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Racial Differences in Glycemic Markers: A Cross-sectional Analysis of Community-Based Data

Elizabeth Selvin, PhD, MPH; Michael W. Steffes, MD, PhD; Christie M. Ballantyne, MD; Ron C. Hoogeveen, PhD; Josef Coresh, MD, PhD; and Frederick L. Brancati, MD, MHS
[+] Article, Author, and Disclosure Information

From Johns Hopkins Bloomberg School of Public Health and Johns Hopkins University, Baltimore, Maryland; University of Minnesota, Minneapolis, Minnesota; and Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, Texas.

Acknowledgment: Reagents for the glycated albumin assays were provided by the Asahi Kasei Corporation.

Grant Support: By the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK) (grants R21 DK080294 and K01 DK076595 [Dr. Selvin] and K24 DK62222 [Dr. Brancati]) and by the Johns Hopkins Diabetes Research and Training Center (NIDDK grant P60 DK079637 [Dr. Brancati]). The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2806.

Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Selvin (e-mail, lselvin@jhsph.edu).

Requests for Single Reprints: Elizabeth Selvin, PhD, MPH, Welch Center for Prevention, Epidemiology and Clinical Research and the Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21287; e-mail, lselvin@jhsph.edu.

Current Author Addresses: Drs. Selvin, Coresh, and Brancati: Welch Center for Prevention, Epidemiology and Clinical Research and the Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21287.

Dr. Steffes: University of Minnesota, MMC 609, Room B203, Mayo, 420 Delaware Street SE, Minneapolis, MN 55455.

Dr. Ballantyne: Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, Room F756, Mail Station A601, Houston, TX 77030.

Dr. Hoogeveen: Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS F-701, Room F756, Mail Station F701, Houston, TX 77030.

Author Contributions: Conception and design: E. Selvin, F.L. Brancati.

Analysis and interpretation of the data: E. Selvin, M.W. Steffes, R.C. Hoogeveen.

Drafting of the article: E. Selvin.

Critical revision of the article for important intellectual content: E. Selvin, M.W. Steffes, C.M. Ballantyne, R.C. Hoogeveen, J. Coresh, F.L. Brancati.

Final approval of the article: E. Selvin, M.W. Steffes, R.C. Hoogeveen, J. Coresh, F.L. Brancati.

Provision of study materials or patients: R.C. Hoogeveen.

Statistical expertise: E. Selvin.

Obtaining of funding: E. Selvin.

Collection and assembly of data: E. Selvin, C.M. Ballantyne.

Ann Intern Med. 2011;154(5):303-309. doi:10.7326/0003-4819-154-5-201103010-00004
Text Size: A A A

Background: Although differences between black and white persons in hemoglobin A1c (HbA1c) values are well established, recent studies suggest that this might not reflect differences in glycemia.

Objective: To investigate racial disparities in glycemic markers, including those that reflect biological processes independent of hemoglobin glycation and erythrocyte turnover.

Design: Cross-sectional.

Setting: Community-based.

Participants: 1376 nondiabetic and 343 diabetic adults in a substudy of the Atherosclerosis Risk in Communities Study.

Measurements: Hemoglobin A1c, fasting glucose, glycated albumin, fructosamine, and 1,5-anhydroglucitol levels.

Results: Among persons with and without diabetes, black persons had significantly higher HbA1c, glycated albumin, and fructosamine levels than white persons before and after adjustment for covariates and fasting glucose concentration. Serum 1,5-anhydroglucitol levels, which are reduced in the setting of hyperglycemia-induced glycosuria, were lower in black persons than in white persons, although this difference was statistically significant only in nondiabetic adults.

Limitation: The design was cross-sectional, a limited number of participants with a history of diabetes was included, and the study did not include integrated measures of circulating nonfasting glycemia.

Conclusion: Differences between black and white persons in glycated albumin, fructosamine, and 1,5-anhydroglucitol levels parallel differences between these groups in HbA1c values. Racial differences in hemoglobin glycation and erythrocyte turnover cannot explain racial disparities in these serum markers. The possibility that black persons have systematically higher levels of nonfasting glycemia warrants further study.

Primary Funding Source: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.


Grahic Jump Location
Adjusted standardized difference in glycemic markers (95% CI), by race (black minus white) in persons with and without diabetes.

Adjusted for age, sex, systolic blood pressure, hypertension medication use, body mass index, low-density and high-density lipoprotein cholesterol levels, cholesterol-lowering medication use, cigarette smoking, prevalent coronary heart disease, education level, log-transformed C-reactive protein level, family history of diabetes, and fasting glucose level (except for the model of fasting glucose).

* Serum 1,5-anhydroglucitol is inversely related to glycemia-induced glycosuria.

Grahic Jump Location




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