Endocrine Abstracts (2019) 63 P190 | DOI: 10.1530/endoabs.63.P190

HbA1C as a marker of retrograde glycemic control in diabetes patient with co-existed beta thalassemia: Case report

Zoran Gluvic1, Milena Lackovic1, Vladimir Samardzic1, Jelena Tica Jevtic1, Marina Vujovic1, Bojan Mitrovic1, Anita Vasic-Vlaisavljevic2, Marija Popin Taric2, Violeta Mladenovic3, Sasa Radenkovic4, Milan Obradovic5 & Esma R Isenovic5

1Zemun Clinical Hospital, Department of Endocrinology and mITU, School of Medicine, University of Belgrade, Belgrade, Serbia; 2Zemun Clinical Hospital, Department of Geriatrics, School of Medicine, University of Belgrade, Belgrade, Serbia; 3Clinical Centre Kragujevac, Clinic for Endocrinology and Diabetes, School of medicine, University of Kragujevac, Kragujevac, Serbia; 4Clinical Centre Nis, Clinic for Endocrinology and Diabetes, School of medicine, University of Nis, Nis, Serbia; 5Laboratory of radiobiology and molecular genetics, Institute for nuclear sciences ‘Vinca’, University of Belgrade, Belgrade, Serbia.

Introduction: A number of studies reported that almost every fifth patient with thalassemia hav e diabetes. Various factors could contribute to inadequate retrograde glycemic control in thalassemia patients co-existed with diabetes. According to published data, HbA1C seems to be an insufficient marker of the quality of diabetes control in thalassemia patients.

Case report: We present a male 67 years old type 2 diabetes patient with disease history for 15 years, who is under oral treatment and has microvascular diabetes complications on peripheral nerves and small distal arterial vessels. A retrograde glycemic control determined by HbA1C measurement was unexpectedly satisfied. The patient has been admitted to the hospital because of chronic distal neuropathic pain, right toe trophic ulcer, and electromyography (EMG) finding of distal sensorimotor polyneuropathy. In past medical history, the patient reported a discus hernia (L1-5) surgery and later on noticed the presence of blood transfusions-independent thalassemia. Additionally, his daughter is also a beta thalassemia-heterozygous carrier. Five-point glycemic profile revealed moderate postprandial hyperglycemia and no hypoglycemic episodes. Despite the fact of already EMG confirmed distal polyneuropathy, retrograde glycemic control was optimal (HbA1C 6.5%). The thorough patient examination did not reveal any other chronic micro- or macrovascular diabetes complication. Laboratory analyses show microcytic anemia, mild biochemical syndrome of liver necrosis and remodeling and moderate hepatosplenomegaly detected by abdominal ultrasound. After the introduction of insulin and treatment by hyperbaric oxygen, the patient was discharged slightly improved in regard to actual glycemic control and right toe trophic ulcer healing. Some neuropathic complaints alleviation was achieved by use of alpha lipoic acid, pregabalin and amitriptyline.

Discussion and conclusion: When different factors can interfere with HbA1C measurements in diseases such as thalassemia and hemoglobinopathies, the discrepant findings of profile glycemic control and HbA1C values could be expected. In such patients, it is necessary to measure HbA1C with another method or to use fructosamine as a more reliable marker of retrograde glycemic control. When the 5-point glycemic profile is acceptable, HbA1C can be cautiously used in the estimation of retrograde glycemic control, preferably accompanied by fructosamine.