Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study

See Ling Loy; Jinjie Lin; Yin Bun Cheung; Aravind Venkatesh Sreedharan; Xinyi Chin; Keith M. Godfrey; Kok Hian Tan; Lynette Pei Chi Shek; Yap Seng Chong; Melvin Khee Shing Leow; Chin Meng Khoo; Yung Seng Lee; Shiao Yng Chan; Ngee Lek; Jerry Kok Yen Chan; Fabian Yap

doi:10.1038/s41598-021-00445-w

Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study

See Ling Loy, Jinjie Lin, Yin Bun Cheung, Aravind Venkatesh Sreedharan, Xinyi Chin, Keith M. Godfrey, Kok Hian Tan, Lynette Pei Chi Shek, Yap Seng Chong, Melvin Khee Shing Leow, Chin Meng Khoo, Yung Seng Lee, Shiao Yng Chan, Ngee Lek, Jerry Kok Yen Chan, Fabian Yap

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Abstract

Abnormalities of red blood cell (RBC) indices may affect glycated haemoglobin (HbA1c) levels. We assessed the influence of haemoglobin (Hb) and mean corpuscular volume (MCV) on the performance of HbA1c in detecting dysglycaemia among reproductive aged women planning to conceive. Women aged 18–45 years (n = 985) were classified as normal (12 ≤ Hb ≤ 16 g/dL and 80 ≤ MCV ≤ 100 fL) and abnormal (Hb < 12 g/dL and/or MCV < 80 fL). The Area Under the Receiver Operating Characteristic (AUROC) curve was used to determine the performance of HbA1c in detecting dysglycaemic status (prediabetes and diabetes). There were 771 (78.3%) women with normal RBC indices. The AUROCs for the normal and abnormal groups were 0.75 (95% confidence interval 0.69, 0.81) and 0.80 (0.70, 0.90), respectively, and were not statistically different from one another [difference 0.04 (− 0.16, 0.08)]. Further stratification by ethnicity showed no difference between the two groups among Chinese and Indian women. However, Malay women with normal RBC indices displayed lower AUROC compared to those with abnormal RBC indices (0.71 (0.55, 0.87) vs. 0.98 (0.93, 1.00), p = 0.002). The results suggest that the performance of HbA1c in detecting dysglycaemia was not influenced by abnormal RBC indices based on low Hb and/or low MCV. However, there may be ethnic variations among them.

Original language	English
Article number	20850
Journal	Scientific Reports
Volume	11
DOIs	https://doi.org/10.1038/s41598-021-00445-w
Publication status	Published - Oct 2021
Publication type	A1 Journal article-refereed

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Loy, S. L., Lin, J., Cheung, Y. B., Sreedharan, A. V., Chin, X., Godfrey, K. M., Tan, K. H., Shek, L. P. C., Chong, Y. S., Leow, M. K. S., Khoo, C. M., Lee, Y. S., Chan, S. Y., Lek, N., Chan, J. K. Y., & Yap, F. (2021). Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study. Scientific Reports, 11, Article 20850. https://doi.org/10.1038/s41598-021-00445-w

@article{03e46c0c14994579a1b869aea1d74615,

title = "Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study",

abstract = "Abnormalities of red blood cell (RBC) indices may affect glycated haemoglobin (HbA1c) levels. We assessed the influence of haemoglobin (Hb) and mean corpuscular volume (MCV) on the performance of HbA1c in detecting dysglycaemia among reproductive aged women planning to conceive. Women aged 18–45 years (n = 985) were classified as normal (12 ≤ Hb ≤ 16 g/dL and 80 ≤ MCV ≤ 100 fL) and abnormal (Hb < 12 g/dL and/or MCV < 80 fL). The Area Under the Receiver Operating Characteristic (AUROC) curve was used to determine the performance of HbA1c in detecting dysglycaemic status (prediabetes and diabetes). There were 771 (78.3%) women with normal RBC indices. The AUROCs for the normal and abnormal groups were 0.75 (95% confidence interval 0.69, 0.81) and 0.80 (0.70, 0.90), respectively, and were not statistically different from one another [difference 0.04 (− 0.16, 0.08)]. Further stratification by ethnicity showed no difference between the two groups among Chinese and Indian women. However, Malay women with normal RBC indices displayed lower AUROC compared to those with abnormal RBC indices (0.71 (0.55, 0.87) vs. 0.98 (0.93, 1.00), p = 0.002). The results suggest that the performance of HbA1c in detecting dysglycaemia was not influenced by abnormal RBC indices based on low Hb and/or low MCV. However, there may be ethnic variations among them.",

author = "Loy, {See Ling} and Jinjie Lin and Cheung, {Yin Bun} and Sreedharan, {Aravind Venkatesh} and Xinyi Chin and Godfrey, {Keith M.} and Tan, {Kok Hian} and Shek, {Lynette Pei Chi} and Chong, {Yap Seng} and Leow, {Melvin Khee Shing} and Khoo, {Chin Meng} and Lee, {Yung Seng} and Chan, {Shiao Yng} and Ngee Lek and Chan, {Jerry Kok Yen} and Fabian Yap",

note = "Funding Information: This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health{\textquoteright}s National Medical Research Council (NMRC), Singapore—NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. YBC is supported by a Clinician Scientist Award from the Singapore NMRC (NMRC/CSA/0039/2012). KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042)) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004)), the European Union (Erasmus+ Programme ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP) and the British Heart Foundation (RG/15/17/3174). SYC is supported by a Clinician Scientist Award from the Singapore NMRC (NMRC/CSA-INV/0010/2016). JKYC is supported by a Clinician Scientist Award from the Singapore NMRC (CSA(SI)/008/2016). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Funding Information: K.M.G., Y.S.C., Y.S.L. and F.Y. have received reimbursement for speaking at conferences sponsored by companies selling nutritional products. K.M.G., Y.S.C. and S.Y.C. are part of an academic consortium that has received research funding from Abbott Nutrition, Nestle and Danone. Other authors declare that there is no conflict of interest regarding the publication of this article.",

year = "2021",

month = oct,

doi = "10.1038/s41598-021-00445-w",

language = "English",

volume = "11",

journal = "Scientific Reports",

issn = "2045-2322",

publisher = "Nature Research",

}

Loy, SL, Lin, J, Cheung, YB, Sreedharan, AV, Chin, X, Godfrey, KM, Tan, KH, Shek, LPC, Chong, YS, Leow, MKS, Khoo, CM, Lee, YS, Chan, SY, Lek, N, Chan, JKY & Yap, F 2021, 'Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study', Scientific Reports, vol. 11, 20850. https://doi.org/10.1038/s41598-021-00445-w

TY - JOUR

T1 - Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study

AU - Loy, See Ling

AU - Lin, Jinjie

AU - Cheung, Yin Bun

AU - Sreedharan, Aravind Venkatesh

AU - Chin, Xinyi

AU - Godfrey, Keith M.

AU - Tan, Kok Hian

AU - Shek, Lynette Pei Chi

AU - Chong, Yap Seng

AU - Leow, Melvin Khee Shing

AU - Khoo, Chin Meng

AU - Lee, Yung Seng

AU - Chan, Shiao Yng

AU - Lek, Ngee

AU - Chan, Jerry Kok Yen

AU - Yap, Fabian

N1 - Funding Information: This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC), Singapore—NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. YBC is supported by a Clinician Scientist Award from the Singapore NMRC (NMRC/CSA/0039/2012). KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042)) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004)), the European Union (Erasmus+ Programme ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP) and the British Heart Foundation (RG/15/17/3174). SYC is supported by a Clinician Scientist Award from the Singapore NMRC (NMRC/CSA-INV/0010/2016). JKYC is supported by a Clinician Scientist Award from the Singapore NMRC (CSA(SI)/008/2016). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Funding Information: K.M.G., Y.S.C., Y.S.L. and F.Y. have received reimbursement for speaking at conferences sponsored by companies selling nutritional products. K.M.G., Y.S.C. and S.Y.C. are part of an academic consortium that has received research funding from Abbott Nutrition, Nestle and Danone. Other authors declare that there is no conflict of interest regarding the publication of this article.

PY - 2021/10

Y1 - 2021/10

N2 - Abnormalities of red blood cell (RBC) indices may affect glycated haemoglobin (HbA1c) levels. We assessed the influence of haemoglobin (Hb) and mean corpuscular volume (MCV) on the performance of HbA1c in detecting dysglycaemia among reproductive aged women planning to conceive. Women aged 18–45 years (n = 985) were classified as normal (12 ≤ Hb ≤ 16 g/dL and 80 ≤ MCV ≤ 100 fL) and abnormal (Hb < 12 g/dL and/or MCV < 80 fL). The Area Under the Receiver Operating Characteristic (AUROC) curve was used to determine the performance of HbA1c in detecting dysglycaemic status (prediabetes and diabetes). There were 771 (78.3%) women with normal RBC indices. The AUROCs for the normal and abnormal groups were 0.75 (95% confidence interval 0.69, 0.81) and 0.80 (0.70, 0.90), respectively, and were not statistically different from one another [difference 0.04 (− 0.16, 0.08)]. Further stratification by ethnicity showed no difference between the two groups among Chinese and Indian women. However, Malay women with normal RBC indices displayed lower AUROC compared to those with abnormal RBC indices (0.71 (0.55, 0.87) vs. 0.98 (0.93, 1.00), p = 0.002). The results suggest that the performance of HbA1c in detecting dysglycaemia was not influenced by abnormal RBC indices based on low Hb and/or low MCV. However, there may be ethnic variations among them.

AB - Abnormalities of red blood cell (RBC) indices may affect glycated haemoglobin (HbA1c) levels. We assessed the influence of haemoglobin (Hb) and mean corpuscular volume (MCV) on the performance of HbA1c in detecting dysglycaemia among reproductive aged women planning to conceive. Women aged 18–45 years (n = 985) were classified as normal (12 ≤ Hb ≤ 16 g/dL and 80 ≤ MCV ≤ 100 fL) and abnormal (Hb < 12 g/dL and/or MCV < 80 fL). The Area Under the Receiver Operating Characteristic (AUROC) curve was used to determine the performance of HbA1c in detecting dysglycaemic status (prediabetes and diabetes). There were 771 (78.3%) women with normal RBC indices. The AUROCs for the normal and abnormal groups were 0.75 (95% confidence interval 0.69, 0.81) and 0.80 (0.70, 0.90), respectively, and were not statistically different from one another [difference 0.04 (− 0.16, 0.08)]. Further stratification by ethnicity showed no difference between the two groups among Chinese and Indian women. However, Malay women with normal RBC indices displayed lower AUROC compared to those with abnormal RBC indices (0.71 (0.55, 0.87) vs. 0.98 (0.93, 1.00), p = 0.002). The results suggest that the performance of HbA1c in detecting dysglycaemia was not influenced by abnormal RBC indices based on low Hb and/or low MCV. However, there may be ethnic variations among them.

U2 - 10.1038/s41598-021-00445-w

DO - 10.1038/s41598-021-00445-w

M3 - Article

AN - SCOPUS:85117724599

SN - 2045-2322

VL - 11

JO - Scientific Reports

JF - Scientific Reports

M1 - 20850

ER -

Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study

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