الفهرس 
Introductionيوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Diabetes mellitus (DM) is a syndrome of metabolic disorder caused by various influencing pathogenic factors, resulting in islet cell dysfunction, insulin resistance (IR), and so on, resulting in sugar, protein, fat, water, and electrolyte imbalance. The etiology may be related to genetic factors, microbial infection and its toxins, among others According to the World Health Organization (WHO), the number of people with diabetes has nearly quadrupled in the last 40 years Glycosylated hemoglobin (HbA1c) is a hemoglobin (Hb) composed of glycosylation of valine residues at the NH2 end of globin β chain, which can be used as an indicator of blood glucose status in patients over the past 3 months. Currently, HbA1c is widely accepted as a mean glycemic index, a measure of the risk of diabetic complications, and a measure of the quality of diabetes care. The measurement of HbA1c is attractive for diagnostic use because the single number provides a comprehensive assessment of glycemic control levels; however, it has some inherent limitations. Several factors unrelated to blood sugar can falsely decrease or increase HbA1c test results. In addition, any factor that reduces the mean life expectancy of red blood cells, regardless of the assay used, mistakenly reduces the test results for HbA1c Iron deficiency anemia (IDA) is caused by the insufficient intake or excessive loss of iron in the body. Abnormal iron metabolism is related to organ diseases such as liver and heart. The latest research suggests that abnormal iron metabolism plays an important role in the pathogenesis of IR and diabetes (136). An anemic state in which serum iron and blood cell indicators are normal is called a potential iron deficiency state. Excessive iron load can damage pancreatic β cells, trigger peripheral IR, and promote the occurrence of diabetes and its complications At present, there is no uniform conclusion on the changes of serum HbA1c levels in IDA patients. Studies have shown that serum HbA1c levels in patients with diabetes and IDA are remarkably lower than healthy people. In non-diabetic people, IDA can increase serum HbA1c levels. Of course, studies have confirmed that IDA has no considerable correlation with serum HbA1c levels The current study was conducted to assess the influence of iron deficiency anemia on HbA1c in patients with diabetic foot ulcer. A total of 100 patients with diabetic foot were enrolled. Those patients were subdivided based on iron profile either with IDA or without IDA. Both groups had insignificant differences as regard baseline data. Our results were in agreement of a study by Solomon et al. in which Out of 174 diabetic patients, 89(51.1%) were male and 85 (48.9%) were female. The mean age was 47.5 ± 15.83. They found that both groups had insignificant differences as regard sociodemographic data (138). Also, Vijaya Durairaj reported the same findings (139). Another study enrolled prospectively a total of 336 patients with diabetic foot. Out of those patients; IDA was detected in 180(53.6%) patients with diabetic foot. It was found that those patients with anemia had significantly longer duration of disease. This could be explained by the comorbid conditions significantly associate with anemia included proteinuria osteomyelitis, moderate as well as severe vascular stenosis, history of stroke and renal impairment. Anemia was significantly associated with poor wound healing and amputation (140). Satisfactory wound healing requires adequate blood flow to provide oxygen and other essential nutrients to damaged tissues. Also, increased red cell deformability in patients with diabetic foot, which may lead to decreased blood flow and delayed wound healing. The decreased oxygenation caused by anemia further compounds the problem Anemia in patients with DFU is associated with adverse outcomes, the presence of anemia leads to poor oxygen delivery to the periphery. In addition, the hyperkinetic state accompanying anemia may heighten the expression of the endothelial adhesion molecule gene leading to thrombus formation further impairing peripheral circulation. All of these could ultimately lead to gangrene of the limb culminating in amputation Mean random blood sugar was significantly higher among patients with non-IDA (258.68 ± 59 vs. 233.94 ± 44.34 (mg/dl); p= 0.02). Also, patients with non-IDA had significantly higher glycosylated hemoglobin in comparison to those with IDA (8.52 ± 1.94 vs. 7.71 ± 1.46 (%); p< 0.001). Also, it was found that glycosylated hemoglobin had insignificant correlations with other parameters in the current study. In line with the current study, previous study revealed that mean RBC, MCV, MCH, MCHC, RDW were 3.45 ± 0.8, 88.57 ± 8.56, 29.89 ± 4.04, 32.97 ± 2.19, 3.45 ± 0.80 respectively. Pearson correlation test was used to determine the association between HbA1C and hematological parameters of the IDA patients. HbA1C was statistically non-significant with RBC, MCV, MCH, MCHC. This is supported by studies done by Sinha et al, Cavagnolli et al, and Kalasker et al (144-146). They all stated that HbA1c concentration tends to be lower in the presence of iron deficiency anemia. According to Sinha et al., suggestion, the reason for lower HbA1c is due to the severity of anemia in the study participants (144). In the current study, association between RBC, red cell indices and HbA1c were determined in IDA group and the result was not statistically significant. Similarly, a study done in 2014 showed no significant correlation with other parameters with exception of borderline significant correlation was observed between MCH and HbA1c in IDA diabetic patients. Also, the authors stated that in comparison between IDA group and non-IDA group; RBC, Hgb, MCV, MCH showed statistically significant mean difference between the two groups This finding regarding lower HbA1c among IDA group could be explained by the fact HbA1c levels are associated with erythrocyte indices such as HB, MCV and MCH. Since, these parameters were lower among IDA group, so HbA1c would be lower among this group. Also, Rafat et al. showed that Hb concentrations were positively correlated with HbA1c concentrations, whereby HbA1c concentrations tended to be decreased in the presence of iron deficiency On the basis of hemoglobin, iron deficient patients fall under three groups: mild anemia, moderate anemia and severe anemia. Based on this classification, previous study reported that 25 (28.7%) of patients had mild, 40 (46%) moderate and 22 (25.3%) severe anemia Diseases affecting the life span of Hb are thought to affect the results of blood A1c measurement. Iron deficiency anemia (IDA), the most common anemia disease, has a wide range of patients. Whether the results of blood A1c measurement are accurate for these patients with iron deficiency anemia accurate, Whether the use of HbA1c to assess blood glucose levels in this group of patients is unclear, so further studies are needed to determine whether IDA has an impact on blood HbA1c measurements In general, this study has showed that, patients with IDA have significantly lower HbA1c compared to non-IDA diabetic patients. Monitoring these patients using HbA1c could be misleading because their actual HbA1c level could be higher than the detected value. Hence, physicians and health care providers should take this into consideration before making any therapeutic decision. They should also consider treating the iron deficiency anemia before diagnosing the diabetes using HbA1c. Detailed examination including large number of participants employing advanced laboratory techniques is recommended In summary, for patients with IDA, the possibility of a false decrease in HbA1c must be taken into account when interpreting the clinical results, and should be supplemented by other tests as glycated albumin. For patients with abnormal HbA1c results, clinicians should comprehensively consider the interfering factors of HbA1c measurement, conduct a comprehensive analysis of the results, and perform relevant necessary examinations to check for anemia and the type of anemia. Caution should be exercised before changing treatment, as anemia may mislead the actual patient’s blood sugar status. The main limitations of the current study included; 1) relatively small sample size, 2) short term period of follow up, and 3) no searching for other causes of anemia. So, multi center future studies on large number of patients are warranted to confirm these results.