Racial Differences in the Relationship of Glucose Concentrations and Hemoglobin A1c Levels
Racial Differences in the Relationship of Glucose Concentrations and Hemoglobin A1c Levels
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DOI：
10.7326/m16-2596
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发表时间：
2017-07-18
影响因子：
39.2
通讯作者：
Beck, Roy W.
中科院分区：
文献类型：
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作者：
Bergenstal, Richard M.;Gal, Robin L.;Beck, Roy W.
背景：在黑人中观察到的高于白人的血红蛋白A(1c) （HbA(1c)）水平是否由于血糖控制较差或血红蛋白糖化的种族差异而存在争议。目的：确定平均血糖和HbA（1c）的关系是否存在种族差异。设计：前瞻性，为期12周的观察性研究。环境：美国有10个糖尿病中心。参与者：104名黑人和104名白人，年龄在8岁或以上，患有1型糖尿病至少2年，HbA（1c）水平为6.0%至12.0%。测量方法：平均葡萄糖浓度，通过连续血糖监测测量，并与HbA（1c）、糖化白蛋白和果糖胺值进行种族比较。结果：黑人的平均HbA（1c）水平为9.1%，白人为8.3%。对于给定的HbA（1c）水平，黑人的平均葡萄糖浓度显著低于白人（P = 0.013），这反映在给定的平均葡萄糖浓度下，黑人的平均HbA（1c）值比白人高0.4个百分点（95% CI， 0.2至0.6个百分点）。相比之下，在糖化白蛋白和果糖胺水平与平均葡萄糖浓度的关系中，没有发现显著的种族差异（两种比较的P均为0.20）。局限性：HbA（1c）水平低于6.5%的参与者太少，无法将结果推广到这些个体。结论：平均而言，与白人相比，黑人的HbA（1c）水平高估了平均葡萄糖浓度，可能是由于血红蛋白糖化的种族差异。然而，由于种族只能部分解释黑人和白人之间观察到的HbA（1c）差异，未来的研究应侧重于识别和修改阻碍黑人糖尿病患者血糖控制改善的障碍。
Background: Debate exists as to whether the higher hemoglobin A(1c) (HbA(1c)) levels observed in black persons than in white persons are due to worse glycemic control or racial differences in the glycation of hemoglobin.Objective: To determine whether a racial difference exists in the relationship of mean glucose and HbA(1c).Design: Prospective, 12-week observational study.Setting: 10 diabetes centers in the United States.Participants: 104 black persons and 104 white persons aged 8 years or older who had had type 1 diabetes for at least 2 years and had an HbA(1c) level of 6.0% to 12.0%.Measurements: Mean glucose concentration, measured by using continuous glucose monitoring and compared by race with HbA(1c), glycated albumin, and fructosamine values.Results: The mean HbA(1c) level was 9.1% in black persons and 8.3% in white persons. For a given HbA(1c) level, the mean glucose concentration was significantly lower in black persons than in white persons (P = 0.013), which was reflected in mean HbA(1c) values in black persons being 0.4 percentage points (95% CI, 0.2 to 0.6 percentage points) higher than those in white persons for a given mean glucose concentration. In contrast, no significant racial differences were found in the relationship of glycated albumin and fructosamine levels with the mean glucose concentration (P > 0.20 for both comparisons).Limitation: There were too few participants with HbA(1c) levels less than 6.5% to generalize the results to such individuals.Conclusion: On average, HbA(1c) levels overestimate the mean glucose concentration in black persons compared with white persons, possibly owing to racial differences in the glycation of hemoglobin. However, because race only partially explains the observed HbA(1c) differences between black persons and white persons, future research should focus on identifying and modifying barriers impeding improved glycemic control in black persons with diabetes.