的医疗保健。
