David C. Ziemer, MD, MPH; Paul Kolm, PhD; William S. Weintraub, MD; Viola Vaccarino, MD, PhD; Mary K. Rhee, MD, MS; Jennifer G. Twombly, MD, PhD; K.M. Venkat Narayan, MD, MPH, MBA; David D. Koch, PhD; Lawrence S. Phillips, MD
Ziemer DC, Kolm P, Weintraub WS, Vaccarino V, Rhee MK, Twombly JG, et al. Glucose-Independent, Black–White Differences in Hemoglobin A1c Levels: A Cross-sectional Analysis of 2 Studies. Ann Intern Med. 2010;152:770-777. doi: 10.7326/0003-4819-152-12-201006150-00004
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Published: Ann Intern Med. 2010;152(12):770-777.
A previous study of participants with prediabetes found that hemoglobin A1c (HbA1c) levels differed between black and white participants with no differences in glucose concentration.
To determine whether blackâ€“white differences in HbA1c level are present in other populations and across the full spectrum of glycemia.
1581 non-Hispanic black and white participants between 18 and 87 years of age without known diabetes in the SIGT (Screening for Impaired Glucose Tolerance) study and 1967 non-Hispanic black and white participants older than 40 years without known diabetes in the NHANES III (Third National Health and Nutrition Examination Survey).
HbA1c levels, anthropometry, and plasma glucose levels during oral glucose tolerance testing.
Hemoglobin A1c levels were higher in black than in white participants with normal glucose tolerance (0.13 percentage point [PÂ < 0.001] in the SIGT sample and 0.21 percentage point [PÂ < 0.001] in the NHANES III sample), prediabetes (0.26 percentage point [PÂ < 0.001] and 0.30 percentage point [PÂ < 0.001], respectively), or diabetes (0.47 percentage point [PÂ < 0.020] and 0.47 percentage point [PÂ < 0.013], respectively) after adjustment for plasma glucose levels and other characteristics known to correlate with HbA1c levels.
The mechanism for the differences is unknown.
Black persons have higher HbA1c levels than white persons across the full spectrum of glycemia, and the differences increase as glucose intolerance worsens. These findings could limit the use of HbA1c to screen for glucose intolerance, indicate the risk for complications, measure quality of care, and evaluate disparities in health.
National Institutes of Health and National Institute of Diabetes, Digestive, and Kidney Diseases.
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Cardiology, Endocrine and Metabolism, Diabetes, Coronary Risk Factors.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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