Yusuke Tsugawa, MD, MPH; Kenneth J. Mukamal, MD, MPH; Christina C. Wee, MD, MPH
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2083.
Tsugawa Y, Mukamal KJ, Wee CC. Hemoglobin A1c Diagnostic Cutoff Differences Between Black and White Persons. Ann Intern Med. 2013;158:73-74. doi: 10.7326/0003-4819-158-1-201301010-00018
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Published: Ann Intern Med. 2013;158(1):73-74.
We thank Dr. Dagogo-Jack for his comments. We agree that the design of our study has important limitations—many of which we acknowledged in the paper—and that our results must be interpreted cautiously. Our main conclusion was that our findings do not support increasing the diagnostic threshold of HbA1c in black persons, given that HbA1c values seem higher in black persons than in white persons (1). Although our study did suggest the possibility that the risk for retinopathy begins to increase at lower HbA1c levels in black persons than in white persons, we were careful not to overinterpret these results and suggested future longitudinal studies with repeated measurements of HbA1c to confirm them. We agree that racial differences may exist in some other measures of glycemia, including glycated albumin (2).
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