Association Between HbA1c Levels and Iron Deficiency Anaemia Among Diabetic and Non-Diabetic Libyan Patients

Mahmoud Ashawesh; Sarah Khalafullah; Fatim Albeshri; Naema Swisi; Nourya Salem

doi:10.54361/ajmas.269938

Authors

Mahmoud Ashawesh Department of Medical Laboratories Sciences, Faculty of Medical Technology, the University of Tripoli, Libya https://orcid.org/0000-0003-4581-043X
Sarah Khalafullah Department of Medical Laboratories Sciences, Faculty of Medical Technology, the University of Tripoli, Libya https://orcid.org/0009-0007-7990-3200
Fatim Albeshri Department of Medical Laboratories Sciences, Faculty of Medical Technology, the University of Tripoli, Libya https://orcid.org/0009-0000-6966-513X
Naema Swisi Department of Medical Laboratories Sciences, Faculty of Medical Technology, the University of Tripoli, Libya https://orcid.org/0000-0002-7978-6338
Nourya Salem Department of Medical Laboratories Sciences, Faculty of Medical Technology, the University of Tripoli, Libya https://orcid.org/0000-0002-1983-5994

DOI:

https://doi.org/10.54361/ajmas.269938

Keywords:

Iron Deficiency Anaemia, Anaemia, Diabetes Mellitus, HbA1c, Iron Profile

Abstract

A haemoglobin A1c (HbA1c) is an essential marker for assessing long-term glycemic control and diagnosing diabetes mellitus. However, iron deficiency anaemia (IDA), one of the most common nutritional disorders worldwide, may alter HbA1c levels even in non-diabetic individuals, leading to misinterpretation of glycemic status. This study aims to examine the effect of IDA on HbA1c levels in Libyan patients with and without diabetes, while also exploring the correlation between HbA1c levels and the iron profile. A cross-sectional study was conducted in a period from March to June 2026. The study included 90 participants: 30 diabetic individuals with IDA, 30 non-diabetic individuals with IDA, and 30 healthy individuals. Venous blood samples were collected under sterile conditions, including CBC, blood glucose measurements (Fasting blood glucose (FBS) and HbA1c), and an iron profile assessment. Data were analysed using SPSS v27 and significance was set at p < 0.05. The results showed that HbA1c levels differed significantly among the three groups (p < 0.001), increasing from the control (5.16%) to non-diabetic IDA participants (5.55%) and reaching the highest values in diabetic IDA patients (8.31%). Notably, HbA1c was significantly higher in non-diabetic IDA subjects than in healthy controls despite normal FBS levels. HbA1c correlated negatively with serum iron and ferritin and positively with total iron-binding capacity (TIBC) (p < 0.001). After adjustment for fasting glucose, serum iron remained the strongest independent correlate of HbA1c (r = −0.30, p = 0.004). IDA was associated with significantly higher HbA1c levels, even in non-diabetic individuals with normal fasting glucose, indicating that iron status can influence HbA1c independently of glycemia. These findings suggest that HbA1c results should be interpreted carefully in patients with IDA to avoid potential misclassification of glycemic status. Assessment of iron parameters alongside HbA1c may improve diagnostic accuracy, and further large-scale studies are recommended to clarify the underlying mechanisms and clinical impact of this independent relationship.