Admission hemoglobin level and prognosis of type 2 diabetes mellitus and possible confounding factors: Correspondence

TO THE EDITOR

We read with interest a case report on “Association between admission hemoglobin level and prognosis in patients with type 2 diabetes mellitus” by Song

[1]. A retrospective examination of patients diagnosed with type 2 diabetes mellitus (T2DM) bet was undertaken[1]. End-stage renal disease or a 50% drop in estimated glomerular filtration rate was the composite outcome[1]. Song

[1] concluded that Hemoglobin levels and renal damage were found to have a U-shaped connection in T2DM patients. Hemoglobin levels below 13.3 g/dL at admission are an independent indicator of renal injury[1]. This report by Song

[1] might add some data on application of hemoglobin level in monitoring of diabetic patient. In type 2 diabetes patients, Matsuoka

[2] found that the duration of hypoglycemia was inversely associated with hemoglobin and hemoglobin A1C levels, and was longer at night than during the day. The kidney issue could be the result of a protracted period of hyperglycemia.

There are many possible confounding conditions on the hemoglobin level. In our setting in Indochina, many local people have a common inherited disorder, thalassemia, that has low hemoglobin level. In these thalassemic patients, renal impairment is also common regardless having diabetes or not[3]. Therefore, the conclusion on association by Song

[1] might be applicable in some settings, but not all settings, such as our setting in Indochina. This correspondence can provide a novel insight that the application of hemoglobin level as an indicator might be limited in the area with high prevalence confounding hemoglobin disorder problem.

Sookaromdee P gave ideas, analyzed the data, wrote the manuscript, revising and approving final submission; Wiwanitkit V gave ideas, analyzed the data, revising, supervising and approving final submission; All authors have read and approve the final manuscript.

The authors declare no conflict of interest.

There might be a cure for that, said the White Bear, if you would but promise me never to talk with your mother alone,32 but only when the others are there too; for she will take hold of your hand, he said, and will want to lead you into a room to talk with you alone; but that you must by no means do, or you will bring great misery4 on both of us. 33

Pathum Sookaromdee 0000-0002-8859-5322; Viroj Wiwanitkit 0000-0003-1039-3728.

Thailand

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I am stunned5（） that millions of Americans are threatened by hunger. If every gardener in America - and we re seventy million strong - plants one row for the hungry, we can make quite a dent1（，） in the number of neighbors who don t have enough to eat. Maybe then I will stop feeling guilty about abandoning a hungry man I could have helped.

Zhang H

For seven months, we meet like this. Sometimes we exchange a few words. Sometimes, just an apple. But she is feeding more than my belly10, this angel from heaven. She is feeding my soul. And somehow, I know I am feeding hers as well.

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Zhang H

1 Song HY, Wei CM, Zhou WX, Hu HF, Wan QJ. Association between admission hemoglobin level and prognosis in patients with type 2 diabetes mellitus.

2021; 12: 1917-1927 [PMID: 34888016 DOI: 10.4239/wjd.v12.i11.1917]

2 Matsuoka A, Hirota Y, Takeda A, Kishi M, Hashimoto N, Ohara T, Higo S, Yamada H, Nakamura T, Hamaguchi T,Takeuchi T, Nakagawa Y, Okada Y, Sakaguchi K, Ogawa W. Relationship between glycated hemoglobin level and duration of hypoglycemia in type 2 diabetes patients treated with sulfonylureas: A multicenter cross-sectional study.

2020; 11: 417-425 [PMID: 31461223 DOI: 10.1111/jdi.13132]

3 Demosthenous C, Vlachaki E, Apostolou C, Eleftheriou P, Kotsiafti A, Vetsiou E, Mandala E, Perifanis V, Sarafidis P.Beta-thalassemia: renal complications and mechanisms: a narrative review.

2019; 24: 426-438 [PMID:30947625 DOI: 10.1080/16078454.2019.1599096]