Racial disparity in A1C independent of mean blood glucose in children with type 1 diabetes

Jodi L Kamps, James M Hempe, Stuart A Chalew, Jodi L Kamps, James M Hempe, Stuart A Chalew

Abstract

Objective: Mean blood glucose (MBG) and MBG-independent factors both influence A1C levels. Race was related to A1C independent of MBG in adults. The goal of this study was to determine if racial disparity exists in A1C independent of MBG in children with diabetes.

Research design and methods: Participants included 276 children with type 1 diabetes. A1C and MBG were obtained from multiple clinic visits, and a hemoglobin glycation index (HGI) (an assessment of A1C levels independent of MBG) was calculated. A1C and HGI were analyzed controlling for age, diabetes duration, and MBG. RESULTS African Americans had statistically significantly higher A1C (9.1 +/- 0.1) and HGI (0.64 +/- 0.11) than Caucasians (A1C 8.3 +/- 0.1, HGI -0.15 +/- 0.07) independent of covariates.

Conclusions: Because of racial disparity in A1C, which is independent of MBG, we recommend that A1C and MBG be used together to make therapeutic decisions for children with diabetes.

References

    1. Hempe JM, Gomez R, McCarter RJ, Jr, Chalew SA: High and low hemoglobin glycation phenotypes in type 1 diabetes: a challenge for interpretation of glycemic control. J Diabetes Complications 2002; 16: 313– 320
    1. McCarter RJ, Hempe JM, Gomez R, Chalew SA: Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1 diabetes. Diabetes Care 2004; 27: 1259– 1264
    1. McCarter RJ, Hempe JM, Chalew SA: Mean blood glucose and biological variation have greater influence on HbA1c levels than glucose instability: an analysis of data from the Diabetes Control and Complications Trial. Diabetes Care 2006; 29: 352– 355
    1. Kirk JK, D'Agostino RB, Jr, Bell RA, Passmore LV, Bonds DE, Karter AJ, Narayan KM: Disparities in HbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis. Diabetes Care 2006; 29: 2130– 2136
    1. Kirk JK, Passmore LV, Bell RA, Narayan KM, D'Agostino RB, Jr, Arcury TA, Quandt SA: Disparities in HbA1c levels between Hispanic and non-Hispanic white adults with diabetes: a meta-analysis. Diabetes Care 2008; 31: 240– 246
    1. Herman WH, Dungan KM, Wolffenbuttel BHR, Buse JB, Fahrbach JL, Jiang H, Martin S: Racial and ethnic differences in mean plasma glucose, hemoglobin A1c, and 1,5-anhydroglucitol in over 2000 patients with type 2 diabetes. J Clin Endorinol Metab 2009; 94: 1689– 1694
    1. Herman WH, Ma Y, Uwaifo G, Haffner S, Kahn SE, Horton ES, Lachin JM, Montez MG, Brenneman T, Barrett-Connor E: the Diabetes Prevention Program Research Group. Differences in A1C by race and ethnicity among patients with impaired glucose tolerance in the Diabetes Prevention Program. Diabetes Care 2007; 30: 2453– 2457
    1. Selvin E, Zhu H, Brancati FL: Elevated A1C in adults without a history of diabetes in the U.S. Diabetes Care 2009; 32: 828– 833
    1. Chalew SA, Gomez R, Butler A, Hempe J, Compton T, Mercante D, Rao J, Vargas A: Predictors of glycemic control in children with type 1 diabetes: the importance of race. J Diabetes Complications 2000; 14: 71– 77
    1. Saaddine JB, Fagot-Campagna A, Rolka D, Narayan KM, Geiss L, Eberhardt M, Flegal KM: Distribution of HbA1c levels for children and young adults in the U.S.: Third National Health and Nutrition Examination Survey. Diabetes Care 2002; 25: 1326– 1330
    1. Little RR, Rohlfing CL, Wiedmeyer HM, Myers GL, Sacks DB, Goldstein DE: the NGSP Steering Committee. The National Glycohemoglobin Standardization Program: a five-year progress report. Clin Chem 2001; 47: 1985– 1992
    1. Soros AA, Chalew SA, McCarter RJ, Shepard R, Hempe JM: Hemoglobin glycation index: a robust measure of hemoglobin A1c bias in pediatric type 1 diabetes patients. Pediatr Diabetes. 18January2010. [ Epub ahead of print]
    1. Gould BJ, Davie SJ, Yudkin JS: Investigation of the mechanism underlying the variability of glycated haemoglobin in non-diabetic subjects not related to glycaemia. Clin Chim Acta 1997; 260: 49– 64
    1. Delpierre G, Collard F, Fortpied J, Van Schaftingen E: Fructosamine 3-kinase is involved in intracellular deglycation pathway in human erythrocytes. Biochem J 2002; 365: 801– 808
    1. Arfken CL, Reno PL, Santiago JV, Klein R: Development of proliferative diabetic retinopathy in African-Americans and whites with type 1 diabetes. Diabetes Care 1998; 21: 792– 795

Source: PubMed

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