No ethnic differences in the association of glycated hemoglobin with retinopathy: the national health and nutrition examination survey 2005-2008.
No ethnic differences in the association of glycated hemoglobin with retinopathy: the national health and nutrition examination survey 2005-2008.
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DOI：
10.2337/dc12-0404
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发表时间：
2013-03
期刊：
影响因子：
16.2
通讯作者：
Selvin E
中科院分区：
文献类型：
--
作者：
Bower JK;Brancati FL;Selvin E
目前关于在糖尿病筛查和诊断中使用血红蛋白 A1c (HbA1c) 的建议旨在识别糖尿病微血管并发症风险最高的人群。然而，目前关于 HbA1c 值种族差异的临床影响存在争议。本研究的目的是确定美国成年人代表性样本中 HbA1c 与视网膜病变之间的关联是否因种族群体而异。该研究对 2005-2008 年国家健康和营养检查调查中 2,945 名非西班牙裔白人、1,046 名非西班牙裔黑人和 1,231 名年龄≥40 岁的西班牙裔美国人参与者进行了横断面分析。在非糖尿病成年人中，非西班牙裔白人的平均 HbA1c 为 5.5%，非西班牙裔黑人为 5.7%，西班牙裔美国人为 5.6%。在确诊糖尿病的患者中，非西班牙裔白人的平均 HbA1c 为 6.9%，非西班牙裔黑人为 7.5%，西班牙裔美国人为 7.7%。总体而言，非西班牙裔黑人的视网膜病变患病率最高。在多变量逻辑模型中，HbA1c 临床类别与流行的视网膜病变密切相关。然而，相关性的大小并没有因种族群体而异（所有交互作用的 P 值≥ 0.7）。通过连续建模（每一个百分点）并按糖尿病状态分层（交互作用的所有 P > 0.3），观察到类似的结果。我们观察到 HbA1c 与视网膜病变的关系没有种族差异。这些数据不支持用于糖尿病诊断或筛查的特定种族 HbA1c 切点。
Current recommendations for the use of hemoglobin A1c (HbA1c) in diabetes screening and diagnosis aim to identify those at greatest risk for diabetic microvascular complications. However, there is current controversy regarding the clinical implications of ethnic differences in HbA1c values. The objective of this study was to determine whether the association between HbA1c and retinopathy differs by ethnic group in a representative sample of U.S. adults. The study was a cross-sectional analysis of 2,945 non-Hispanic white, 1,046 non-Hispanic black, and 1,231 Hispanic American participants aged ≥40 years from the 2005–2008 National Health and Nutrition Examination Survey. Among nondiabetic adults, the mean HbA1c was 5.5% in non-Hispanic whites, 5.7% in non-Hispanic blacks, and 5.6% in Hispanic Americans. Among those with diagnosed diabetes, mean HbA1c was 6.9% in non-Hispanic whites, 7.5% in non-Hispanic Blacks, and 7.7% in Hispanic Americans. Overall, non-Hispanic blacks had the highest prevalence of retinopathy. In multivariable logistic models, HbA1c clinical categories were strongly associated with prevalent retinopathy. However, the magnitude of the association did not differ by ethnic group (all P values for interaction ≥ 0.7). Similar results were observed with HbA1c modeled continuously (per one percentage point) and stratified by diabetes status (all P for interactions > 0.3). We observed no ethnic differences in the association of HbA1c with retinopathy. These data do not support ethnic-specific cut points for HbA1c for diagnosis or screening of diabetes mellitus.