Hemoglobin A1c levels are slightly but significantly lower in normoglycemic subjects with the hemoglobin E phenotype

Busadee Pratumvinit, Kanit Reesukumal, Sithikan Hanyongyuth, Sujitra Wangchaijaroenkit, Julaporn Pooliam, Gerald J Kost, Panumas Kamkang, Tze Ping Loh

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Hb mutations can alter the structure, behavior, stability, or quantity of the globin chain produced. Some Hb variants shorten the erythrocyte life span, resulting in physiologically lower hemoglobin A1c (HbA1c) levels. The hemoglobin E (HbE) phenotype involves a single-nucleotide polymorphism that reduces β-globin chain synthesis. We compared the HbA1c levels of subjects with normal Hb (HbAA; N=131) and HbE (N=148) phenotypes, examining potential hematological and biochemical factors contributing to differences in HbA1c levels. All had normal fasting plasma glucose (<5.6 mmol/L), AST, ALT, and creatinine levels. Mean±SD HbA1c levels differed between HbAA and HbE subjects: 5.5±0.3% and 5.3±0.3% (P<0.001) according to an immunoassay, and 5.5±0.3% and 5.3±0.3% (P<0.001) according to cation-exchange HPLC, respectively. In multiple logistic regression, only mean corpuscular volume (P< 0.001) contributed to the difference in HbA1c levels between groups. Although a 0.2% difference in HbA1c is relatively small and unlikely to alter clinical decisions, epidemiologically, this can lead to misclassification of a significant proportion of the population, especially since the threshold of non-diabetes HbA1c (≤5.6%) falls very close to the HbA1c median of the general population.

Original languageEnglish (US)
Pages (from-to)209-213
Number of pages5
JournalAnnals of Laboratory Medicine
Issue number2
StatePublished - Jan 1 2019


  • Hemoglobin A1c
  • Hemoglobin E
  • HPLC
  • Immunoassay

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical


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