Fas and Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand Are Closely Linked to the Levels of Glycated and Fetal Hemoglobin in Patients with Diabetes Mellitus

The aim of this study was to investigate the relationships between apoptotic markers and the levels of glycated and fetal hemoglobin (HbA1c and HbF) in diabetes.The levels of Fas, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), HbF, and HbA1c were measured in 112 patients with type 2 diabetes.Diabetic patients with microalbuminuria had an elevated Fas level and a decreased TRAIL level, compared to healthy controls. Elevated HbF level was more often observed in patients with decreased TRAIL level than in those with increased TRAIL level (33.9% versus 12.5%, p0.05). Fas was positively correlated with HbA1c (r = 0.31, p0.001), but TRAIL was inversely correlated with HbA1c and HbF (r = -0.30 and r = -0.32, respectively; p0.001). In a multivariate logistic regression analysis, decreased TRAIL level was significantly associated with enhanced HbF production after adjusting for potential confounders [odds ratio, 1.35 (95% CI, 1.09 - 2.87), p = 0.004]. The diagnostic ability of TRAIL to identify an elevated HbF1.0% was significantly higher than that of the Fas [0.760 (95% CI, 0.638 - 0.882) versus 0.589 (95% CI, 0.457 - 0.721), p0.001].Fas is closely associated with long-term hyperglycemia, while TRAIL plays certain roles in enhancing HbF production in type 2 diabetes.