Ethnic Differences in Glycemic Markers in Patients With Type 2 Diabetes

OBJECTIVE: Recent studies have reported hemoglobin A(1c) (HbA(1c)) differences across ethnic groups that could limit its use in clinical practice. The authors of the A1C-Derived Average Glucose study have advocated to report HbA(1c) in estimated average glucose (AG) equivalents. The aim of this study was to assess the relationships between HbA(1c) and the mean of three 7-point self-monitored blood glucose (BG) profiles, and to assess whether estimated AG is an accurate measure of glycemia in different ethnic groups. RESEARCH DESIGN AND METHODS: We evaluated 1,879 participants with type 2 diabetes in the DURABLE trial who were 30 to 80 years of age, from 11 countries, and, according to self-reported ethnic origin, were Caucasian, of African descent (black), Asian, or Hispanic. We performed logistic regression of the relationship between the mean self-monitored BG and HbA(1c), and estimated AG, according to ethnic background. RESULTS: Baseline mean (SD) HbA(1c) was 9.0% (1.3) (75 [SD, 14] mmol/mol), and mean self-monitored BG was 12.1 mmol/L (3.1) (217 [SD, 55] mg/dL). In the clinically relevant HbA(1c) range of 7.0–9.0% (53–75 mmol/mol), non-Caucasian ethnic groups had 0.2–0.5% (2–6 mmol/mol) higher HbA(1c) compared with Caucasians for a given BG level. At the mean self-monitored BG levels ≤11.6 mmol/L, estimated AG overestimated the actual average BG; at levels >11.6 mmol/L, estimated AG underestimated the actual BG levels. CONCLUSIONS: For a given degree of glycemia, HbA(1c) levels vary among different ethnic groups. Ethnicity needs to be taken into account when using HbA(1c) to assess glycemic control or to set glycemic targets. Estimated AG is not a reliable marker for mean glycemia and therefore is of limited clinical value.