Glucose 6-phosphate dehydrogenase deficiency and Southeast Asian-specific mutations lower HbA1c levels in a Thai population: implications for diabetes diagnosis
Authors' conclusion
HbA1c levels were positively correlated with G6PD activity, with individuals carrying G6PD ViangchanG871A and G6PD MahidolG487A exhibiting significantly lower HbA1c levels. Our findings highlight the need to consider G6PD deficiency and G6PD mutations when using HbA1c to diagnose type 2 diabetes in Southeast Asian populations.
Study context
- Population
- Healthy hospital staff at annual health checkups in a Thai cohort; excluded diabetes, diabetes medication use and conditions affecting erythrocyte turnover
- Participants
- 1,007 participants
- Exposure
- G6PD deficiency and G6PD mutations vs normal G6PD
- G6PD deficiencyn = 28
- G6PD ViangchanG871An = 52
- G6PD MahidolG487An = 15
- Normal G6PDn = 492reference
- Outcome
- Association of G6PD deficiency and its common mutations with HbA1c levels
Main finding
As reported in the abstract
G6PD deficiency vs Normal G6PD: P < 0.001 · G6PD ViangchanG871A vs Normal G6PD: P < 0.001 · G6PD MahidolG487A vs Normal G6PD: P < 0.001
Observational data: associations, not effects.
Further findings
HbA1c by HPLC
- HbA1c by HPLC: HPLC: 4.65%, 5.00%, 5.00% vs 5.50%
Correlation of HbA1c with G6PD activity
- R, enzymatic assay (p<0.001)
- 0.208
- R, HPLC (p<0.001)
- 0.211
Optimal HbA1c cutoffs in G6PD mutation carriers
- Prediabetes, enzymatic assay: 33 to <42 mmol/mol (5.2% to <6.0%); sensitivity 70%, specificity 88.64%, accuracy 86.74%
- Prediabetes, HPLC: 34 to <43 mmol/mol (5.3% to <6.1%); sensitivity 72.73%, specificity 86.21%, accuracy 84.70%
- Diabetes, enzymatic assay: ≥42 mmol/mol (≥6.0%); sensitivity 100%, specificity 97.92%, accuracy 97.96%
- Diabetes, HPLC: ≥43 mmol/mol (≥6.1%); sensitivity 100%, specificity 96.88%, accuracy 96.94%
- ROC analysis with bootstrapping
Prediabetes diagnosis with mutation-specific cutoffs vs ADA criteria
- Prediabetes, enzymatic assay: ADA 8.2% → mutation-specific
- 18.4%
- Prediabetes, HPLC: ADA 9.2% → mutation-specific
- 21.4%
- Proportion diagnosed with diabetes remained the same
Original publication
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