JONG WEON CHOI1, MOON HEE LEE2, TATSUYOSHI FUJII3, NORIYOSHI FUJII3
1Department of Laboratory Medicine, College of Medicine, Inha University, 27 Inhang-ro, Jung-gu, Incheon 22332, Republic of Korea - 2Department of Internal Medicine, College of Medicine, Inha University, Incheon, Republic of Korea - 3School of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
Objective: Elevated hemoglobin F (HbF) level has been reported in diabetic patients; however, the reason for the raised HbF synthesis is unclear. The aim of this study was to investigate whether enhanced HbF production is associated with erythropoietin (EPO) level and total oxygen concentration (ctO2) in patients with diabetes.
Methods: Glycated hemoglobin (HbA1c), HbF, EPO, oxygen saturation (sO2), and renal parameters were measured in type 2 diabetic patients. The ctO2 was calculated using sO2, partial pressure of oxygen, and Hb sub-fractions.
Results: Serum EPO concentration was significantly higher in patients with HbF >1.0% than in those with HbF ≤1.0% (13.9 IU/L versus 8.5 IU/L, p <0.001). Median ctO2 level was significantly lower in the elevated HbF group than in the non-elevated HbF group (12.0 vol% versus 16.5 vol%, p <0.001). The HbF concentration was closely associated with EPO and ctO2 levels after adjust- ing for potential confounders [r = 0.306 and r = -0.257, respectively, p <0.001]. In a multivariate logistic regression analysis, a decreased ctO2 level (<11.2 vol%) was significantly associated with enhanced HbF production [odds ratio, 1.47 (95% CI, 1.02- 3.07), p = 0.009]. In a receiver operating characteristic curve, the diagnostic ability of EPO and ctO2 to identify HbF>1.0% in dia- betics was superior to that of HbA1c [0.743 (95% CI, 0.636-0.850) and 0.677 (95% CI, 0.569-0.784) versus 0.570 (95% CI, 0.446- 0.694); respectively, p <0.001].
Conclusion: An increased EPO level seems to play an important role in the enhanced HbF production of diabetics in conjunc- tion with a decreased ctO2 level.
fetal hemoglobin, erythropoietin, total oxygen concentration, diabetes mellitus