Racial differences in performance of HbA1c for the classification of diabetes and prediabetes among US adults of non-Hispanic black and white race.
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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.
SUBMITTER: Ford CN
PROVIDER: S-EPMC7282707 | biostudies-literature | 2019 Oct
REPOSITORIES: biostudies-literature
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