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. 2012 Sep 17:11:110.
doi: 10.1186/1475-2840-11-110.

Increased blood glycohemoglobin A1c levels lead to overestimation of arterial oxygen saturation by pulse oximetry in patients with type 2 diabetes

Li Jin Pu  1 , Ying Shen, Lin Lu, Rui Yan Zhang, Qi Zhang, Wei Feng Shen
Affiliations

Increased blood glycohemoglobin A1c levels lead to overestimation of arterial oxygen saturation by pulse oximetry in patients with type 2 diabetes

Li Jin Pu et al. Cardiovasc Diabetol. .

Abstract

Background: Non-enzymatic glycation increases hemoglobin-oxygen affinity and reduces oxygen delivery to tissues by altering the structure and function of hemoglobin.

Objectives: We investigated whether an elevated blood concentration of glycosylated hemoglobin (HbA1c) could induce falsely high pulse oximeter oxygen saturation (SpO2) in type 2 diabetic patients during mechanical ventilation or oxygen therapy.

Methods: Arterial oxygen saturation (SaO2) and partial pressure of oxygen (PO2) were determined with simultaneous monitoring of SpO2 in 261 type 2 diabetic patients during ventilation or oxygen inhalation.

Results: Blood concentration of HbA1c was >7% in 114 patients and ≤ 7% in 147 patients. Both SaO2 (96.2 ± 2.9%, 95% confidence interval [CI] 95.7-96.7% vs. 95.1 ± 2.8%, 95% CI 94.7-95.6%) and SpO2 (98.0 ± 2.6%, 95% CI 97.6-98.5% vs. 95.3 ± 2.8%, 95% CI 94.9-95.8%) were significantly higher in patients with HbA1c >7% than in those with HbA1c ≤ 7% (Data are mean ± SD, all p < 0.01), but PO2 did not significantly differ between the two groups. Bland-Altman analysis demonstrated a significant bias between SpO2 and SaO2 (1.83 ±0.55%, 95% CI 1.73% -1.94%) and limits of agreement (0.76% and 2.92%) in patients with HbA1c >7%. The differences between SpO2 and SaO2 correlated closely with blood HbA1c levels (Pearson's r = 0.307, p < 0.01).

Conclusions: Elevated blood HbA1c levels lead to an overestimation of SaO2 by SpO2, suggesting that arterial blood gas analysis may be needed for type 2 diabetic patients with poor glycemic control during the treatment of hypoxemia.

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Figures

Figure 1
Figure 1
Correlation of the difference between SpO2and SaO2with blood HbA1c levels in patients with poor glycemic control.
Figure 2
Figure 2
Arterial oxyhemoglobin sigmoid curves (PO2, partial pressure of oxygen; SaO2,arterial oxygen saturation).
Figure 3
Figure 3
Bland-Altman plots for bias and limits of agreement in patients with poor glycemic control.
See this image and copyright information in PMC

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