CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(02): 253-258
DOI: 10.1055/s-0042-1757589
Original Article

Effect of Iron Deficiency Anemia on Glycated Albumin Levels: A Comparative Study in Nondiabetic Subjects with Iron Deficiency Anemia

Pralayakaveri Jyothsna
1   Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
Musturu M. Suchitra
1   Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
Medooru Kusuma Kumari
1   Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
C. Chandrasekhar
2   Department of Hematology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
Nandyala Rukmangadha
3   Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
4   Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
Bhattaram Siddhartha Kumar
5   Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.
› Author Affiliations
Funding This work was supported by Sri Balaji Aarogya Vara Prasadini Scheme of Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.


Objective Glycated hemoglobin A1c (HbA1c), used for monitoring glycemia control, is altered in iron deficiency anemia (IDA). Glycated albumin (GA) is considered an alternate biomarker to HbA1c. However, effect of IDA on GA needs to be studied.

Materials and Methods Thirty nondiabetic cases with IDA and 30 healthy controls were included. Fasting plasma glucose (FPG), creatinine, urea, albumin, total protein, ferritin, iron, unsaturated iron binding capacity, hemoglobin (Hb), HbA1c, complete hemogram, and GA were estimated. Transferrin saturation and total iron binding capacity (TIBC) were calculated. Statistical analysis was done using unpaired two-tailed t-test/Mann–Whitney U-test and Pearson's correlation/Spearman-rank correlation, as appropriate.

Results Total protein, albumin, Hb, iron, ferritin, and transferrin saturation were significantly lower while FPG, GA, TIBC, and HbA1c were significantly higher in cases compared to controls. HbA1C and GA have a significant negative correlation with iron, transferrin saturation, and ferritin. Significant negative correlations of GA with albumin (r = –0.754; p < 0.001) and Hb (r = –0.435; p = 0.001) and that of HbA1c with albumin (r = –0.271; p = 0.03) and Hb (r = –0.629; p  < 0.001) while significant positive correlation of Hb with albumin (r = 0.395; p = 0.002) and HbA1c with FPG (r = 0.415; p = 0.001) were observed.

Conclusion Low albumin levels increase plasma protein glycation, including albumin. Hence, elevated GA levels indicate false elevation of GA in scenario of lowered albumin observed in IDA, similar to HbA1c. Thus, using GA in diabetes mellitus with IDA should be avoided or used with caution to prevent potentially inappropriate treatment intensification and risk of hypoglycemia.

Publication History

Article published online:
20 October 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011; 94 (03) 311-321
  • 2 Sacks DB. Measurement of hemoglobinA1c. Diabetes Care 2012; 35: 2674-2680
  • 3 Dagogo-Jack S. Pitfalls in the use of HbA1(c) as a diagnostic test: the ethnic conundrum. Nat Rev Endocrinol 2010; 6 (10) 589-593
  • 4 Gallagher EJ, Le Roith D, Bloomgarden Z. Review of hemoglobin A(1c) in the management of diabetes. J Diabetes 2009; 1 (01) 9-17
  • 5 Kohzuma T, Koga M. Lucica GA-L glycated albumin assay kit: a new diagnostic test for diabetes mellitus. Mol Diagn Ther 2010; 14 (01) 49-51
  • 6 Koga M, Kasayama S. Clinical impact of glycated albumin as another glycemic control marker. Endocr J 2010; 57 (09) 751-762
  • 7 Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA 1997; 277 (12) 973-976
  • 8 Zhang CG, Chang SJ, Settu K, Chen CJ, Liu JT. High-sensitivity glycated hemoglobin (HbA1c) aptasensor in rapid-prototyping surface plasmon resonance. Sens Actuators B Chem 2019; 279 DOI: 10.1016/j.snb.2018.09.077.
  • 9 Coban E, Ozdogan M, Timuragaoglu A. Effect of iron deficiency anemia on the levels of hemoglobin A1c in nondiabetic patients. Acta Haematol 2004; 112 (03) 126-128
  • 10 Bonora E, Calcaterra F, Lombardi S. et al. Plasma glucose levels throughout the day and HbA(1c) interrelationships in type 2 diabetes: implications for treatment and monitoring of metabolic control. Diabetes Care 2001; 24 (12) 2023-2029
  • 11 Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab 2008; 93 (07) 2447-2453
  • 12 Radin MS. Pitfalls in hemoglobin A1c measurement: when results may be misleading. J Gen Intern Med 2014; 29 (02) 388-394
  • 13 Shanthi B, Revathy C, Manjula Devi AJ. , Subhashree, Effect of iron deficiency on glycation of haemoglobin in nondiabetics. J Clin Diagn Res 2013; 7 (01) 15-17
  • 14 Shekhar H, Mangukiya K, Kaur A, Jadeja P. Effect of iron deficiency anemia on glycation of haemoglobin in nondiabetics. Int J Sci Nat 2014; 5 (03) 477-479
  • 15 Brooks AP, Metcalfe J, Day JL, Edwards MS. Iron deficiency and glycosylated haemoglobin A. Lancet 1980; 2 (8186): 141
  • 16 Gram-Hansen P, Eriksen J, Mourits-Andersen T, Olesen L. Glycosylated haemoglobin (HbA1c) in iron- and vitamin B12 deficiency. J Intern Med 1990; 227 (02) 133-136
  • 17 El-Agouza I, Abu Shahla A, Sirdah M. The effect of iron deficiency anaemia on the levels of haemoglobin subtypes: possible consequences for clinical diagnosis. Clin Lab Haematol 2002; 24 (05) 285-289
  • 18 Sinha N, Mishra TK, Singh T, Gupta N. Effect of iron deficiency anemia on hemoglobin A1c levels. Ann Lab Med 2012; 32 (01) 17-22
  • 19 Tarim O, Küçükerdoğan A, Günay U, Eralp O, Ercan I. Effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus. Pediatr Int 1999; 41 (04) 357-362
  • 20 Sluiter WJ, van Essen LH, Reitsma WD, Doorenbos H. Glycosylated haemoglobin and iron deficiency. Lancet 1980; 2 (8193): 531-532
  • 21 Rodríguez-Segade S, Rodríguez J, Mayan D, Camiña F. Plasma albumin concentration is a predictor of HbA1c among type 2 diabetic patients, independently of fasting plasma glucose and fructosamine. Diabetes Care 2005; 28 (02) 437-439
  • 22 Tiwari S, Bothale M, Hasan I. et al. Association between serum albumin and glycated hemoglobin in Asian Indian subjects. Indian J Endocrinol Metab 2015; 19 (01) 52-55
  • 23 UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352 (9131): 837-853
  • 24 Kouzuma T, Usami T, Yamakoshi M, Takahashi M, Imamura S. An enzymatic method for the measurement of glycated albumin in biological samples. Clin Chim Acta 2002; 324 (1-2): 61-71
  • 25 Austin GE, Mullins RH, Morin LG. Non-enzymic glycation of individual plasma proteins in normoglycemic and hyperglycemic patients. Clin Chem 1987; 33 (12) 2220-2224
  • 26 Bhonsle HS, Singh SK, Srivastava G, Boppana R, Kulkarni MJ. Albumin competitively inhibits glycation of less abundant proteins. Protein Pept Lett 2008; 15 (07) 663-667
  • 27 Bhonsle HS, Korwar AM, Kote SS. et al. Low plasma albumin levels are associated with increased plasma protein glycation and HbA1c in diabetes. J Proteome Res 2012; 11 (02) 1391-1396
  • 28 Roohk HV, Zaidi AR. A review of glycated albumin as an intermediate glycation index for controlling diabetes. J Diabetes Sci Technol 2008; 2 (06) 1114-1121
  • 29 Koga M. Glycated albumin; clinical usefulness. Clin Chim Acta 2014; 433: 96-104
  • 30 Kaysen GA. Association between inflammation and malnutrition as risk factors of cardiovascular disease. Blood Purif 2006; 24 (01) 51-55