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Racial differences in diabetes diagnostic thresholds
Date:8/6/2012

eople 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 Car
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Contact: Kelly Lawman
klawman@bidmc.harvard.edu
617-667-7305
Beth Israel Deaconess Medical Center
Source:Eurekalert

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