Should the Hemoglobin A1c Diagnostic Cutoff Differ Between Blacks and Whites?: A Cross-sectional Study

Tsugawa Y, Mukamal KJ, Davis RB, Taylor WC, Wee CC. Ann Intern Med. 2012;157(3):153-159. 

BACKGROUND Hemoglobin A1c (HbA1c) levels are known to be consistently higher in black persons than in white persons at any given glycemic level. Whether the optimal diagnostic threshold of HbA1c should differ between blacks and whites is unclear. 

OBJECTIVE To compare the relationships between HbA1c level and the prevalence of retinopathy in black and white U.S. adults. 

DESIGN Cross-sectional study. 

SETTING A nationally representative sample of the National Health and Nutrition Examination Survey from 2005 through 2008. 

PATIENTS 2804 white persons and 1008 black persons aged 40 years or older in the United States. 

MEASUREMENTS Prevalence of retinopathy. Logistic regression models and restricted cubic spline models were constructed separately for white and black populations to test the HbA1c levels at which risk for retinopathy begins to increase.

RESULTS After adjustment for age, sex, hypertension, body mass index, family history of diabetes, and use of antidiabetes medications or insulin, the lowest HbA1c category for which the prevalence of retinopathy was significantly higher than the reference category (<5.5%) was 6.0% to 6.4% for white persons (risk difference, 4.8% [95% CI, 0.5% to 9.1%]) and 5.5% to 5.9% for black persons (risk difference, 5.3% [CI, 1.0% to 9.5%]). The restricted cubic spline models indicated that the risk for retinopathy increased at lower HbA1c levels in black persons than in white persons.

LIMITATION The cross-sectional design of the study precluded examining the effect of the duration at each HbA1c level. 

CONCLUSION The prevalence of retinopathy begins to increase at a lower HbA1c level in black Americans than in white Americans. The findings do not support increasing the diagnostic threshold of HbA1c in black persons. 



August 2012 

Last Modified: 2/26/2013