This article is more than 5 years old. Information may no longer be current.
Meta-analysis estimates disparity in HbA1c for Hispanic patients
Click Here to Manage Email Alerts
Hispanic patients with diabetes demonstrated HbA1C levels that were an estimated 0.5% higher than non-Hispanic white patients with diabetes, according to a recent study.
Researchers at Wake Forest University School of Medicine in North Carolina and the Centers for Disease Control and Prevention in Atlanta conducted a meta-analysis of Hispanic and non-Hispanic patients with diabetes to determine the disparities in HbA1C levels between the two groups. The researchers reviewed data from 495 studies found on PubMed and other databases. Eleven of these studies met the inclusion criteria.
During the meta-analysis, researchers found a mean difference in HbA1C levels of –0.46 (P<0.0001), relating to HbA1C levels approximately 0.5% higher in Hispanic patients. The researchers found similar results when they grouped studies by design, HbA1C data collection method and care type.
Diabetes Care. 2008;31:240-246.
In this paper, the researchers are saying that HbA1c levels are higher in Hispanics than in non-Hispanic whites. Most would conclude that that meant blood sugar was worse in one group than in the other. That is one possible explanation, but it is not the only possible explanation. There are factors that cause HbA1c differences between groups besides just blood sugar. There are differences between HbA1c and other tests of blood sugar control which are persistent within individual people over time and may contribute to this.
We have published several papers on this concept, which we have called the glycation gap over the last several years. Dr.’s Harold Snieder and David Leslie and their colleagues have found evidence that genes affect HbA1c. We collaborated with them to show that that is through a mechanism other than blood sugar itself.
Dr. William Herman led a group from the Diabetes Prevention Program that showed in 2007 there are differences in HbA1c between people of different races that cannot be explained by differences in blood glucose control. That raises concerns that perhaps standard goals for diabetes treatment are not necessarily valid for all people equally and perhaps they need to be more individually tailored.
Clearly it’s important given the differences in prevalence of complications between Hispanics and non-Hispanic whites. So the challenge is to figure out whether we’re going to reduce the prevalence of complications strictly by improving blood sugar control and whether blood sugar goals should be the same for all. One of the questions is whether some of the factors affecting HbA1c besides blood sugar may actually alter the risk of complications. We’re currently conducting research to address that. We hope to publish results in the near future.
– Robert Cohen, MD
Associate Professor of Medicine at the University of Cincinnati College of Medicine