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Falsely low glycosylated haemoglobin levels probably secondary to hypersplenism in a patient with diabetes mellitus
  1. Guy Hayakawa1,
  2. Maya M Leibowitz1,
  3. Sateesh Kumar Nagumantry2 and
  4. Samson Oghenetsovwe Oyibo1
  1. 1Diabetes and Endocrinology, North West Anglia NHS Foundation Trust, Peterborough, UK
  2. 2Haematology, Peterborough City Hospital, Peterborough, UK
  1. Correspondence to Dr Samson Oghenetsovwe Oyibo; samoyibo{at}


A man in his 70s presented with a history of low glycated haemoglobin (HbA1c) values despite a diagnosis of type 2 diabetes. His blood glucose readings ranged between 8 and 15 mmol/L, but his HbA1c values were below 27 mmol/mol. Initial investigations demonstrated evidence of reduced red blood cell lifespan as a cause of misleadingly low HbA1c values. Further investigation revealed chronic liver disease and splenomegaly, with hypersplenism being the probable cause of increased red blood cell turnover. HbA1c estimation was no longer reliable, so ongoing diabetic care was guided by home capillary blood glucose monitoring. Healthcare providers and clinical laboratorians need to be aware of the possible clinical implications of very low HbA1c values in patients with type 2 diabetes.

  • Diabetes
  • Alcoholic liver disease
  • Haematology (incl blood transfusion)

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  • Contributors We confirm that all authors (GH, MML, SKN and SOO) made (1) substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; (2) drafting the work or revising it critically for important intellectual content; (3) final approval of the version to be published and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: GH, MML, SKN and SOO. The following authors gave final approval of the manuscript: GH, MML, SKN and SOO.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.