Retinopathy develops at similar glucose levels but higher HbA 1c levels in people with black African ancestry compared to white European ancestry: evidence for the need to individualize HbA 1c interpretation.

Autor: Staimez LR; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA., Rhee MK; Atlanta Veterans Affairs Medical Centre, Decatur, GA, USA.; Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA., Deng Y; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA., Safo SE; Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA., Butler SM; Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA., Legvold BT; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA., Jackson SL; Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA., Ford CN; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA., Wilson PWF; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.; Atlanta Veterans Affairs Medical Centre, Decatur, GA, USA.; Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA., Long Q; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA., Phillips LS; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.; Atlanta Veterans Affairs Medical Centre, Decatur, GA, USA.; Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
Jazyk: angličtina
Zdroj: Diabetic medicine : a journal of the British Diabetic Association [Diabet Med] 2020 Jun; Vol. 37 (6), pp. 1049-1057. Date of Electronic Publication: 2020 Apr 25.
DOI: 10.1111/dme.14289
Abstrakt: Aims: To examine the association of HbA 1c and glucose levels with incident diabetic retinopathy according to black African or white European ancestry.
Methods: In this retrospective cohort study of 202 500 US Veterans with diabetes (2000-2014), measures included HbA 1c , outpatient random serum/plasma glucose, and incident retinopathy [conversion from negative to ≥2 positive evaluations (ICD-9 codes), without a subsequent negative].
Results: At baseline, the study population had a mean age of 59.3 years, their mean BMI was 31.9 kg/m 2 , HbA 1c level was 57 mmol/mol (7.4%) and glucose level was 8.8 mmol/l, and 77% were of white European ancestry (white individuals) and 21% of black African ancestry (black individuals). HbA 1c was 0.3% higher in black vs white individuals (P < 0.001), adjusting for baseline age, sex, BMI, estimated glomerular filtration rate (eGFR), haemoglobin, and average systolic blood pressure and glucose. Over 11 years, incident retinopathy occurred in 9% of black and 7% of white individuals, but black individuals had higher HbA 1c , glucose, and systolic blood pressure (all P < 0.001); adjusted for these factors, incident retinopathy was reduced in black vs white individuals (P < 0.001). The population incidence of retinopathy (7%) was associated with higher mean baseline HbA 1c in individuals with black vs white ancestry [63 mmol/mol (7.9%) vs 58 mmol/mol (7.5%); P < 0.001)], but with similar baseline glucose levels (9.0 vs 9.0 mmol/l; P = 0.660, all adjusted for baseline age, sex and BMI).
Conclusions: Since retinopathy occurs at higher HbA 1c levels in black people for a given level of average plasma glucose, strategies may be needed to individualize the interpretation of HbA 1c measurements.
(© 2020 Diabetes UK.)
Databáze: MEDLINE
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