95% of researchers rate our articles as excellent or good
Learn more about the work of our research integrity team to safeguard the quality of each article we publish.
Find out more
ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1500660
Rectify The Impact Of Shor ter Red Blood Cell Lifespan Upon HbA1c Detection Values In T2DM Patients: Modeling And Inter nal-exter nal Ver ification
Provisionally accepted
Li Zhang 1
Ximan Gao 1 Xuying Meng 2
Guangyang Ma 1
Jing Li 1
Weilin Wang 1 Sisi Chen 1 Yongjian Ma 3
Pei Yu 1
Saijun Zhou 1*- 1 Tianjin Metabolic Diseases Hospital, Tianjin Medical University, Tianjin, China
- 2 Second Hospital of Tianjin Medical University, Tianjin, China
- 3 Shenzhen University, Shenzhen, Guangdong Province, China
To determine the effect of red blood cell (RBC) lifespan variability on glycosylated hemoglobin (HbA1c) measurements in type 2 diabetes mellitus (T2DM) individuals and develop a mathematical model for adjusting HbA1c values.Methods: We tracked glucose levels in 516 T2DM patients from Chu Hsien-I Memorial Hospital, categorized into Construction (n = 416) and Internal (n = 100) cohorts. Additionally, 165 participants from Tianjin diabetic retinopathy screening cohort, serving as the Independent cohort. RBC lifespan was determined using the CO breath test, and Hemoglobin glycation variation index (HGI) was calculated from the difference between measured and estimated HbA1c (eHbA1c). Model efficacy was evaluated using AUC, accuracy, sensitivity, and specificity.Results: An inflection in the HGI-RBC lifespan model occurred at 66 days, with HbA1c underestimation when RBC lifespan was below 90 days, notably in the ≤ 66 days group. This underestimation increased the risk of cardiovascular and peripheral neuropathy complications.To rectify the impact of the shorter RBC lifespan in T2DM patients, the correction formula was established as HbA1c(c) = -0.05629×RBC lifespan + 1.127×HbA1c + 3.178 (R = 0.7360) in the ≤ 66 day lifespan group and HbA1c(c) = -0.004772 × RBC lifespan + 0.7569 × HbA1c + 2.394 (R = 0.7344) in the 67 to 89 day group. The corrected HbA1c models exhibited satisfactory predictive performance in all cohorts.Conclusions: Accurate adjustment for the effects of RBC lifespan on HbA1c values in
Keywords: Glycosylated hemoglobin (HbA1c), Hemoglobin glycation index (HGI), red blood cell lifespan, type 2 diabetes mellitus, Correction model
Received: 23 Sep 2024; Accepted: 28 Mar 2025.
Copyright: © 2025 Zhang, Gao, Meng, Ma, Li, Wang, Chen, Ma, Yu and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Saijun Zhou, Tianjin Metabolic Diseases Hospital, Tianjin Medical University, Tianjin, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.