Iron deficiency anemia (IDA) was associated with higher hemoglobin A1C (A1C) levels relative to measured glucose values in patients with type 2 diabetes mellitus (T2DM) hospitalized for ischemic stroke, according to a retrospective cohort analysis presented at the AACE Annual Meeting 2026.

The analysis included 677 adults hospitalized for ischemic stroke between 2017 and 2025, including 177 patients who met biochemical criteria for IDA and 500 controls. Propensity score matching and weighted linear regression were used to adjust for baseline differences and confounding variables.

Patients with IDA were younger than controls (median age 57 vs 64 years; P<.001), more frequently women (72.3% vs 42.0%; P<.001), and more commonly non-White (52.5% vs 38.6%; P=.001). The IDA group also had a greater comorbidity burden, reflected by a higher mean Elixhauser index (5.71 vs 4.71; P<.001).

Despite the higher comorbidity burden, patients with IDA had lower glucose values at admission, discharge, and overall hospitalization. Hypoglycemic events occurred more frequently in the IDA group (9.0% vs 4.2%; P=.015), although insulin dosing did not significantly differ between groups.

The discrepancy between measured glucose and estimated average glucose derived from A1C was significantly greater in patients with IDA than in controls (19.99 vs 8.20 mg/dL; P<.001). After adjustment for confounders, IDA remained independently associated with a 4.4% increase in A1C (P=.002).

The findings support cautious interpretation of A1C in patients with ischemic stroke and concurrent IDA, particularly when glucose values and A1C appear discordant.