Glycemic Assessment in a Patient with HB Leiden and Type 2 Diabetes

ABSTRACT Objective: To evaluate the discordance between blood glucose and hemoglobin A1c (HbA1c) levels in a patient with hemoglobin (Hb) Leiden and type 2 diabetes. Methods: Case report. Results: Measurement of HbA1c levels by immunoturbidimetric assay and boronate affinity high-performance liquid chromatography revealed values of 4.6 (26.8 mmol/mol) and 4.8% (29.0 mmol/mol), respectively, while his fasting plasma glucose was 170 mg/dL and fructosamine was 345 mmol/L. Hb Leiden accounted for 27% of total hemoglobin, and the patient had splenomegaly and elevated hemolytic indices. Conclusion: The discrepancy between normal HbA1c and high blood sugar levels is attributed to chronic hemolysis. Treatment and monitoring options for this patient's diabetes and diabetes-related comorbid conditions will require careful management. Abbreviations: FPG = fasting plasma glucose; Hb = hemoglobin; HbA1c = hemoglobin A1c; RBC = red blood cell; SMBG = self-monitoring of blood glucose