Racial Differences in and Prognostic Value of Biomarkers of Hyperglycemia

Parrinello, Christina M.; Sharrett, A. Richey; Maruthur, Nisa M.; Bergenstal, Richard M.; Grams, Morgan E.; Selvin, Elizabeth

doi:10.2337/dc15-1360

Cited by 23 publications

(18 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In other studies in ARIC, we also observed that associations of nontraditional biomarkers of hyperglycemia (fructosamine and glycated albumin) with clinical outcomes were also similar in blacks and whites (39). Ultimately, the literature suggests that HbA 1c is a similarly valid diagnostic and prognostic tool in persons of different races/ethnicities and supports recommendations for using the same HbA 1c diagnostic cut points across racial/ethnic groups (10,70).…”

Section: Prognostic Value Of Hba1c In Different Racial/ethnic Groupssupporting

confidence: 76%

“…Importantly, the higher levels of HbA 1c are also seen for other biomarkers of chronic hyperglycemia, specifically fructosamine and glycated albumin (39–42). Because fructosamine and glycated albumin are unaffected by the hematologic factors that might affect HbA 1c , racial differences in erythrocyte turnover or hemoglobin glycation cannot explain racial differences in these hemoglobin-independent serum biomarkers of hyperglycemia.…”

Section: What Might Explain Racial Differences In Hba1c?mentioning

confidence: 99%

See 1 more Smart Citation

Are There Clinical Implications of Racial Differences in HbA1c? A Difference, to Be a Difference, Must Make a Difference

Selvin

2016

Diabetes Care

Self Cite

View full text Add to dashboard Cite

Studies that have compared HbA1c levels by race have consistently demonstrated higher HbA1c levels in African Americans than in whites. These racial differences in HbA1c have not been explained by measured differences in glycemia, sociodemographic factors, clinical factors, access to care, or quality of care. Recently, a number of nonglycemic factors and several genetic polymorphisms that operate through nonglycemic mechanisms have been associated with HbA1c. Their distributions across racial groups and their impact on hemoglobin glycation need to be systematically explored. Thus, on the basis of evidence for racial differences in HbA1c, current clinical guidelines from the American Diabetes Association state: “It is important to take…race/ethnicity…into consideration when using the A1C to diagnose diabetes.” However, it is not clear from the guidelines how this recommendation might be actualized. So, the critical question is not whether racial differences in HbA1c exist between African Americans and whites; the important question is whether the observed differences in HbA1c level are clinically meaningful. Therefore, given the current controversy, we provide a Point-Counterpoint debate on this issue. In the preceding point narrative, Dr. Herman provides his argument that the failure to acknowledge that HbA1c might be a biased measure of average glycemia and an unwillingness to rigorously investigate this hypothesis will slow scientific progress and has the potential to do great harm. In the counterpoint narrative below, Dr. Selvin argues that there is no compelling evidence for racial differences in the validity of HbA1c as a measure of hyperglycemia and that race is a poor surrogate for differences in underlying causes of disease risk.—William T. CefaluEditor in Chief, Diabetes Care

show abstract

Section: Prognostic Value Of Hba1c In Different Racial/ethnic Groupssupporting

confidence: 76%

Section: What Might Explain Racial Differences In Hba1c?mentioning

confidence: 99%

Are There Clinical Implications of Racial Differences in HbA1c? A Difference, to Be a Difference, Must Make a Difference

Selvin

2016

Diabetes Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…l,5-AG is inversely associated with blood glucose concentrations as a result of competitive inhibition by glucose in the proximal tubule [4] and is thought to be useful for intermediate-term monitoring of glycaemic variability in people with diabetes [5]. In epidemiological studies, low concentrations have been associated with greater diabetes risk [6,7] and, in the setting of diabetes with retinopathy, chronic kidney disease [7][8][9] and cardiovascular disease [10,11]. In people without diabetes, 1,5-AG may reflect carbohydrate digestion [12,13].…”

Section: Introductionmentioning

confidence: 99%

Effects of dietary carbohydrate on 1,5‐anhydroglucitol in a population without diabetes: results from the OmniCarb trial

et al. 2017

View full text Add to dashboard Cite

Background 1,5-anhydroglucitol (1,5-AG) is monosaccharide derived from foods that can be used to monitor hyperglycemic excursions in diabetes. Determinants of 1,5-AG in persons without diabetes are largely uncharacterized and the effects of dietary changes in amount and type of carbohydrates on 1,5-AG are unknown. Methods We conducted an ancillary study to a completed, randomized clinical trial in overweight and obese adults without diabetes (N=159). Using a crossover design, participants were fed each of four diets for 5-weeks with 2-week intervening washout periods. The four diets were: high glycemic index (GI≥65) with high %carb (58% kcal), low GI (GI≤45) with low %carb (40% kcal), low GI with high %carb; and high GI with low %carb. Plasma 1,5-AG was measured at baseline and after each feeding period. Results At baseline, participants were mean age 53 years (53% female, 52% non-Hispanic black, 50% obese). Mean fasting glucose and 1,5-AG were 97 mg/dL (5.4 mmol/L) and 18.6 μg/mL (113.3 μmol/L). Compared to baseline, each of the 4 randomized diets reduced 1,5-AG −2.4 to −3.7 μg/mL (−14.6 to −22.5 μmol/L); all P-values <0.001). Reducing either glycemic index or proportion of carbohydrates lowered 1,5-AG. These effects were additive, such that reducing both glycemic index and proportion carbohydrate decreased 1,5-AG by −1.31 μg/mL (−1.63, −0.99; P<0.001; −8.0; −9.9, −6.0 μmol/L). Furthermore, these effects were confirmed in a subgroup with 12 hour glucose monitoring and no documented hyperglycemia (fasting glucose <160 mg/dL or 8.9 mmol/L). Conclusions Both type and amount of dietary carbohydrates affect 1,5-AG plasma concentrations in adults without diabetes. This finding contradicts the long-standing notion that 1,5-AG remains at constant concentrations in the blood in the absence of hyperglycemic excursions.

show abstract

“…In the United States, young people of African descent have increased risk of short‐term complications (ketoacidosis and severe hypoglycemia) when adjusted for socioeconomic status, and higher HbA1c even when adjusted for mean glucose levels . HbA1c was higher even when fasting glucose is <7 mmol/L in black individuals both with and without diabetes compared with white, but the prognostic value of HbA1c for predicting cardiovascular disease, nephropathy and retinopathy were similar …”

Section: Care For the Preschool Child With Type 1 Diabetes In Limitedmentioning

confidence: 99%

“…171 HbA1c was higher even when fasting glucose is <7 mmol/L in black individuals both with and without diabetes compared with white, but the prognostic value of HbA1c for predicting cardiovascular disease, nephropathy and retinopathy were similar. 172 The financial issues need to be addressed upfront by the treating team. The challenge of finding ways to support the families lies chiefly with the care providers.…”

Section: Care For the Preschool Child With Type 1 Diabetes In Limitmentioning

confidence: 99%

Managing diabetes in preschool children

et al. 2017

View full text Add to dashboard Cite

Racial Differences in and Prognostic Value of Biomarkers of Hyperglycemia

Cited by 23 publications

References 41 publications

Are There Clinical Implications of Racial Differences in HbA1c? A Difference, to Be a Difference, Must Make a Difference

Are There Clinical Implications of Racial Differences in HbA1c? A Difference, to Be a Difference, Must Make a Difference

Effects of dietary carbohydrate on 1,5‐anhydroglucitol in a population without diabetes: results from the OmniCarb trial

Managing diabetes in preschool children

Contact Info

Product

Resources

About