Racial differences in glycemic markers: a cross-sectional analysis of community-based data

Abstract

Background: Although differences between black and white persons in hemoglobin A(1c) (HbA(1c)) values are well established, recent studies suggest that this might not reflect differences in glycemia.

Objective: To investigate racial disparities in glycemic markers, including those that reflect biological processes independent of hemoglobin glycation and erythrocyte turnover.

Design: Cross-sectional.

Setting: Community-based.

Participants: 1376 nondiabetic and 343 diabetic adults in a substudy of the Atherosclerosis Risk in Communities Study.

Measurements: Hemoglobin A(1c), fasting glucose, glycated albumin, fructosamine, and 1,5-anhydroglucitol levels.

Results: Among persons with and without diabetes, black persons had significantly higher HbA(1c), glycated albumin, and fructosamine levels than white persons before and after adjustment for covariates and fasting glucose concentration. Serum 1,5-anhydroglucitol levels, which are reduced in the setting of hyperglycemia-induced glycosuria, were lower in black persons than in white persons, although this difference was statistically significant only in nondiabetic adults.

Limitation: The design was cross-sectional, a limited number of participants with a history of diabetes was included, and the study did not include integrated measures of circulating nonfasting glycemia.

Conclusion: Differences between black and white persons in glycated albumin, fructosamine, and 1,5-anhydroglucitol levels parallel differences between these groups in HbA(1c) values. Racial differences in hemoglobin glycation and erythrocyte turnover cannot explain racial disparities in these serum markers. The possibility that black persons have systematically higher levels of nonfasting glycemia warrants further study.

Primary funding source: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.

Figure

Adjusted standardized difference in glycemic markers (95%CI), by race (black or white) in persons with and without diabetes. Adjusted for age, sex, systolic blood pressure, hypertension medication use, body mass index, low-density and high-density lipoprotein cholesterol levels, cholesterol-lowering medication use, cigarette smoking, prevalent coronary heart disease, education level, log-transformed C-reactive protein, family history of diabetes, and fasting glucose level (except for the model of fasting glucose). * Serum 1,5-anhydroglucitol is inversely related to glycemia-induced glycosuria.