Cargando…

A1C Underperforms as a Diagnostic Test in Africans Even in the Absence of Nutritional Deficiencies, Anemia and Hemoglobinopathies: Insight From the Africans in America Study

Introduction: To improve detection of undiagnosed diabetes in Africa, there is movement to replace the OGTT with A1C. The performance of A1C in the absence of hemoglobin-related micronutrient deficiencies, anemia and heterozygous hemoglobinopathies is unknown. Therefore, we determined in 441 African...

Descripción completa

Detalles Bibliográficos
Autores principales: Briker, Sara M., Aduwo, Jessica Y., Mugeni, Regine, Horlyck-Romanovsky, Margrethe F., DuBose, Christopher W., Mabundo, Lilian S., Hormenu, Thomas, Chung, Stephanie T., Ha, Joon, Sherman, Arthur, Sumner, Anne E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692432/
https://www.ncbi.nlm.nih.gov/pubmed/31447780
http://dx.doi.org/10.3389/fendo.2019.00533
_version_ 1783443551100600320
author Briker, Sara M.
Aduwo, Jessica Y.
Mugeni, Regine
Horlyck-Romanovsky, Margrethe F.
DuBose, Christopher W.
Mabundo, Lilian S.
Hormenu, Thomas
Chung, Stephanie T.
Ha, Joon
Sherman, Arthur
Sumner, Anne E.
author_facet Briker, Sara M.
Aduwo, Jessica Y.
Mugeni, Regine
Horlyck-Romanovsky, Margrethe F.
DuBose, Christopher W.
Mabundo, Lilian S.
Hormenu, Thomas
Chung, Stephanie T.
Ha, Joon
Sherman, Arthur
Sumner, Anne E.
author_sort Briker, Sara M.
collection PubMed
description Introduction: To improve detection of undiagnosed diabetes in Africa, there is movement to replace the OGTT with A1C. The performance of A1C in the absence of hemoglobin-related micronutrient deficiencies, anemia and heterozygous hemoglobinopathies is unknown. Therefore, we determined in 441 African-born blacks living in America [male: 65% (281/441), age: 38 ± 10 y (mean ± SD), BMI: 27.5 ± 4.4 kg/m(2)] (1) nutritional and hematologic profiles and (2) glucose tolerance categorization by OGTT and A1C. Methods: Hematologic and nutritional status were assessed. Hemoglobin <11 g/dL occurred in 3% (11/441) of patients and led to exclusion. A1C and OGTT were performed in the remaining 430 participants. ADA thresholds for A1C and OGTT were used. Diagnosis by A1C required meeting either A1C-alone or A1C&OGTT criteria. Diagnosis by OGTT-alone required detection by OGTT and not A1C. Results: Hemoglobin, mean corpuscular volume and red blood cell distribution width were 14.0 ± 1.3 g/dL, 85.5 ± 5.3 fL, and 13.2 ± 1.2% respectively. B12, folate, and iron deficiency occurred in 1% (5/430), 0% (0/430), and 4% (12/310), respectively. Heterozygous hemoglobinopathy prevalence was 18% (78/430). Overall, diabetes prevalence was 7% (32/430). A1C detected diabetes in 32% (10/32) but OGTT-alone detected 68% (22/32). Overall prediabetes prevalence was 41% (178/430). A1C detected 57% (102/178) but OGTT-alone identified 43% (76/178). After excluding individuals with heterozygous hemoglobinopathies, the rate of missed diagnosis by A1C of abnormal glucose tolerance did not change (OR: 0.99, 95% CI: 0.61, 1.62). Conclusions: In nutritionally replete Africans without anemia or heterozygous hemoglobinopathy, if only A1C is used, ~60% with diabetes and ~40% with prediabetes would be undiagnosed. Clinical Trial Registration:: www.ClinicalTrials.gov, Identifier: NCT00001853
format Online
Article
Text
id pubmed-6692432
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-66924322019-08-23 A1C Underperforms as a Diagnostic Test in Africans Even in the Absence of Nutritional Deficiencies, Anemia and Hemoglobinopathies: Insight From the Africans in America Study Briker, Sara M. Aduwo, Jessica Y. Mugeni, Regine Horlyck-Romanovsky, Margrethe F. DuBose, Christopher W. Mabundo, Lilian S. Hormenu, Thomas Chung, Stephanie T. Ha, Joon Sherman, Arthur Sumner, Anne E. Front Endocrinol (Lausanne) Endocrinology Introduction: To improve detection of undiagnosed diabetes in Africa, there is movement to replace the OGTT with A1C. The performance of A1C in the absence of hemoglobin-related micronutrient deficiencies, anemia and heterozygous hemoglobinopathies is unknown. Therefore, we determined in 441 African-born blacks living in America [male: 65% (281/441), age: 38 ± 10 y (mean ± SD), BMI: 27.5 ± 4.4 kg/m(2)] (1) nutritional and hematologic profiles and (2) glucose tolerance categorization by OGTT and A1C. Methods: Hematologic and nutritional status were assessed. Hemoglobin <11 g/dL occurred in 3% (11/441) of patients and led to exclusion. A1C and OGTT were performed in the remaining 430 participants. ADA thresholds for A1C and OGTT were used. Diagnosis by A1C required meeting either A1C-alone or A1C&OGTT criteria. Diagnosis by OGTT-alone required detection by OGTT and not A1C. Results: Hemoglobin, mean corpuscular volume and red blood cell distribution width were 14.0 ± 1.3 g/dL, 85.5 ± 5.3 fL, and 13.2 ± 1.2% respectively. B12, folate, and iron deficiency occurred in 1% (5/430), 0% (0/430), and 4% (12/310), respectively. Heterozygous hemoglobinopathy prevalence was 18% (78/430). Overall, diabetes prevalence was 7% (32/430). A1C detected diabetes in 32% (10/32) but OGTT-alone detected 68% (22/32). Overall prediabetes prevalence was 41% (178/430). A1C detected 57% (102/178) but OGTT-alone identified 43% (76/178). After excluding individuals with heterozygous hemoglobinopathies, the rate of missed diagnosis by A1C of abnormal glucose tolerance did not change (OR: 0.99, 95% CI: 0.61, 1.62). Conclusions: In nutritionally replete Africans without anemia or heterozygous hemoglobinopathy, if only A1C is used, ~60% with diabetes and ~40% with prediabetes would be undiagnosed. Clinical Trial Registration:: www.ClinicalTrials.gov, Identifier: NCT00001853 Frontiers Media S.A. 2019-08-07 /pmc/articles/PMC6692432/ /pubmed/31447780 http://dx.doi.org/10.3389/fendo.2019.00533 Text en Copyright © 2019 Briker, Aduwo, Mugeni, Horlyck-Romanovsky, DuBose, Mabundo, Hormenu, Chung, Ha, Sherman and Sumner. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Briker, Sara M.
Aduwo, Jessica Y.
Mugeni, Regine
Horlyck-Romanovsky, Margrethe F.
DuBose, Christopher W.
Mabundo, Lilian S.
Hormenu, Thomas
Chung, Stephanie T.
Ha, Joon
Sherman, Arthur
Sumner, Anne E.
A1C Underperforms as a Diagnostic Test in Africans Even in the Absence of Nutritional Deficiencies, Anemia and Hemoglobinopathies: Insight From the Africans in America Study
title A1C Underperforms as a Diagnostic Test in Africans Even in the Absence of Nutritional Deficiencies, Anemia and Hemoglobinopathies: Insight From the Africans in America Study
title_full A1C Underperforms as a Diagnostic Test in Africans Even in the Absence of Nutritional Deficiencies, Anemia and Hemoglobinopathies: Insight From the Africans in America Study
title_fullStr A1C Underperforms as a Diagnostic Test in Africans Even in the Absence of Nutritional Deficiencies, Anemia and Hemoglobinopathies: Insight From the Africans in America Study
title_full_unstemmed A1C Underperforms as a Diagnostic Test in Africans Even in the Absence of Nutritional Deficiencies, Anemia and Hemoglobinopathies: Insight From the Africans in America Study
title_short A1C Underperforms as a Diagnostic Test in Africans Even in the Absence of Nutritional Deficiencies, Anemia and Hemoglobinopathies: Insight From the Africans in America Study
title_sort a1c underperforms as a diagnostic test in africans even in the absence of nutritional deficiencies, anemia and hemoglobinopathies: insight from the africans in america study
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692432/
https://www.ncbi.nlm.nih.gov/pubmed/31447780
http://dx.doi.org/10.3389/fendo.2019.00533
work_keys_str_mv AT brikersaram a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy
AT aduwojessicay a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy
AT mugeniregine a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy
AT horlyckromanovskymargrethef a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy
AT dubosechristopherw a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy
AT mabundolilians a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy
AT hormenuthomas a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy
AT chungstephaniet a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy
AT hajoon a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy
AT shermanarthur a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy
AT sumnerannee a1cunderperformsasadiagnostictestinafricansevenintheabsenceofnutritionaldeficienciesanemiaandhemoglobinopathiesinsightfromtheafricansinamericastudy