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Prevalence and Effect of Hemoglobin E Disorders on HbA1c and Lipid Profile of Diabetic Patients at Surin Hospital Wasunt Srisurin MD* * Department of Medicine, Surin Hospital, Surin, ThailandObjective: To evaluate the prevalence of hemoglobin E disorders (HbE) and their characteristics in diabetic patients at SurinHospital. Effects of HbE on HbA1c measurement and other variables in diabetic patients were also studied.Material and Method: A cross-sectional study was performed. One thousand nine hundred seventy eight patients wererecruited randomly using a systemic random sampling method. HbE screening test and Hb typing was performed. HbA1cwas measured by turbidimetric inhibition immunoassay.Results: The prevalence of homozygous HbE (HbEE) and HbE trait were 7.9% and 35.3% respectively. When compared withthe negative screening group, the variables that were significantly higher in the HbEE group were hemoglobin A1c (HbA1c)< 6.5% (p < 0.010), HbA1c < 7% (p < 0.010), serum cholesterol level (CHOL) < 200 mg/dl (p < 0.010), low densitylipoprotein (LDL) < 100 mg/dl (p = 0.021), and anemia by Hb measurement (p < 0.010). The adjusted odds ratio and 95%confidence interval (CI) of HbA1c < 6.5% and < 7% in HbEE when compared with the negative screening group were 5.16(3.55-7.50) and 4.60 (3.04-6.97) respectively. The means of HbA1c, Hb, CHOL, and LDL in HbEE were significantly lowerthan the other groups (p < 0.010 in all variables). The adjusted odds ratio and 95% CI of HbA1c < 6.5% and < 7% in HbEtrait when compared with the negative screening group were 1.12 (1.01-1.24) and 1.17 (1.06-1.29) respectively.Conclusion: Hemoglobin E disorders are highly prevalent in diabetes patients at Surin Hospital. HbA1c, CHOL, and LDLwere significantly lower in diabetic patients with HbEE.Keywords: Hemoglobin E disorder, HbEE, HbE trait, Diabetes mellitus, DM, Surin HospitalJ Med Assoc Thai 2011; 94 (1): 36-42Full text. e-Journal: http://www.mat.or.th/journal Hemoglobin E disorder (HbE) is one of the associations have advocated HbA1c targets belowworld’s most common and important mutations(1-4). 7% or 6.5% and fasting plasma glucose (FPG) levelsHbE trait and homozygous HbE (HbEE) are mild below 130 mg/dl or 110 mg/dl(8-10). HbE can affectdisorders. HbE occurs in high frequency at the junction the immunoassays used for HbA1c measurement.of Thailand, Laos, and Cambodia(5). The resistance of Some current HbA1c methods show clinicallyHbE trait red cells to invasion by P falciparum is most significant interference with samples containinglikely the cause for its high prevalence throughout HbE(11). There were significant differences of HbA1cthe world(6). values between normal controls and hemoglobin E- Hemoglobin A1c (HbA1c) is a marker of containing samples(12).long-term glycemic control in patients with diabetes The author evaluated the prevalence ofmellitus (DM) and is directly related to the risk of HbE in the diabetes clinic at Surin Hospital, which isdiabetic complications(7). Lowering HbA1c close to the located in the northeastern region of Thailand andnormal range has associated with a markedly decreased near the boundary of Cambodia. Effects of HbE onfrequency and extent of microvascular and neuropathic HbA1c measurement and other variables in diabeticcomplications in diabetic patients. Various diabetes patients were also studied.Correspondence to: Material and MethodSrisurin W, Department of Medicine, Surin Hospital, Muengdistrict, Mueng Surin, Surin 32000, Thailand. A cross-sectional study was conducted inPhone: 044-511-006 the diabetes clinic at Surin Hospital between FebruaryE-mail: wasuntsrisurin@gmail.com 2009 and January 2010. The proposal was approved36 J Med Assoc Thai Vol. 94 No. 1 2011 2.
by the Ethics Committee of Surin Hospital. The Statistical analysiscommittee classified the proposal as R-to-R (routine Results were analyzed using SPSS forto research study). The sample size was calculated Windows version 11.0. Data were described infrom the population of 3,176 diabetic patients in the percentages, means, and standard deviations (SD).clinic(13). One thousand nine hundred seventy eight The Pearson Chi-square test was used to comparepatients were recruited randomly using a systemic differences between nominal variables. Fisher’s exactrandom sampling method. test and continuity correction were used when Inclusion criteria were diabetic patients necessary. Two-tailed tests were used to determinefollowed in the clinic more than six months. At each the statistical significance at p-value less than 0.05.visit, the patients were treated by physicians and a The odds ratio with 95% confidence interval (CI) ofmultidisciplinary team based on the American Diabetes each nominal variable was calculated. The distributionsAssociation (ADA) standard recommendations that of data were evaluated by Kolmogorov-Smirnov test.consist of position statements that represent official Kruskal-Wallis test was used to determine differencesADA opinion as denoted by formal review and between means in each group. Stata version 6.0 wasapproval(8,14). used to analyze logistic regression and adjusted odds Exclusion criteria were blood loss from any ratio with 95% CI.cause within six months before data collection, activetuberculosis, renal failure, liver impairment, malignancy, Resultsknown cases of hemolytic diseases other than HbE, One thousand nine hundred seventy eightor failure to follow the clinical practice guideline of diabetic patients in the diabetes clinic at Surin Hospitalthe clinic. were studied in a one-year period between February FPG, HbA1c, lipid profile, complete blood 2009 and January 2010. Thirty point eight percentcount including hemoglobin concentration (Hb), BUN, were male and 855 cases had HbE. The prevalence ofcreatinine, and dichlorophenol-indolephenol (DCIP) HbEE and HbE trait were 7.9% and 35.3% respectively.test were collected on the same day after the patients In each group there was no difference between sexhad been regularly treated for more than six months. (p = 0.740), age under 60 years (p = 0.866) and bodyHemoglobin typing was performed in cases of positive mass index (BMI) < 23 Kg/m2 (p = 0.453). DiabeticDCIP test by Hb Gold analyzer (Drew Scientific Ltd., patients with HbA1c reaching the target of < 6.5%England) using low-pressure liquid chromatography and < 7% were highest in HbEE (67.5% with p < 0.010,(LPLC). The interpretation of HbE from Hb Gold 79.0% with p < 0.010 respectively), whereas the diabeticchromatogram was based on hematologic data in patients with FPG < 110 mg/dl or FPG < 130 mg/dl hadvarious HbE syndromes(15). HbA1c was measured by no statistically significant difference between groupsturbidimetric inhibition immunoassay and the reagent (Table 1). Diabetic patients with HbEE were significantlywas Tina-Quant Hemoglobin A1c II Cobas. Lipid profile more anemic (78.3% in male and 80.2% in female) thanconsists of serum cholesterol level (CHOL), triglyceride the other groups (p < 0.010 both). There were no(TG), high-density lipoprotein (HDL) and low-density significant differences in means of age, length of DM,lipoprotein (LDL). CHOL and TG were measured by BMI, FPG, TG, HDL, BUN, or creatinine among theenzymatic colorimetric assay; the reagents were groups. The means of HbA1c, Hematocrit, Hb, CHOL,Cholesterol CHOD-PAP Cobas and Triglyceride GPO- and LDL were significantly lower in HbEE (Table 2).PAP Cobas respectively. HDL and LDL were measured When compared with the negative screeningby homogenous enzymatic colorimetric assay; the group, diabetic patients with HbEE significantlyreagents were HDL-C plus third generation Cobas and had more HbA1c < 6.5% (p < 0.010), HbA1c < 7% (p <LDL-C plus second generation Cobas respectively. 0.010), CHOL< 200 mg/dl (p < 0.010), LDL < 100 mg/dlBoth HbA1c and lipid profile were analyzed by Roche/ (p = 0.021), and anemia by various levels of Hb(17,18)Hitachi 917 automatic analyzer. The DCIP test was KKU- (p < 0.010 in all categories). The crude odds ratio andDCIP-Clear reagent(16). 95% CI of HbA1c < 6.5% and < 7% in HbEE were 5.81 Patients were classified into three groups: (4.05-8.32) and 5.20 (3.48-7.77) respectively (Table 3).negative screening, HbE trait, and HbEE. There are The variables of BMI < 23 Kg/m2, FPG < 110 mg/dl, FPGvarious standards in the hemoglobin range(17,18), the < 130 mg/dl, TG < 150 mg/dl, HDL > 40 mg/dl in males,cut-off point of anemia for each sex was classified by and HDL > 50 mg/dl in females were not significantlyWHO standard(17). different between groups.J Med Assoc Thai Vol. 94 No. 1 2011 37 3.
Table 1. Prevalence of HbE disorders and the variables among each groupCharacteristics All (%) Negative screening (%) HbE trait (%) HbEE (%) p-value*Cases 1,978 1,123 (56.8) 698 (35.3) 157 (7.9)Male/female 0.31 0.32 0.30 0.29 0.740Age under 60 years 1,096 (55.4) 606 (54.0) 405 (58.0) 85 (54.1) 0.225BMI < 23 kg/m2 854 (44.2) 494 (44.9) 228 (42.4) 72 (47.1) 0.453FPG < 110 mg/dl 406 (20.5) 225 (20.0) 143 (20.5) 38 (24.2) 0.480FPG < 130 mg/dl 920 (46.5) 506 (45.1) 341 (48.9) 73 (46.5) 0.287HbA1c < 6.5% 619 (31.3) 296 (26.4) 217 (31.1) 106 (67.5) <0.010HbA1c < 7.0% 994 (47.7) 471 (41.9) 349 (50.0) 124 (79.0) <0.010Hb < 13 g/dl in male 240 (39.3) 121 (34.2) 83 (39.5) 36 (78.3) <0.010Hb < 12 g/dl in female 719 (52.6) 370 (48.1) 260 (53.3) 89 (80.2) <0.010* Pearson Chi-squareHbE = hemoglobin E disorder; HbEE = homozygous HbE; HbA1c = hemoglobin A1c; BMI = body mass index; FPG =fasting plasma glucoseTable 2. Means and standard deviations of the variables of each groupCharacteristics All Negative screening HbE trait HbEE p-value* Mean (SD) Mean (SD) Mean (SD) Mean (SD)Age (year) 58.70 (11.1) 59.00 (11.3) 58.30 (10.9) 58.70 (10.1) 0.223Length of DM (year) 5.21 (2.98) 5.11 (2.55) 5.30 (3.42) 5.54 (3.68) 0.757BMI (kg/m2) 23.90 (4.16) 23.80 (4.18) 24.00 (4.20) 23.30 (3.82) 0.138FPG (mg/dl) 142.60 (48.9) 143.40 (50.2) 141.20 (46.3) 143.00 (50.6) 0.712HbA1c (%) 7.50 (1.88) 7.69 (1.95) 7.43 (1.76) 6.47 (1.51) <0.010Hematocrit (%) 37.50 (4.87) 38.50 (7.75) 37.10 (4.46) 32.40 (4.00) <0.010Hb (g/dl) 12.20 (1.72) 12.40 (1.74) 12.10 (1.62) 11.00 (1.50) <0.010CHOL (mg/dl) 198.60 (43.6) 198.90 (42.5) 201.50 (46.0) 182.90 (36.5) <0.010TG (mg/dl) 175.90 (110.4) 176.40 (113.6) 178.50 (109.9) 160.60 (86.0) 0.155LDL (mg/dl) 121.40 (37.9) 121.20 (37.1) 124.60 (39.8) 109.10 (31.5) <0.010HDL in male (mg/dl) 47.00 (13.6) 47.40 (14.1) 47.10 (13.2) 44.40 (10.9) 0.349HDL in female (mg/dl) 50.70 (12.8) 50.70 (12.9) 50.50 (11.8) 51.60 (16.0) 0.928* Kruskal Wallis testCHOL = cholesterol level; TG = triglyceride; LDL = low density lipoprotein; HDL = high density lipoprotein; Hb =hemoglobin concentration; BMI = body mass index; FPG = fasting plasma glucose When compared with the negative screening Logistic HbA1c < 7% HbEE DM < 5 yearsgroup, diabetic patients with HbE trait significantly Age < 60 years Anemia LDL < 100 mg/dlhad more HbA1c < 6.5% (p = 0.029), HbA1c < 7% Between negative screening group and(p = 0.001), there were no significant differences of diabetic patients with HbE trait, logistic regressionanemia in each sex. The crude odds ratio and 95% CI showed the models:of HbA1c < 6.5% and < 7% in HbE trait were 1.26 Logistic HbA1c < 6.5% HbE trait DM < 5 years(1.02-1.55) and 1.38 (1.15-1.67) respectively (Table 3). Age < 60 years Anemia LDL< 100 mg/dl Logistic HbA1c < 7% HbE trait DM < 5 yearsLogistic regression Age < 60 years Anemia LDL < 100 mg/dl Between negative screening group and diabetic The adjusted odds ratio and 95% CI ofpatients with HbEE, logistic regression showed the HbA1c < 6.5% and < 7% in HbEE were 5.16 (3.55-7.50)models: and 4.60 (3.04-6.97) respectively. The adjusted odds ratio Logistic HbA1c < 6.5% HbEE DM < 5 years and 95% CI of HbA1c < 6.5% and < 7% in HbE traitAge < 60 years Anemia were 1.12 (1.01-1.24) and 1.17 (1.06-1.29) respectively.38 J Med Assoc Thai Vol. 94 No. 1 2011 4.
Table 3. Crude odds ratios of DM with HbEE and HbE trait compared with the group of DM with negative screening HbEE HbE trait Odds ratio 95% of CI Odds ratio 95% of CIHbA1c < 6.5% 5.81 4.05-8.32 1.26 1.02-1.55HbA1c < 7.0% 5.20 3.48-7.77 1.38 1.15-1.67BMI < 23 kg/m2 1.09 0.78-1.53 0.91 0.75-1.10FPG < 110 mg/dl 1.27 0.86-1.89 1.03 0.81-1.30FPG < 130 mg/dl 1.06 0.76-1.48 1.17 0.96-1.41TG < 150 mg/dl 1.37 0.98-1.92 0.97 0.80-1.18CHOL < 200 mg/dl 2.04 1.42-2.94 0.97 0.80-1.17LDL < 100 mg/dl 1.50 1.06-2.12 0.91 0.74-1.12HDL > 40 mg/dl in male 0.64 0.34-1.21 0.87 0.60-1.26HDL > 50 mg/dl in female 1.19 0.80-1.78 0.96 0.76-1.20Hb < 13 g/dl in male 6.93 3.33-14.45 1.26 0.88-1.79Hb < 12 g/dl in female 4.36 2.68-7.10 1.23 0.98-1.54DM = diabetes mellitusDiscussion Although Hb typing was not performed in Intensive glucose therapy in patients with all cases of the negative screening group, this groupnewly diagnosed type 2 DM was associated with a had few contaminations with the other types ofreduced risk of microvascular complications (7) . hemoglobinopathy referred to in the previous data(20).Measuring HbA1c levels is recommended in all clinical However, all subjects in the clinic should be tested forpractice guidelines of DM because it directly relates to Hb typing and serum iron in a future study when thesuch complications. Turbidimetric inhibition immuno- author’s budget allows.assay is widely used to measure HbA1c levels in the The prevalence of HbE in the diabeteshospitals of Thailand. Surin province, which is an clinic at Surin Hospital is very high. In pregnantendemic area for HbE disorder, also uses this method. women, the prevalence of HbEE and HbE trait at The present study shows results of HbA1c in Surin Hospital were 9.0% and 38.2% whereas atdiabetic patients with HbE using this immunoassay. Maharaj Nakorn Chiang Mai Hospital were 0.8% andFrom the original study of DCIP test in Thai-Khmer 13.1% respectively(20,21). The prevalence of HbE inindividuals living in the provinces of Surin and Burirum, diabetic patients and pregnant women at Surin Hospitalthe DCIP test had 100% sensitivity and 98.7% specificity did not much differ.for HbE with 98.6% positive predictive value and 100% There were significant differences in HbA1cnegative predictive value(16). The ratio of HbE trait and values between the negative screening and HbEHbEE in the study did not differ from the present. disorder groups, especially in HbEE. The odds ratiosAccording to the present data, there should not be the of patients reaching HbA1c targets compared to thepossibility of misinterpretation to be negative screening negative screening group were significantly more thanand only one false positive case was seen in the present five times in HbEE, whereas the patients reachingstudy. However, the sensitivity and specificity of DCIP FPG targets had no significant difference betweentest for HbE in a recent study were 97.16% and 98.93%, them (Table 3). Whether this observation was due tothe combination of DCIP test and mean corpuscular interference or better glycemic control could not bevolume (MCV) < 80 fL as screening test can increase determined. However, the interpretation of glycemicthe sensitivity(19). This combination was applied in the control using HbA1c in the endemic area for HbEdiabetic clinic at Surin Hospital and the results in some should be carefully considered if current HbA1caspects including economy will be evaluated. Neither measuring method has interference with samplesthe similarity of sensitivity and specificity of DCIP test containing HbE. Since measuring HbA1c by highbetween HbEE and HbE trait nor the ratio of HbEE and performance liquid chromatography in HbEE also hasHbE trait was clarified in a recent large scale study(19). significant interference(22), both screening for HbE inJ Med Assoc Thai Vol. 94 No. 1 2011 39 5.
diabetic patients and identifying HbEE in positive Lamabadusuriya SP, Peto TE, Perera G, et al.cases are necessary in endemic areas. Alternative Thalassaemia in Sri Lanka: implications for theparameters to evaluate long-term glycemic control in future health burden of Asian populations. SriHbEE patients should also be created. Lanka Thalassaemia Study Group. Lancet 2000; The means of CHOL and LDL were lowest 355: 786-91.in HbEE (Table 2), and those of reaching targets for 4. Weatherall DJ. Introduction to the problem ofCHOL and LDL were significantly higher in HbEE hemoglobin E-beta thalassemia. J Pediatr Hematol(Table 3). Normal lipid composition and organization is Oncol 2000; 22: 551.lost in some subpopulations of RBC in hemoglobin- 5. Wasi P. Haemoglobinopathies includingopathies(23), whether the finding of low CHOL and LDL thalassaemia. Part 1: Tropical Asia. Clin Haematollevels in HbEE relate to this characteristic. Oxidative 1981; 10: 707-29.modification of lipoproteins had been reported in 6. Chotivanich K, Udomsangpetch R, Pattanapanyasatbeta-thalassemia/HbE and had been suggested to relate K, Chierakul W, Simpson J, Looareesuwan S, et al.to atherogenesis risk. The reduction of cholesteryl Hemoglobin E: a balanced polymorphism protectivelinoleate can be used as a severity index(24). The against high parasitemias and thus severe Pbenefit of finding low CHOL and LDL levels in diabetic falciparum malaria. Blood 2002; 100: 1172-6.patients with HbEE is doubtful. Further study should 7. UK Prospective Diabetes Study (UKPDS) Group.be performed to determine the origins and vascular Intensive blood-glucose control with sulphonyl-outcomes. ureas or insulin compared with conventional treatment and risk of complications in patientsConclusion with type 2 diabetes (UKPDS 33). Lancet 1998; Hemoglobin E disorders are highly prevalent 352: 837-53.in diabetes patients at Surin Hospital. HbA1c, CHOL, 8. American Diabetes Association. Standards ofand LDL were significantly lower in diabetic patients medical care in diabetes—2009. Diabetes Carewith HbEE. The identification of diabetic patients with 2009; 32(Suppl 1): S13-61.HbEE in endemic areas is necessary if current HbA1c 9. Ryden L, Standl E, Bartnik M, Van den Berghe G,measuring method has interference with samples Betteridge J, de Boer MJ, et al. Guidelines oncontaining HbE. diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force onAcknowledgements Diabetes and Cardiovascular Diseases of the The author thank all the staff in the European Society of Cardiology (ESC) and of themultidisciplinary team and the patients in the diabetes European Association for the Study of Diabetesclinic. The author also wishes to thank Prof. Dr. Wannee (EASD). Eur Heart J 2007; 28: 88-136.Nitiyanant, Department of Medicine, Faculty of Medicine, 10. Del Prato S, Felton AM, Munro N, Nesto R, ZimmetSiriraj Hospital for consultation. P, Zinman B. Improving glucose management: ten steps to get more patients with type 2 diabetes toPotential conflict of interest glycaemic goal. Int J Clin Pract 2005; 59: 1345-55. None. 11. Little RR, Rohlfing CL, Hanson S, Connolly S, Higgins T, Weykamp CW, et al. Effects of hemoglobinReferences (Hb) E and HbD traits on measurements of glycated 1. Chernoff AI, Minnich V, Nanakorn S, Tuchinda S, Hb (HbA1c) by 23 methods. Clin Chem 2008; 54: Kashemsant C. Studies on hemoglobin E. I. The 1277-82. clinical, hematologic, and genetic characteristics 12. Paisooksantivatana K, Kongsomgan A, of the hemoglobin E syndromes. J Lab Clin Med Banyatsuppasin W, Khupulsup K. Influence of 1956; 47: 455-89. hemoglobin E on measurement of hemoglobin 2. Old JM, Olivieri NF, Thein SL. Avoidance and A1c by immunoassays. Diabetes Res Clin Pract population control. In: Weatherall DJ, Clegg JB, 2009; 83: e84-5. Gibsons R, Higgs DR, Old JM, Olivieri NF, editros. 13. Lemeshow S, Hosmer DW, Klar J, Lwanga SK. The thalassaemia syndromes. Oxford: Blackwell Adequacy of sample size in health studies. Science; 2001: 597-629. New York: John Wiley & Sons; 1990: 1-4. 3. de Silva S, Fisher CA, Premawardhena A, 14. American Diabetes Association. Standards of40 J Med Assoc Thai Vol. 94 No. 1 2011 6.
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ความชุก และผลของฮีโมโกลบินอีตอฮีโมโกลบิน เอวันซี และ lipid profile ในผูปวยเบาหวานที่ ่ ้ ่โรงพยาบาลสุรนทร์ ิวสันต์ ศรีสรนทร์ ุิวัตถุประสงค์: เพื่อค้นหาความชุกของฮีโมโกลบิน อี ในผู้ป่วยเบาหวานของคลินิกเบาหวานโรงพยาบาลสุรินทร์และศึกษาคุณลักษณะของผู้ป่วยเบาหวานที่มีฮีโมโกลบิน อีวัสดุและวิธีการ: ทำการศึกษาภาคตัดขวางโดยวิธีสุ่มตัวอย่างแบบมีระบบจำนวน 1,978 คน จากผู้ป่วยทั้งหมด3,176 คน ตั้งแต่เดือนกุมภาพันธ์ พ.ศ. 2552 ถึงเดือนมกราคม พ.ศ. 2553 ตรวจคัดกรองเพื่อค้นหาฮีโมโกลบิน อีแล้วส่งตรวจยืนยันโดยการตรวจหาชนิดของฮีโมโกลบินด้วยวิธีมาตรฐาน ตรวจวัดฮีโมโกลบินเอวันซีโดยวิธียับยั้งความขุ่นด้วยแอนติบอดีผลการศึกษา: พบค่าความชุกของโรคโลหิตจางธาลัสซีเมียชนิดอี ร้อยละ 7.9 และฮีโมโกลบิน อี แฝงร้อยละ 35.3เมื่อเปรียบเทียบกับกลุ่มที่การตรวจคัดกรองให้ผลลบ ตัวแปรในกลุ่มโรคโลหิตจางธาลัสซีเมีย ชนิดอีที่พบสูงกว่าอย่างมีนัยสำคัญทางสถิติได้แก่ จำนวนผู้มีค่าฮีโมโกลบินเอวันซีน้อยกว่า 6.5% (p < 0.010), ฮีโมโกลบินเอวันซีน้อยกว่า 7% (p < 0.010), คอเลสเตอรอลในเลือดน้อยกว่า 200 มิลลิกรัมต่อเดซิลตร (p < 0.010), แอลดีแอลน้อยกว่า ิ100 มิลลิกรัมต่อเดซิลตร (p = 0.021) และภาวะโลหิตจาง (p < 0.010) ตามลำดับ โดยค่า odds ratio เมือปรับค่าแล้ว ิ ่และค่าความเชื่อมั่น 95% ของฮีโมโกลบินเอวันซีน้อยกว่า 6.5% และ 7% ในโรคโลหิตจางธาลัสซีเมียชนิดอี เมื่อเปรียบเทียบกับกลุมที่การตรวจคัดกรองให้ผลลบ คือ 5.16 (3.55-7.50) และ 4.60 (3.04-6.97) ตามลำดับ ค่าเฉลียของ ่ ่ฮีโมโกลบินเอวันซี, ฮีโมโกลบิน, คอเลสเตอรอล และแอลดีแอลในกลุ่มโรคโลหิตจางธาลัสซีเมียชนิดอีต่ำกว่ากลุ่มอื่นอย่างมีนยสำคัญทางสถิติ โดยทังหมดมีคา p < 0.010 ค่า odds ratio เมือปรับค่าแล้ว และค่า ความเชือมัน 95% ั ้ ่ ่ ่ ่ของฮีโมโกลบินเอวันซีนอยกว่า 6.5% และ 7% ในฮีโมโกลบินอีแฝง เมือเปรียบเทียบกับกลุมที่การตรวจคัดกรองให้ผลลบ ้ ่ ่คือ 1.12 (1.01-1.24) และ 1.17 (1.06-1.29) ตามลำดับสรุป: พบผูมีฮโมโกลบินอีสงในผูปวยเบาหวานของโรงพยาบาลสุรนทร์ ในผูปวยเบาหวานทีเป็นโรคโลหิตจางธาลัสซีเมีย ้ ี ู ้ ่ ิ ้ ่ ่ชนิดอี เมื่อเปรียบเทียบกับกลุ่มที่การตรวจคัดกรองให้ผลลบ พบผลการตรวจวัดฮีโมโกลบินเอวันซี ด้วยวิธียับยั้งความขุ่นด้วยแอนติบอดี, คอเลสเตอรอล และแอลดีแอลต่ำกว่าอย่างมีนัยสำคัญทางสถิติ42 J Med Assoc Thai Vol. 94 No. 1 2011 Recommended
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