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Glycemic Monitoring in Diabetics with Sickle Cell Plus ß-Thalassemia Hemoglobinopathy

At time of writing, Primary Care Resident, Duke University Medical Center, Durham, NC; now, Clinical Pharmacist, Franciscan Pharmacy, Syracuse, NY

Philip T Rodgers, PharmD BCPS CDE CPP

Clinical Pharmacist, Duke University Medical Center; Clinical Associate Professor, School of Pharmacy, University of North Carolina

Martha B Adams, MD MA

Associate Clinical Professor, Department of Medicine, Division of General Internal Medicine, Duke University Medical Center

Reprints: Dr. Rodgers, Duke University Medical Center 3089, Durham, NC 27710-3089, fax 919/681-2741, philip.rodgers{at}duke.edu

OBJECTIVE: To report a case of diabetes management in a patient with a hemoglobinopathy that caused her clinician to seek a different measure of glycemic control, fructosamine, rather than glycosylated hemoglobin (HbA_1c).

CASE SUMMARY: A 53-year-old African American woman presented with a past medical history of type 2 diabetes, hypertension, seizure disorder, rheumatoid arthritis, and sickle cell disease plus ß-thalassemia. She reported fasting blood glucose values ranging broadly from 50 to 320 mg/dL, yet her HbA_1c result remained steady in a low range of <6%. A measure of fructosamine returned elevated at 340 µmol/L (reference range 200–300).

DISCUSSION: We believe that this patient's hemoglobinopathy resulted in falsely low levels of HbA_1c, and we substantiate this interpretation with the patient's self-monitored blood glucose values from home that appeared higher and inconsistent with the HbA_1c results. Although few reports on using the measure of fructosamine appear in the literature, this patient's high fructosamine result supports fructosamine as the more appropriate measure of glycemic control.

CONCLUSIONS: Serum fructosamine levels may be considered as an appropriate laboratory measurement when monitoring long-term glycemic control in patients with type 2 diabetes mellitus and sickle cell disease.

Key Words: ß-thalassemia, hemoglobinopathy, type 2 diabetes, sickle cell disease

Published Online, August 2, 2005. www.theannals.com, DOI 10.1345/aph.1G010

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