Study of Blood Sugar Levels and Glycosylated Hemoglobin in Patients of Sickle Cell Hemoglobinopathy

Abstract

Introduction Hemoglobin A1c (HbA1c) is widely accepted practical method of assessing glucose control in diabetic population and is also used for diagnosis and screening of diabetic and pre-diabetic population. As there may be abnormal hemoglobin as well as alteration in the RBC life span in sickle cell disorder there is fallacies between HbA1c and other measures of diabetes mellitus control. AIMS AND OBJECTIVE To analyse various hemoglobin sub fractions in patients of sickle cell hemoglobinopathies and study variation in HbA1c when compared to blood glucose levels. MATERIALS AND METHODOLOGY This study was a prospective observational study. The sample size was of 50 patients. Complete blood count, Hb electrophoresis by HPLC method, fasting and post prandial blood sugar was done in all the patients. RESULTS Out of 50 patients, 23 had Sickle cell disease and 27 had Sickle cell trait. There were 20 male and 30 females and there was no significant difference in the mean age of both. The difference in the mean hemoglobin of both the groups (SCD & SCT) was statistically significant. (p-value < 0.005).There was significant difference in A1a, A1b, HbF, A0 sub fractions of hemoglobin between SCD and SCT groups.(p-value-<0.001).11 out of 50 patients had either abnormal sugar levels or HbA1c to consider xiii them as Impaired Glucose Tolerance or diabetic. Of these 11 patients 4 had sickle cell disease and 7 had sickle cell trait. The mean HbA1c of patients in the sickle cell disease group was 3.678%(±3.2) and in patients of sickle cell trait was 5.3889.(± 0.6). However in both the groups i.e. SCD&SCT mean HbA1c was highly variable and non consistent when compared with blood glucose levels. CONCLUSION The highly variable and non-consistent values of glycosylated hemoglobin under or over estimates the glycemic control in patients with sickle cell disorder. This may lead to mismanagement of diabetes in them. The diagnosis and screening of pre diabetes cannot be recommended by A1c values in patients having sickle hemoglobinopathy.