Navigation Links
Racial differences in diabetes diagnostic thresholds

BOSTON Healthcare providers should take into account differences among racial groups when using hemoglobin A1C levels to diagnose and monitor diabetes, new research from Beth Israel Deaconess Medical Center suggests.

In a study published Aug. 7 in the Annals of Internal Medicine, researchers analyzed National Health and Nutrition Survey data from 2005 to 2008 to examine the association between hemoglobin A1C levels in black and white adults and the risk for retinopathy, an eye complication of diabetes that is detectable early in the disease and can ultimately lead to blindness.

"There have been several studies indicating that hemoglobin A1C levels are consistently higher in blacks than in whites, even though underlying blood sugar levels are similar," said lead author Yusuke Tsugawa, MD, MPH, a primary care fellow at Beth Israel Deaconess Medical Center. "We looked at the data to determine if a higher diagnostic cutoff of A1C level should be used to diagnose diabetes in blacks than in whites, or if there should be a single cutoff for all races."

Diabetes has been historically diagnosed based on blood glucose tests, but in 2010 the International Expert Committee recommended adding hemoglobin A1C because it is a more reliable test that reflects average blood sugar over the past two to three months.

In line with the Expert Committee's recommendation, the World Health Organization and the American Diabetes Association subsequently adopted a hemoglobin A1C level of 6.5 percent or higher as a new diagnostic criterion for diabetes. For people who do not have diabetes, a normal hemoglobin A1C level is around 5 percent.

Given the evidence of naturally higher A1C levels in black people, the researchers expected to also find a delayed development of retinopathy in blacks compared to whites. Instead, the data showed that the A1C level where the risk of retinopathy begins to increase was paradoxically lower in black people compared to white people.

"Our study results show that the risk of diabetic retinopathy is higher for blacks at any given hemoglobin A1C level between 5 percent and 7 percent, and that the higher risk at a hemoglobin A1C level of 5.5 to 5.9 percent for blacks was comparable to the risk at a hemoglobin A1C level of 6.0 to 6.4 percent for whites," said Tsugawa. "This indicates that black people may be more vulnerable to high A1C status than whites."

Further research may bear out the team's hunch that the guidelines may serve those at risk for diabetes better if the diagnostic threshold were lowered for blacks compared to whites.

"Globally, diabetes is one of our most prevalent public health concerns, so this could have important health care delivery and health care policy implications" said Tsugawa. "It may be appropriate for doctors to more closely monitor for early diabetic complications for their black patients than for their white patients and black patients with diabetes may benefit from retinal exams at an earlier stage of their disease."

"And if future studies show that setting race-specific cutoff points for A1C is cost-effective, we might be able to trim healthcare expenditure in diabetes by targeting interventions toward specific, high-risk black populations," said Tsugawa.

The study was not able to examine how long individuals were at the observed A1C status. Since the development of retinopathy depends on both the level of elevated blood glucose and the duration at that level, further studies with repeated A1C measurements would lend greater validity, and give a fuller picture of the complex associations among A1C level, duration and race.

"Another unanswered question is the underlying mechanism as to why A1C levels are consistently higher in blacks than whites," said senior author Christina Wee, MD, MPH, Associate Section Chief for Research in the Division of General Medicine and Primary Care at BIDMC. "This may be due to biological differences or socio-behavioral differences including disparities in access to health and preventive care, which often lead to dramatically different policy implications. We're unclear on the cause, but we're certain it warrants further investigation."


Contact: Kelly Lawman
Beth Israel Deaconess Medical Center

Related medicine news :

1. Black gay men worldwide 15 times more likely to have HIV and racial disparity
2. New CDC study on racial disparities in infant mortality published in Journal of Womens Health
3. Multiracial youths show similar vulnerability to peer pressure as whites
4. Racial Gap in Kids Dental Care Vanishing: Study
5. Racial make-up of community impacts obesity risk
6. UC Irvine study finds racial, economic disparities in ovarian cancer care, survival
7. Mayo Clinic study links healthy muscle mass to healthy bones, finds differences by gender
8. Study finds significant skull differences between closely linked groups
9. More Evidence That Exercise Helps Fight Diabetes
10. Obesity in type 2 diabetes: Recommendations from guidelines are largely consistent
11. Weight Control Can Cut Womens Diabetes Risk, Study Shows
Post Your Comments:
(Date:11/27/2015)... ... November 27, 2015 , ... Consistent with the ... 2016 Building Better Radiology Marketing Programs meeting will showcase some of ... 6, 2016, at Caesars Palace in Las Vegas with a pre-conference session on ...
(Date:11/27/2015)... ... November 27, 2015 , ... The moment you stop ... not only fulfilling the needs of advisers and clients but going above and ... providing top-tier customer service. However, there's always room for improvement, which is why ...
(Date:11/27/2015)... (PRWEB) , ... November 27, 2015 , ... ... the largest, most successful and prominent nonprofit healthcare organizations in the country. They ... involvement with various organizations, and helped advance the healthcare industry as a whole ...
(Date:11/27/2015)... ... 2015 , ... Indosoft Inc., developer and distributor of the ... LTS (Long Term Support) into its Q-Suite 5.10 product line. , Making the ... a version of Asterisk that will receive not only security fixes, but feature ...
(Date:11/26/2015)... ... November 26, 2015 , ... CognisantMD ... for diagnostic imaging in the Waterloo region. Using the Ocean Platform, family physicians ... directly from their electronic medical record (EMR) without the need for redundant patient ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... , November 26, 2015 ... Juntendo universitetssjukhus ser potential att använda ... magnetresonansbilder (MR-bilder) för patienter med multipel ... ett forskningsavtal med SyntheticMR AB för att ... forskningsprojekt på sjukhuset. Med SyMRI kan man ...
(Date:11/26/2015)... , Nov. 26, 2015 Research ... addition of the "2016 Future Horizons and ... (TDM) Market: Supplier Shares, Country Segment Forecasts, Competitive ... --> --> ... analysis of the Italian therapeutic drug monitoring market, ...
(Date:11/25/2015)... Nov. 25, 2015  Amgen (NASDAQ: AMGN ) ... (BLA) with the United States ... a biosimilar candidate to Humira ® (adalimumab). Amgen ... submitted to the FDA and represents Amgen,s first BLA ... E. Harper , M.D., executive vice president of Research ...
Breaking Medicine Technology: