title: Decline in haemoglobin A1c values in diabetic patients receiving interferon-alpha and ribavirin for chronic hepatitis C.
abstract: Haemoglobin A1c (A1c) levels are lower during haemolysis because of the shorter exposure of haemoglobin (Hb) to plasma glucose. Ribavirin (RBV) used in combination with interferon-alpha (IFN) for chronic hepatitis C causes reversible haemolytic anaemia. This study examined the extent to which RBV treatment influences A1c levels in diabetic patients. A retrospective analysis identified 32 diabetic patients who underwent hepatitis C treatment with IFN and RBV. Each subject had at least three measures of A1c, Hb and glucose: before, during and after therapy. A1c values decreased from a mean pretreatment level of 7.2% to an on-treatment A1c level of 5.2% [mean paired difference -2.01%; 95% confidence interval (CI) -1.59% to -2.43%; P < 0.001]. During therapy, mean Hb levels decreased from 15.1 g/dL at baseline to a nadir of 11.7 g/dL (P < 0.001) with a rise in lactose dehydrogenase levels and reticulocyte counts, and unchanged mean corpuscular volume values confirming haemolysis. At the same time, glucose levels declined by a mean of 38.4 mg/dL (95% CI 13.4-63.5 mg/dL; P = 0.002) as did body weights by a mean of 3.15 kg (P < 0.001). According to published glucose-A1c correlation tables, this decline of glucose concentration by 38.4 mg/dL correlates to a decline in A1c level of 1.08%. In conclusion, reductions of A1c levels by a mean of 2.01% during hepatitis C therapy with IFN + RBV are due to a combination of decreased glucose levels (1.08%) and RBV-induced haemolysis (0.93%). A1c levels should not be measured during hepatitis C treatment with IFN + RBV because they do not adequately reflect glycaemic control.
authors.affiliation: Bronx Veterans Affairs Medical Center, New York, USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Greenberg
authors.forename: A S
authors.initials: AS
authors.lastname: Rosman
authors.forename: L S
authors.initials: LS
authors.lastname: Eldeiry
authors.forename: Z
authors.initials: Z
authors.lastname: Naqvi
authors.forename: N
authors.initials: N
authors.lastname: Bräu
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001786:Blood Glucose; D001835:Body Weight; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy; D003920:Diabetes Mellitus / Q000097:blood*; D004909:Erythrocyte Indices; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006454:Hemoglobins / Q000032:analysis; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D017701:Reticulocyte Count; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D006454:Hemoglobins; D016898:Interferon-alpha; D007770:L-Lactate Dehydrogenase; D012254:Ribavirin