Abstract P296: Racial Differences in Hyperglycemia: Comparative Prognostic Value of Traditional and Nontraditional Glycemic Markers
Background: Associations of nontraditional measures of hyperglycemia with clinical outcomes in blacks and whites are unknown and could help address the debate over race-specific cut-points for hemoglobin A1c (HbA1c).
Methods: We included 9,434 white and 2,898 black participants from the ARIC Study with measures of HbA1c, fructosamine, glycated albumin and 1,5-anhydroglucitol (1,5-AG) at visit 2 (1990-92). Diagnosed diabetes was defined by self-reported physician diagnosis of diabetes or glucose-lowering medication use. We created cut-points for the nontraditional markers corresponding to accepted HbA1c clinical cut-points. For each glycemic marker, we used Cox models to assess adjusted associations with incident coronary heart disease (CHD), ischemic stroke, heart failure and end-stage renal disease (ESRD) through 2011; and logistic regression for concurrent retinopathy. We included an interaction term for category of glycemia and race.
Results: Median levels in blacks versus whites without diagnosed diabetes were 5.7 and 5.4% for HbA1c; 234 and 225 μmol/L for fructosamine; 13.3 and 12.5% for glycated albumin; and 17.3 and 19.0 μg/mL for 1,5-AG, respectively. Median levels in blacks versus whites with diagnosed diabetes were 8.8 and 7.4% for HbA1c; 344 and 292 μmol/L for fructosamine; 22.5 and 17.7% for glycated albumin; and 3.5 and 6.6 μg/mL for 1,5-AG, respectively. Associations of hyperglycemia, as assessed by different glycemic markers, with CHD and ESRD were similar by race (p-values for interaction >0.20, Figure). Results were similar for stroke, heart failure and retinopathy (p-values for interaction >0.10).
Conclusions: Blacks had consistently higher levels of glycemia than whites as assessed by higher HbA1c, fructosamine, and glycated albumin, and lower 1,5-AG. However, associations of all glycemic markers with outcomes were similar by race. Our results support the use of similar clinical cut-points for diagnosis and management of diabetes using HbA1c in blacks and whites.
Author Disclosures: C.M. Parrinello: None. N.M. Maruthur: None. A.R. Sharrett: None. R. Klein: None. R. Bergenstal: H. Other; Modest; served on a scientific advisory board, consulted or performed clinical research with Abbott Diabetes Care, Bayer, Becton Dickinson, Boehringer Ingelheim, AstraZeneca, DexCom, Eli Lilly, Halozyme,, Hygieia, Johnson & Johnson, Medtronic, Merck, Novo Nordisk, Roche, Sanofi and Takeda, He has inherited Merck stock. He is a volunteer for ADA and JDRF.. M.E. Grams: None. J. Coresh: None. E. Selvin: None.
- © 2015 by American Heart Association, Inc.