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Diabet Med. 2019 Jun 12. doi: 10.1111/dme.13979. [Epub ahead of print]

Racial differences in performance of HbA1c for the classification of diabetes and prediabetes among US adults of non-Hispanic black and white race.

Author information

1
Emory Global Diabetes Research Centre, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
2
Nutrition and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
3
Atlanta VA Medical Centre, Decatur, GA, USA.
4
Division of Endocrinology and Metabolism, Department of Medicine, Emory University, Atlanta, GA, USA.
5
Division for Heart Disease and Stroke Prevention, National Centre for Chronic Disease Prevention and Health Promotion, Centres for Disease Control and Prevention, Atlanta, GA, USA.
6
Division of Cardiology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.

Abstract

AIM:

To characterize differences between black and white people in optimal HbA1c thresholds for diagnoses of diabetes and prediabetes.

METHODS:

Data were included from the National Health and Nutrition Examination Survey, 2005-2014. Black and white adults (age 18-70 years) who underwent an oral glucose tolerance test and had available fasting plasma glucose, 2-h plasma glucose and HbA1c measurements were eligible for inclusion. Diabetes or prediabetes status was defined by fasting plasma glucose and 2-h plasma glucose using American Diabetes Association criteria. Classification of diabetes, prediabetes and dysglycaemia by HbA1c was evaluated for a range of HbA1c thresholds, with optimal thresholds defined as those values that maximized the sum of sensitivity and specificity (Youden's index).

RESULTS:

In 5324 black (32.3%) and white (67.7%) individuals, Youden's index (optimal) thresholds for HbA1c were ≥42 mmol/mol (6.0%) and ≥39 mmol/mol (5.7%) for discriminating diabetes vs non-diabetes, ≥ 44 mmol/mol (6.2%) and ≥39 mmol/mol (5.7%) for discriminating diabetes vs prediabetes (excluding normoglycaemia), ≥39 mmol/mol (5.7%) and ≥37 mmol/mol (5.5%) for discriminating dysglycaemia vs normoglycaemia, and ≥39 mmol/mol (5.7%) and ≥37 mmol/mol (5.5%) for discriminating prediabetes vs normoglycaemia (excluding diabetes), in black and white people, respectively.

CONCLUSIONS:

Consistently higher optimal HbA1c thresholds in black people than in white people suggest a need to individualize HbA1c relative to glucose levels if HbA1c is used to diagnose diabetes and prediabetes.

PMID:
31187544
DOI:
10.1111/dme.13979

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