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. 2016 Feb;39(2):271-7.
doi: 10.2337/dc15-1699. Epub 2015 Dec 17.

A1C Combined With Glycated Albumin Improves Detection of Prediabetes in Africans: The Africans in America Study

Anne E Sumner  1 , Michelle T Duong  2 , Paola C Aldana  2 , Madia Ricks  2 , Marshall K Tulloch-Reid  3 , Jay N Lozier  4 , Stephanie T Chung  2 , David B Sacks  4
Affiliations

A1C Combined With Glycated Albumin Improves Detection of Prediabetes in Africans: The Africans in America Study

Anne E Sumner et al. Diabetes Care. 2016 Feb.

Abstract

Objective: Slowing the diabetes epidemic in Africa requires improved detection of prediabetes. A1C, a form of glycated hemoglobin A, is recommended for diagnosing prediabetes. The glycated proteins, fructosamine and glycated albumin (GA), are hemoglobin-independent alternatives to A1C, but their efficacy in Africans is unknown. Our goals were to determine the ability of A1C, fructosamine, and GA to detect prediabetes in U.S.-based Africans and the value of combining A1C with either fructosamine or GA.

Research design and methods: Oral glucose tolerance tests (OGTT) were performed in 217 self-identified healthy African immigrants (69% male, age 39 ± 10 years [mean ± SD], BMI 27.6 ± 4.5 kg/m(2)). A1C, fructosamine, and GA were measured. Prediabetes was diagnosed by American Diabetes Association criteria for glucose obtained from a 2-h OGTT. The thresholds to diagnose prediabetes by A1C, fructosamine, and GA were the cutoff at the upper tertile for each variable: ≥5.7% (39 mmol/mol) (range 4.2-6.6% [22.4-48.6 mmol/mol]), ≥230 µmol/L (range 161-269 µmol/L), and ≥13.35% (range 10.20-16.07%), respectively.

Results: Prediabetes occurred in 34% (74 of 217). The diagnostic sensitivities of A1C, fructosamine, and GA were 50%, 41%, and 42%, respectively. The P values for comparison with A1C were both >0.3. Combining A1C with either fructosamine or GA increased sensitivities. However, the sensitivity of A1C combined with fructosamine was not better than for A1C alone (72% vs. 50%, P = 0.172). In contrast, the sensitivity of A1C combined with GA was higher than for A1C alone (78% vs. 50%, P < 0.001).

Conclusions: As individual tests, A1C, fructosamine, and GA detected ≤50% of Africans with prediabetes. However, combining A1C with GA made it possible to identify nearly 80% of Africans with prediabetes.

Trial registration: ClinicalTrials.gov NCT00001853.

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Figures

Figure 1
Figure 1
Design of the Africans in America study evaluating the ability of A1C, fructosamine, and GA to detect prediabetes.
See this image and copyright information in PMC

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