Research Article: Age-Related Associations Between Red Blood Cell Indices and Hemoglobin A1c in Pediatric and Adult Patients: A Retrospective Study
Hoiner Kyle C. Bofetiado, Julie Soder, Muneeza Esani, Juan U. Rojo
Abstract
Objective: Hemoglobin A1c (HbA1c) is the primary laboratory marker for assessing long-term glycemic status, but its interpretation may be influenced by erythrocyte physiology. This study evaluated the association between routinely reported red blood cell (RBC) indices and HbA1c in pediatric and adult diabetic and non-diabetic patients.
Methods: A retrospective observational study was conducted using electronic medical record and laboratory information system data from the University of Texas Medical Branch between 2010 and 2025. The pediatric cohort included 565 encounters, and the adult cohort included 14,790 encounters. Hemoglobin (Hgb), hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW) were evaluated using correlation, group comparison, and multivariable regression analyses.
Results: Significant associations between HbA1c and multiple RBC indices were identified in both pediatric and adult populations, although the pattern of associations differed by age. Pediatric patients demonstrated predominantly hemoglobin-related associations, whereas adult patients showed stronger relationships involving erythrocyte morphology. Adult diabetic patients also demonstrated significant differences in several RBC indices compared with matched non-diabetic controls. However, glycemic control was not independently associated with the overall presence of abnormal RBC indices after multivariable adjustment.
Conclusion: Routine CBC-derived RBC indices demonstrated age-related associations with HbA1c across pediatric and adult populations. Although these indices should not be considered independent markers of diabetes or glycemic control, they may provide additional laboratory context when interpreting HbA1c results.
Keywords: Glycated Hemoglobin; Erythrocyte Indices; Diabetes Mellitus; Age Factors; Retrospective Studies.
Int. J. Bio. Lab. Sci 2026(15)2:127-137 【PDF】
