ASSOCIATION OF AUGMENTED HEMOGLOBIN F PRODUCTION WITH ERYTHROPOIETIN AND TOTAL OXYGEN CONCENTRATION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

초록

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 (ctO(2)) in patients with diabetes. Methods: Glycated hemoglobin (HbA1c), HbF, EPO, oxygen saturation (sO(2)), and renal parameters were measured in type 2 diabetic patients. The ctO(2) was calculated using sO(2), 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 ctO(2) 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 ctO(2) levels after adjusting for potential confounders [r = 0.306 and r = -0.257, respectively, p < 0.001]. In a multivariate logistic regression analysis, a decreased ctO(2) level (< 11.2 vol%) was significantly associated with enhanced HbF production [odds ratio, 1.47 (95% CI, 1.023.07), p = 0.009]. In a receiver operating characteristic curve, the diagnostic ability of EPO and ctO(2) to identify HbF > 1.0% in diabetics 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, 0.4460.694); respectively, p < 0.001]. Conclusion: An increased EPO level seems to play an important role in the enhanced HbF production of diabetics in conjunction with a decreased ctO(2) level.

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