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Title: Association between Hemoglobin and Hemoglobin A<sub>1c</sub>: A Data-Driven Analysis of Health Checkup Data in Japan
Authors: Takeuchi, Masato  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0002-2990-2687 (unconfirmed)
Kawakami, Koji
Author's alias: 竹内, 正人
川上, 浩司
Keywords: anemia
diabetes mellitus
spline curve
generalized additive mixed model
machine learning
Issue Date: Dec-2018
Publisher: MDPI AG
Journal title: Journal of clinical medicine
Volume: 7
Issue: 12
Thesis number: 539
Abstract: Background: Interpretation of hemoglobin A1c (HbA1c) levels may be confounded by spurious results in anemic persons, but its degree is not well-established. Methods: We used an employer-based health insurance database, containing health checkup data and medical claims data; both were linked via a unique identifier of each beneficiary. This study included persons aged 18–75 years who participated in health checkups, with a confirmed or suspected diagnosis of diabetes. The relationship between hemoglobin (Hb) and HbA1c is shown in a spline curve using a machine learning technique accounting for patient factors and within-person correlations. Spline curves were also shown in several sub-populations. Results: Overall, a decreased Hb value was associated with a lower HbA1c value, but the extent differed among populations. In the whole cohort of the type-2 diabetes group (55, 420 persons), the curve was generally a plateau in the persons with a Hb value <120–130 g/L. Among the 18, 478 persons with HbA1c around 48 mmol/mol, we observed a liner trend. Among the current glucose-lowering medication users (6253 persons), we found a right upward curve. Conclusions: The relationship between Hb and HbA1c may not be straightforward, varying among populations of different clinical interest. Our results indicate that a simple formulation between the Hb and HbA1c values is unlikely.
Rights: © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
URI: http://hdl.handle.net/2433/245363
DOI(Published Version): 10.3390/jcm7120539
PubMed ID: 30545047
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