{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T17:41:57Z","timestamp":1789839717888,"version":"4.0.1"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T00:00:00Z","timestamp":1609372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"Fogarty International Center of the National Institutes of Health","award":["grant D43 TW009337"],"award-info":[{"award-number":["grant D43 TW009337"]}]},{"DOI":"10.13039\/501100001731","name":"Danida Fellowship Centre","doi-asserted-by":"publisher","award":["grant: 16-P01-TAN"],"award-info":[{"award-number":["grant: 16-P01-TAN"]}],"id":[{"id":"10.13039\/501100001731","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>Hemoglobin A1c (HbA1c) is recommended for diagnosing and monitoring diabetes. However, in people with sickle cell disease (SCD), sickle cell trait (SCT), \u03b1-thalassemia or glucose-6-phosphate dehydrogenase (G6PD) deficiency, HbA1c may underestimate the prevalence of diabetes. There are no data on the extent of this problem in sub-Saharan Africa despite having high prevalence of these red blood cell disorders.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>Blood samples from 431 adults in northwestern Tanzania, randomly selected from the prospective cohort study, Chronic Infections, Comorbidities and Diabetes in Africa (CICADA), were analysed for SCT\/SCD, \u03b1-thalassemia and G6PD deficiency and tested for associations with the combined prevalence of prediabetes and diabetes (PD\/DM) by HbA1c, using the HemoCue 501 HbA1c instrument, and by 2-hour oral glucose tolerance test (OGTT).<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The mean age of the participants was 40.5 (SD11.6) years; 61% were females and 71% were HIV-infected. Among 431 participants, 110 (25.5%) had SCT and none had SCD. Heterozygous \u03b1-thalassemia (heterozygous \u03b1+ AT) was present in 186 (43%) of the participants, while 52 participants (12%) had homozygous \u03b1-thalassemia (homozygous \u03b1+ AT). Furthermore, 40 (9.3%) participants, all females, had heterozygous G6PD deficiency while 24 (5.6%) males and 4 (0.9%) females had hemizygous and homozygous G6PD deficiency, respectively. In adjusted analysis, participants with SCT were 85% less likely to be diagnosed with PD\/DM by HbA1c compared to those without SCT (OR = 0.15, 95% CI: 0.08, 0.26,<jats:italic>P<\/jats:italic>&lt; 0.001). When using OGTT, in adjusted analysis, SCT was not associated with diagnosis of PD\/DM while participants with homozygous \u03b1<jats:sup>+<\/jats:sup>AT and hemizygous G6PD deficiency were more likely to be diagnosed with PD\/DM.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>HbA1c underestimates the prevalence of PD\/DM among Tanzanian adults with SCT. Further research using other HbA1c instruments is needed to optimize HbA1c use among populations with high prevalence of hemoglobinopathies or G6PD deficiency.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0244782","type":"journal-article","created":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T20:04:33Z","timestamp":1609445073000},"page":"e0244782","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Influence of hemoglobinopathies and glucose-6-phosphate dehydrogenase deficiency on diagnosis of diabetes by HbA1c among Tanzanian adults with and without HIV: A cross-sectional study"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6523-9894","authenticated-orcid":true,"given":"Belinda","family":"Kweka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Lyimo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kidola","family":"Jeremiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Filteau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9967-5822","authenticated-orcid":true,"given":"Andrea M.","family":"Rehman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Friis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alphaxard","family":"Manjurano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8561-0155","authenticated-orcid":true,"given":"Daniel","family":"Faurholt-Jepsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rikke","family":"Krogh-Madsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"PrayGod","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3551-9710","authenticated-orcid":true,"given":"Douglas C.","family":"Heimburger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,31]]},"reference":[{"issue":"1","key":"pone.0244782.ref001","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.diabres.2009.10.007","article-title":"Global estimates of the prevalence of diabetes for 2010 and 2030","volume":"87","author":"JE Shaw","year":"2010","journal-title":"Diabetes research and clinical practice"},{"key":"pone.0244782.ref002","unstructured":"Organization WH. 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