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Racial differences in performance of HbA1c for the classification of diabetes and prediabetes among US adults of non-Hispanic black and white race
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July 15 2019
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Source: Diabet Med. 36(10):1234-1242
Details:
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Alternative Title:Diabet Med
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Personal Author:
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Description:Objective:
Higher HbA1c levels in non-Hispanic black compared to white people (black and white) at similar glucose levels could lead to misclassification when using HbA1c to diagnose diabetes, prediabetes and/or dysglycemia. The objective of this study was to characterize black/white differences in optimal HbA1c cutoffs for diabetes and prediabetes.
Research Design and Methods:
Data were included from the National Health and Nutrition Examination Survey, 2005–2014. Eligible participants were black and white adults (18–70 years) who underwent an oral glucose tolerance test and had fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), and HbA1c measurements. Diabetes or prediabetes status was defined by FPG and 2hPG, using American Diabetes Association criteria. Classification of diabetes, prediabetes, and dysglycemia by HbA1c was evaluated for a range of HbA1c cutoffs with optimal cutoffs defined as the value that maximized the sum of sensitivity and specificity (Youden’s Index; YI).
Results:
In 5,324 black (32.3%) and white (67.7%) participants, YI (optimal) cutoffs were HbA1c ≥42 mmol/mol (6.0%) and ≥39 mmol/mol (5.7%) for discriminating diabetes vs. non-diabetes, HbA1c ≥ 44 mmol/mol (6.2%) and ≥39 mmol/mol (5.7%) for discriminating diabetes vs. prediabetes (excluding normoglycemia), HbA1c ≥39 mmol/mol (5.7%) and ≥37 mmol/mol (5.5%) for discriminating dysglycemia vs. normoglycemia, and HbA1c ≥39 mmol/mol (5.7%) and ≥37 mmol/mol (5.5%) for discriminating prediabetes vs. normoglycemia (excluding diabetes), in black and white people, respectively.
Conclusions:
Consistently higher optimal HbA1c cutoffs in black vs. white people suggest a need for individualizing HbA1c relative to glucose levels if HbA1c is used to diagnose diabetes and prediabetes.
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Pubmed ID:31187544
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Pubmed Central ID:PMC7282707
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