Effect of Iron Deficiency Anaemia on HbA1c Levels among Non-Diabetic Females

Abstract

Iron deficiency anaemia (IDA) and Diabetes Mellitus both represent significant global public health concerns. HbA1c is one of the most used methods for diagnosis and monitoring of Diabetes. While several studies have explored the relationship between IDA and HbA1c, the findings are still inconsistent. Therefore, identifying the factors contributing to these inconsistencies is crucial for improving clinical interpretation and diagnostic accuracy of HbA1c, particularly in patients with IDA. This study aimed to investigate the impact of IDA on HbA1c levels, assessing the role of its severity on HbA1c levels and contributing to a better understanding of the reasons behind the conflicting findings.  A cross-sectional case-control study was carried out at AL Wahda Hospital in Darna city, Libya, spanning from January 2025 to June 2025 and included 212 non-diabetic females aged 15-49, divided into 106 diagnosed with IDA (study group) and 106 age- and sex matched non-anemic (Control group). Medical history was obtained from each participant, and the following laboratory tests were performed: HbA1c, CBC, and Serum ferritin. Statistical analysis was performed using SPSS software version 26, applying the Kolmogorov–Smirnov test, Sign test, General linear model test and Kruskal Wallis test. Serum ferritin and haemoglobin had a statistically significant impact on HbA1c levels (P = 0.03) and (P=0.05), respectively. However, no statistically significant difference was found in the mean HbA1c between females with IDA and those without IDA (5.52 ± 0.40 vs 5.48 ± 0.52, P= 0.54), although a mild decrease was observed in the mean HbA1c of females with IDA compared to those without IDA. In addition, the study revealed no statistically significant differences in HbA1c levels across anaemia severity groups (P = 0.42). These findings suggest that HbA1c is significantly associated with serum ferritin and haemoglobin in non-diabetic females. However, this study may provide additional insights regarding the relationship between IDA and HbA1c within the context of previously inconsistent studies. Therefore, in IDA patients, reliance solely on HbA1c results may potentially lead to overestimation or underestimation of glycemic control, and HbA1c need to be interpreted cautiously in anaemic patients.