Racial and Ethnic Differences in the Relationship between HbA1c and Blood Glucose: Implications for the Diagnosis of Diabetes
Racial and Ethnic Differences in the Relationship between HbA1c and Blood Glucose: Implications for the Diagnosis of Diabetes
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DOI：
10.1210/jc.2011-1894
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发表时间：
2012-04-01
影响因子：
5.8
通讯作者：
Cohen, Robert M.
中科院分区：
文献类型：
--
作者：
Herman, William H.;Cohen, Robert M.
血红蛋白A1 c（HbA 1c）被广泛用作糖尿病平均血糖的指标，作为糖尿病并发症发生风险的衡量标准，以及作为糖尿病护理质量的衡量标准。在2010年，美国糖尿病协会建议，HbA 1c测试，在实验室使用由国家糖化血红蛋白标准化计划认证的方法进行，用于糖尿病的诊断。虽然HbA 1c与传统的血糖标准相比具有许多优点，但它也有许多缺点。血红蛋白病、地中海贫血综合征、影响红细胞存活和红细胞年龄的因素、尿毒症、高胆红素血症和缺铁可能会改变HbA 1c检测结果，作为平均HbA 1c的指标。最近，HbA 1c和血糖之间关系的种族和民族差异也被描述。虽然种族和民族差异的原因尚不清楚，但红细胞存活率、细胞外-细胞内葡萄糖平衡和血红蛋白糖化的非溶血性遗传决定因素等因素的差异正在被探讨。在这些差异的原因得到更明确的定义之前，依赖HbA 1c作为糖尿病诊断的唯一甚至首选标准可能会产生系统性错误和错误分类。在筛查和诊断糖尿病时，必须仔细考虑HbA 1c，并与传统的血糖标准结合使用。（临床内分泌代谢杂志97：1067-1072，2012）
Hemoglobin A1c (HbA1c) is widely used as an index of mean glycemia in diabetes, as a measure of risk for the development of diabetic complications, and as a measure of the quality of diabetes care. In 2010, the American Diabetes Association recommended that HbA1c tests, performed in a laboratory using a method certified by the National Glycohemoglobin Standardization Program, be used for the diagnosis of diabetes. Although HbA1c has a number of advantages compared to traditional glucose criteria, it has a number of disadvantages. Hemoglobinopathies, thalassemia syndromes, factors that impact red blood cell survival and red blood cell age, uremia, hyperbilirubinemia, and iron deficiency may alter HbA1c test results as a measure of average glycemia. Recently, racial and ethnic differences in the relationship between HbA1c and blood glucose have also been described. Although the reasons for racial and ethnic differences remain unknown, factors such as differences in red cell survival, extracellular-intracellular glucose balance, and nonglycemic genetic determinants of hemoglobin glycation are being explored as contributors. Until the reasons for these differences are more clearly defined, reliance on HbA1c as the sole, or even preferred, criterion for the diagnosis of diabetes creates the potential for systematic error and misclassification. HbA1c must be used thoughtfully and in combination with traditional glucose criteria when screening for and diagnosing diabetes. (J Clin Endocrinol Metab 97: 1067-1072, 2012)