Serum Ferritin as a Predictive Biomarker for Glycemic Control in Type 2 Diabetes; A Cross-sectional Analysis

Objective to determine whether serum ferritin is associated with glycemic control, measured by HbA1c, in Pakistani adults with T2DM. Methodology: A descriptive cross-sectional study was conducted at Nishtar Medical University/Hospital, Multan, from 24 August 2022 to 24 February 2023. Consecutive adults aged 30–70 years with physician-diagnosed T2DM of >2 years’ duration were enrolled (n = 151). Patients on iron therapy, with anemia, acute infection, blood donation, pregnancy, or chronic renal/hepatic disease were excluded. Serum ferritin (chemiluminescent immunoassay) and HbA1c (HPLC) were measured. Elevated ferritin was defined as >250 ng/mL in males or >120 ng/mL in females. Correlations were assessed with Spearman’s ?; chi-square tests were used post-stratification. Significance was set at p ? 0.05. Results: Mean age was 48.8 ± 10.8 years; 57.0 % were female. Median HbA1c was 7.7 % (IQR 3.3); 58.9 % (n = 89) had uncontrolled diabetes (HbA1c ? 7 %). Median ferritin was 96 ng/mL (IQR 131), with elevated levels in 30.5 % of participants. HbA1c correlated positively with ferritin (? = 0.252, p = 0.002). Elevated ferritin was more common in uncontrolled versus controlled diabetes (44.9 % vs 9.7 %; p < 0.001). The HbA1c-ferritin correlation remained significant among females, obese patients, rural residents, non-hypertensive individuals, and those without a family history of hypertension. Conclusions: Serum ferritin is independently associated with poorer glycemic control in Pakistani adults with T2DM and may serve as a practical adjunct biomarker for risk stratification in routine care. Prospective studies are needed to validate its predictive value and explore therapeutic strategies targeting iron overload. Keywords: Serum ferritin, Type 2 diabetes mellitus, Glycemic control, Biomarker