Impact of Iron-Deficiency Anemia on HbA1c Measurement in Non-Diabetic Algerian Adults

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Published Oct 11, 2026
https://doi.org/10.62438/tunismed.v104i09.6725
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Vol. 104 No. 09 (2026): Tunis Med Sept 2026

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Sabrine Deghima
Department of Medical Biology, Rouiba Hospital, Algiers University of Health Sciences, 16000, Algiers, Algeria.
https://orcid.org/0009-0008-2550-5634
Nadhir Gharbi
Department of Medical Biology, Rouiba Hospital, Algiers University of Health Sciences, 16000, Algiers, Algeria
Zohra Sedoud
Department of Medical Biology, Rouiba Hospital, Algiers University of Health Sciences, 16000, Algiers, Algeria
Kamel Djenouhat
Department of Medical Biology, Rouiba Hospital, Algiers University of Health Sciences, 16000, Algiers, Algeria

Abstract

Introduction-Aim: Glycated haemoglobin (HbA1c) is a widely used clinical marker for assessing glycaemic control in patients with diabetes. However, certain conditions may affect the reliability of this marker, anaemia, particularly iron deficiency anaemia, being a common source of
HbA1c variability. This study aimed to determine the total haemoglobin threshold below which HbA1c measurements become uninterpretable.
Methods: The study included 99 patients with iron deficiency anaemia, in whom three main parameters were measured: HbA1c, total haemoglobin and fructosamine. The population was stratified into three groups according to anaemia severity, and a correlation analysis was performed between HbA1c and fructosamine, a glycaemic marker independent of anaemia.
Results: Mean HbA1c was 5.90% ± 0.88 in moderate anaemia, 5.87% ± 0.72 in mild anaemia and 6.43% ± 1.12 in severe anaemia. These differences were not statistically significant (Kruskal–Wallis test, p = 0.34). A statistically significant positive correlation between HbA1c and fructosamine was observed in the moderate (ρ = 0.39; p = 0.007) and mild (ρ = 0.38; p = 0.017) anaemia groups, but not in the severe anaemia group (p = 0.503).
Conclusion: Our preliminary findings show that below a total haemoglobin threshold of 9 g/dL in men and 8 g/dL in women, HbA1c is no longer a reliable marker of glycaemic control, and that the use of alternative markers, such as fructosamine, represents a valuable alternative until iron
deficiency is corrected

Keywords:

Glycated haemoglobin, Iron deficiency anaemia, Fructosamine, Glycaemic control, Algeria

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