Glucose-Independent, Black-White Differences in Hemoglobin A1c Levels
Glucose-Independent, Black-White Differences in Hemoglobin A1c Levels
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DOI：
10.7326/0003-4819-152-12-201006150-00004
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发表时间：
2010-06-15
影响因子：
39.2
通讯作者：
Phillips, Lawrence S.
中科院分区：
文献类型：
--
作者：
Ziemer, David C.;Kolm, Paul;Phillips, Lawrence S.
背景：先前对糖尿病前期参与者的研究发现，在黑人和白人参与者中，糖化血红蛋白A(1c)(HbA(1c))水平不同，血糖浓度没有差异。目的：确定其他人群和整个血糖谱中是否存在HbA(1c)水平的黑人和白人差异。设计：横断面，研究对象：门诊患者。研究对象：在SIGT(糖耐量受损筛查)研究中，1581名年龄在18岁到87岁之间、没有糖尿病的非西班牙裔黑人和白人参与者，以及在NHANES III(第三次国家健康和营养检查调查)中，1967名年龄在40岁以上、没有糖尿病的非西班牙裔黑人和白人参与者。测量：糖耐量试验中的HBA(1c)水平、人体测量和血糖水平。结果：糖耐量正常的黑人患者的HbA(1c)水平高于白人(0.13个百分点[P<；0.001)、糖尿病前期(分别为0.26个百分点[P<；0.001]和0.30个百分点[P<；0.001])或糖尿病(分别为0.47个百分点[P<；0.020]和0.47个百分点[P<；0.013])。限制：这种差异的机制尚不清楚。结论：在整个血糖谱中，黑人的Hba(1c)水平高于白人，并且这种差异随着糖耐量异常的加重而增加。这些发现可能限制糖化血红蛋白(1c)在筛查糖耐量异常、指出并发症风险、测量护理质量和评估健康差异方面的使用。
Background: A previous study of participants with prediabetes found that hemoglobin A(1c) (HbA(1c)) levels differed between black and white participants with no differences in glucose concentration.Objective: To determine whether black-white differences in HbA(1c) level are present in other populations and across the full spectrum of glycemia.Design: Cross-sectional, retrospective.Setting: Outpatient.Participants: 1581 non-Hispanic black and white participants between 18 and 87 years of age without known diabetes in the SIGT (Screening for Impaired Glucose Tolerance) study and 1967 non-Hispanic black and white participants older than 40 years without known diabetes in the NHANES III (Third National Health and Nutrition Examination Survey).Measurements: HbA(1c) levels, anthropometry, and plasma glucose levels during oral glucose tolerance testing.Results: Hemoglobin A(1c) levels were higher in black than in white participants with normal glucose tolerance (0.13 percentage point [P < 0.001] in the SIGT sample and 0.21 percentage point [P < 0.001] in the NHANES III sample), prediabetes (0.26 percentage point [P < 0.001] and 0.30 percentage point [P < 0.001], respectively), or diabetes (0.47 percentage point [P < 0.020] and 0.47 percentage point [P < 0.013], respectively) after adjustment for plasma glucose levels and other characteristics known to correlate with HbA(1c) levels.Limitation: The mechanism for the differences is unknown.Conclusion: Black persons have higher HbA(1c) levels than white persons across the full spectrum of glycemia, and the differences increase as glucose intolerance worsens. These findings could limit the use of HbA(1c) to screen for glucose intolerance, indicate the risk for complications, measure quality of care, and evaluate disparities in health.