Evidence map›Paper›PMID 26098445›Full record

ArticleNutrition & diabetes2015

Implications of iron deficiency/anemia on the classification of diabetes using HbA1c.

S M Attard, A H Herring, H Wang, A-G Howard, A L Thompson, L S Adair, E J Mayer-Davis, P Gordon-Larsen

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Nutrition & diabetes, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 2 pooled it
1.3field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 32 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Trial
  4. Article
  5. Review
  6. Article
  7. Article
  8. Review
  9. Iron Deficiency and its Relationship with Chronic Heart Failure- A Review.Cardiovascular & hematological agents in medicinal chemistry · 2025
    Review
  10. Review
  11. Sex-Specific Associations of Iron-Anemia Status With Hemoglobin A1C Levels Among Hispanics/Latinos Without Self-Reported Diabetes Mellitus: The Hispanic Community Health Study/Study of Latinos.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022
    Article
  12. Article
  13. The Oral Glucose Tolerance Test: 100 Years Later.Diabetes, metabolic syndrome and obesity : targets and therapy · 2020
    Review
  14. Increased Levels of Glycated Hemoglobin A1c and Iron Deficiency Anemia: A Review.Medical science monitor : international medical journal of experimental and clinical research · 2019
    Review
  15. Article
  16. Article
  17. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 2 countries.

S M AttardDepartment of Nutrition, Gillings School of Global Public Health, UNC-Chapel Hill, Chapel Hill, NC, USA.
A H Herring1] Carolina Population Center, UNC-Chapel Hill, Chapel Hill, NC, USA [2] Department of Biostatistics, Gillings School of Global Public Health, UNC-Chapel Hill, Chapel Hill, NC, USA.
H WangNational Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China.
A-G Howard1] Carolina Population Center, UNC-Chapel Hill, Chapel Hill, NC, USA [2] Department of Biostatistics, Gillings School of Global Public Health, UNC-Chapel Hill, Chapel Hill, NC, USA.
A L Thompson1] Carolina Population Center, UNC-Chapel Hill, Chapel Hill, NC, USA [2] Department of Anthropology, UNC-Chapel Hill, Chapel Hill, NC, USA.
L S Adair1] Department of Nutrition, Gillings School of Global Public Health, UNC-Chapel Hill, Chapel Hill, NC, USA [2] Carolina Population Center, UNC-Chapel Hill, Chapel Hill, NC, USA.
E J Mayer-Davis1] Department of Nutrition, Gillings School of Global Public Health, UNC-Chapel Hill, Chapel Hill, NC, USA [2] Department of Medicine, UNC-Chapel Hill, Chapel Hill, NC, USA.
P Gordon-Larsen1] Department of Nutrition, Gillings School of Global Public Health, UNC-Chapel Hill, Chapel Hill, NC, USA [2] Carolina Population Center, UNC-Chapel Hill, Chapel Hill, NC, USA.ORCID 0000000153224188
University of North Carolina at Chapel Hill · USUniversity of North Carolina Health Care · USChinese Center For Disease Control and Prevention · CN

Funding

MONITORING SOCIAL CHANGE: HEALTH, REPRODUCTION, AGINGR01HD030880 · NICHD · UNIV OF NORTH CAROLINA CHAPEL HILL · PI ADAIR, LINDA S, POPKIN, BARRY M · 1994 to 2024
$27.0M
Carolina Population CenterR24HD050924 · NICHD · UNIV OF NORTH CAROLINA CHAPEL HILL · PI MORGAN, SAMUEL PHILIP · 2005 to 2014
$10.0M
Research Services CoreP2CHD050924 · NICHD · UNIV OF NORTH CAROLINA CHAPEL HILL · PI KAREN B GUZZO · 2015 to 2026
$9.6M
Emergence of Cardiometabolic Risk Across the Lifecycle in ChinaR01HL108427 · NHLBI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI GORDON-LARSEN, PENNY · 2012 to 2015
$2.7M
Environmental Change and Inflammation: Age, Cohort and Household Effects in ChinaK01HD071948 · NICHD · UNIV OF NORTH CAROLINA CHAPEL HILL · PI THOMPSON, AMANDA L · 2012 to 2014
$338k
NHLBI NIH HHS R01 HL108427NICHD NIH HHS K01 HD071948NICHD NIH HHS P2C HD050924NICHD NIH HHS R01 HD030880NICHD NIH HHS R24 HD050924
6 · The paper itself

Abstract

BACKGROUND/

objectivesNonglycemic factors like iron deficiency (ID) or anemia may interfere with classification of diabetes and prediabetes using hemoglobin A1c (HbA1c). However, few population-based studies of diabetes in areas with endemic ID/anemia have been conducted. We aimed to determine how mutually exclusive categories of ID alone, anemia alone and iron-deficiency anemia (IDA) were each associated with prediabetes and diabetes prevalence using fasting blood glucose (FBG) versus HbA1c in a population-based study of adults with endemic ID/anemia. SUBJECTS/

methodsWe used data from the China Health and Nutrition Survey, a longitudinal, population-based study across 228 communities within nine provinces of China. This analysis included 7308 adults seen in the 2009 survey aged 18-75 years. We used descriptive and covariate-adjusted models to examine relative risk of prediabetes and diabetes using FBG alone, HbA1c alone, HbA1c and FBG, or neither (normoglycemia) by anemia alone, ID alone, IDA or normal iron/hemoglobin.

resultsApproximately 65% of individuals with diabetes in our sample were concordantly classified with diabetes using both FBG and HbA1c, while 35% had a discordant diabetes classification: they were classified using either FBG or HbA1c, but not both. Fewer participants with ID alone versus normal iron/hemoglobin were classified with diabetes using HbA1c only. From covariate-adjusted, multinomial regression analyses, the adjusted prevalence of prediabetes using HbA1c only was 22% for men with anemia alone, but 13% for men with normal iron/hemoglobin. In contrast, the predicted prevalence of prediabetes using HbA1c only was 8% for women with ID alone, compared with 13% for women with normal iron/hemoglobin.

conclusionsThese findings suggest potential misclassification of diabetes using HbA1c in areas of endemic ID/anemia. Estimating diabetes prevalence using HbA1c may result in under-diagnosis in women with ID and over-diagnosis in men with anemia.

Identifiers

PMID26098445
PMCPMC4491857
OpenAlexW1520128497

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.