AIMS Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency or thalassemia have a shorter red blood cell lifespan; therefore, HbA1c is underestimated in these patients. To address these issues, we sought an early indicator for G6PD deficiency or thalassemia in DM patients. METHODS A total of 4908 patients with DM and 1848 subjects without DM were included in this study. Fasting glucose (FG) levels, HbA1c levels, hemogram profiles and G6PD activities were measured. Genotypic analyses of G6PD deficiency and thalassemia were performed. RESULTS DM patients with G6PD deficiency had significantly higher FG/HbA1c ratios than did those without G6PD deficiency (26.54 vs. 18.36; p < 0.0001). We divided the FG level into four categories: ≤150, 151-250, 251-350, and ≥351 mg/dL. Among all groups, only patients with DM and G6PD deficiency had higher FG/HbA1c ratios than those of patients with DM alone or DM with thalassemia. To evaluate the reliability of the FG/HbA1c ratio, receiver operating characteristic analyses were performed. The areas under the curve for detecting FG ≤ 150, 151-250, 251-350, and ≥351 mg/dL with G6PD deficiency based on the FG/HbA1c ratio were 0.839 (p < 0.001), 0.888 (p < 0.001), 0.891 (p < 0.001), and 0.640 (p = 0.3954), respectively. G6PD deficiency was confirmed by genetic analysis. We found common mutations that influenced G6PD activity and HbA1c levels. CONCLUSIONS The FG/HbA1c ratio is a good indicator of DM with G6PD deficiency. If this ratio is determined to be high in a clinical setting, then the clinician must consider whether the patient has a G6PD deficiency, and HbA1c reference values must be adjusted to avoid misdiagnosis and incorrect treatment decisions.

中文翻译：

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空腹血糖与HbA1c的比率是2型糖尿病患者G6PD缺乏症的好指标，但不是地中海贫血的好指标。

目的：患有6-磷酸葡萄糖脱氢酶（G6PD）缺乏症或地中海贫血的患者的红细胞寿命较短；因此，这些患者中的HbA1c被低估了。为了解决这些问题，我们寻求了DM患者G6PD缺乏或地中海贫血的早期指标。方法本研究共纳入4908例DM患者和1848例无DM患者。测量空腹血糖（FG）水平，HbA1c水平，血象图和G6PD活性。对G6PD缺乏症和地中海贫血进行了基因型分析。结果G6PD缺乏症的DM患者的FG / HbA1c比明显高于G6PD缺乏症的患者（26.54 vs. 18.36； p <0.0001）。我们将FG水平分为四类：≤150、151-250、251-350和≥351mg / dL。在所有群体中 只有DM和G6PD缺乏症患者的FG / HbA1c比值高于单独使用DM或地中海贫血的DM患者。为了评估FG / HbA1c比的可靠性，进行了接收机工作特性分析。根据FG / HbA1c比，检测G6PD缺乏的FG≤150、151-250、251-350和≥351mg / dL的曲线下面积分别为0.839（p <0.001），0.888（p <0.001），分别为0.891（p <0.001）和0.640（p = 0.3954）。通过基因分析证实了G6PD的缺乏。我们发现影响G6PD活性和HbA1c水平的常见突变。结论FG / HbA1c比值是DM缺乏G6PD的良好指标。如果在临床环境中确定该比率较高，则临床医生必须考虑患者是否患有G6PD缺乏症，