Sickle Cell Trait and Diabetes

iStock-185126935People with sickle cell trait have one copy of a gene that can confer frank sickle cell disease to offspring, if combined with a second gene for the condition from a partner. As Rick and I discuss on PodMed this week, people with sickle cell trait may not have the often severe manifestations of sickle cell disease but they do experience consequences of the trait, specifically aberrant hemoglobin A1c measurements if they also have diabetes.  Since about 10% of African Americans do have sickle cell trait and the prevalence of diabetes is increasing, awareness of this is important for physicians and patients alike, as reported in JAMA this week.

Data from just over 4600 subjects from several different studies were examined retrospectively. The association of sickle cell trait with hemoglobin A1c measurements after controlling for fasting glucose or 2 hour glucose measurements was the primary outcome. Those with sickle cell trait had lower hemoglobin A1c levels for any given fasting or 2-hour glucose measurements, for an average of 5.72% versus 6.01% when compared to subjects without sickle cell trait. Clearly such a difference can skew interpretations of glucose control among those who also have diabetes, with Rick opining that this is yet one more factor doctors need to account for in using hemoglobin A1c.  We both acknowledge the fact that some investigators and clinicians are advocating for fasting glucose rather than hemoglobin A1c as a better metric for the state of an individual's diabetes, and suspect we'll be hearing more about this issue in upcoming studies.

Other topics this week include Prognostic Mutations in Myelodysplastic Syndrome after Stem-Cell Transplantation in NEJM, Nicotine, Carcinogen, and Toxicant Exposure: Comparison of E-Cigarette and Nicotine Replacement Therapy Users in Annals, and Pediatric Exposures to Veterinary Pharmaceuticals in Pediatrics. Until next week, y'all well.

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