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Relationship Between Average Glucose Levels and HbA1c Differs Across Racial Groups: A Substudy of the GRADE

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The link between average glucose and HbA1c varies by race. Non-Hispanic Black individuals had higher HbA1c for a given average glucose compared to non-Hispanic Whites, impacting diabetes management goals.

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Area of Science:

  • Endocrinology
  • Diabetes Mellitus Research
  • Clinical Chemistry

Background:

  • Hemoglobin A1c (HbA1c) is a key marker for long-term glucose control.
  • Previous studies suggest potential racial/ethnic differences in HbA1c accuracy.
  • Understanding these differences is crucial for equitable diabetes care.

Purpose of the Study:

  • To investigate if the relationship between average glucose (AG) and HbA1c differs across racial/ethnic groups.
  • To assess the impact of race on glucose monitoring metrics and their correlation with HbA1c.

Main Methods:

  • Prospective substudy of the GRADE trial involving 1,454 participants.
  • Utilized 10-day continuous glucose monitoring (CGM) to calculate average glucose (AG10).
  • Measured HbA1c, glycated albumin, fasting plasma glucose (FPG), and glucose area under the curve (AUC).

Main Results:

  • The relationship between AG10 and HbA1c significantly differed between non-Hispanic Black (NHB) and non-Hispanic White (NHW) individuals.
  • NHB patients showed higher HbA1c levels (0.2-0.6 percentage points) than NHW patients for similar AG10 levels (100-250 mg/dL).
  • These racial differences persisted after adjusting for demographic and other factors.

Conclusions:

  • Glucose measures, including average glucose, fasting plasma glucose, and glucose AUC, show a consistently different relationship with HbA1c and glycated albumin across racial groups.
  • These findings necessitate consideration when establishing diabetes treatment goals and diagnostic criteria for diverse populations.
  • Highlights the need for race-conscious interpretation of glycemic control markers.