Zhang Li, Gao Ximan, Meng Xuying, Ma Guangyang, Li Jing, Wang Weilin, Chen Sisi, Ma Yongjian, Yu Pei, Zhou Saijun
NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China.
Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, China.
Front Endocrinol (Lausanne). 2025 Apr 15;16:1500660. doi: 10.3389/fendo.2025.1500660. eCollection 2025.
To determine the effect of red blood cell (RBC) lifespan variability on glycosylated hemoglobin (HbA1c) measurements in type 2 diabetes mellitus (T2DM) individuals and develop a mathematical model for adjusting HbA1c values.
We tracked glucose levels in 516 T2DM patients from Chu Hsien-I Memorial Hospital, categorized into Construction (n = 416) and Internal (n = 100) cohorts. Additionally, 165 participants from Tianjin diabetic retinopathy screening cohort, serving as the Independent cohort. RBC lifespan was determined using the CO breath test, and Hemoglobin glycation variation index (HGI) was calculated from the difference between measured and estimated HbA1c (eHbA1c). Model efficacy was evaluated using AUC, accuracy, sensitivity, and specificity.
An inflection in the HGI-RBC lifespan model occurred at 66 days, with HbA1c underestimation when RBC lifespan was below 90 days, notably in the ≤ 66 days group. This underestimation increased the risk of cardiovascular and peripheral neuropathy complications. To rectify the impact of the shorter RBC lifespan in T2DM patients, the correction formula was established as HbA1c(c) = -0.05629×RBC lifespan + 1.127×HbA1c + 3.178 (R = 0.7360) in the ≤ 66 day lifespan group and HbA1c(c) = -0.004772 × RBC lifespan + 0.7569 × HbA1c + 2.394 (R = 0.7344) in the 67 to 89 day group. The corrected HbA1c models exhibited satisfactory predictive performance in all cohorts.
Accurate adjustment for the effects of RBC lifespan on HbA1c values in T2DM patients is expected to enhance blood glucose management and the efficacious prevention and treatment of diabetes-associated complications.
Chu Hsien-I Memorial Hospital of Tianjin Medical University, identifier ChiCTR2100046557.
确定红细胞（RBC）寿命变异性对2型糖尿病（T2DM）患者糖化血红蛋白（HbA1c）测量值的影响，并建立一个用于调整HbA1c值的数学模型。
我们追踪了竹贤一纪念医院516例T2DM患者的血糖水平，将其分为构建队列（n = 416）和内部队列（n = 100）。此外，来自天津糖尿病视网膜病变筛查队列的165名参与者作为独立队列。使用CO呼气试验确定RBC寿命，并根据测量的HbA1c与估计的HbA1c（eHbA1c）之间的差异计算血红蛋白糖化变异指数（HGI）。使用AUC、准确性、敏感性和特异性评估模型效能。
HGI-RBC寿命模型在66天时出现拐点，当RBC寿命低于90天时HbA1c被低估，在≤66天组尤为明显。这种低估增加了心血管和周围神经病变并发症的风险。为纠正T2DM患者RBC寿命较短的影响，在≤66天寿命组中建立的校正公式为HbA1c(c)= -0.05629×RBC寿命 + 1.127×HbA1c + 3.178（R = 0.7360），在67至89天组中为HbA1c(c)= -0.004772×RBC寿命 + 0.7569×HbA1c + 2.394（R = 0.7344）。校正后的HbA1c模型在所有队列中均表现出令人满意的预测性能。
准确调整RBC寿命对T2DM患者HbA1c值的影响，有望加强血糖管理以及有效预防和治疗糖尿病相关并发症。
天津医科大学竹贤一纪念医院，标识符ChiCTR2100046557。
