Selvin Elizabeth
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, and Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
Diabetes Care. 2016 Aug;39(8):1462-7. doi: 10.2337/dc16-0042.
Studies that have compared HbA1c levels by race have consistently demonstrated higher HbA1c levels in African Americans than in whites. These racial differences in HbA1c have not been explained by measured differences in glycemia, sociodemographic factors, clinical factors, access to care, or quality of care. Recently, a number of nonglycemic factors and several genetic polymorphisms that operate through nonglycemic mechanisms have been associated with HbA1c Their distributions across racial groups and their impact on hemoglobin glycation need to be systematically explored. Thus, on the basis of evidence for racial differences in HbA1c, current clinical guidelines from the American Diabetes Association state: "It is important to take…race/ethnicity…into consideration when using the A1C to diagnose diabetes." However, it is not clear from the guidelines how this recommendation might be actualized. So, the critical question is not whether racial differences in HbA1c exist between African Americans and whites; the important question is whether the observed differences in HbA1c level are clinically meaningful. Therefore, given the current controversy, we provide a Point-Counterpoint debate on this issue. In the preceding point narrative, Dr. Herman provides his argument that the failure to acknowledge that HbA1c might be a biased measure of average glycemia and an unwillingness to rigorously investigate this hypothesis will slow scientific progress and has the potential to do great harm. In the counterpoint narrative below, Dr. Selvin argues that there is no compelling evidence for racial differences in the validity of HbA1c as a measure of hyperglycemia and that race is a poor surrogate for differences in underlying causes of disease risk.-William T. CefaluEditor in Chief, Diabetes Care.
按种族比较糖化血红蛋白（HbA1c）水平的研究一直表明，非裔美国人的HbA1c水平高于白人。HbA1c的这些种族差异无法通过血糖测量差异、社会人口统计学因素、临床因素、医疗可及性或医疗质量来解释。最近，一些非血糖因素以及通过非血糖机制起作用的几种基因多态性与HbA1c相关。它们在不同种族群体中的分布及其对血红蛋白糖化的影响需要系统地探索。因此，基于HbA1c种族差异的证据，美国糖尿病协会当前的临床指南指出：“在使用A1C诊断糖尿病时，考虑……种族/族裔……很重要。”然而，从指南中尚不清楚该建议如何得以实施。所以，关键问题不是非裔美国人和白人之间HbA1c是否存在种族差异；重要的问题是观察到的HbA1c水平差异在临床上是否有意义。因此，鉴于当前的争议，我们提供关于这个问题的正反观点辩论。在前一篇正方叙述中，赫尔曼博士提出他的观点，即未能认识到HbA1c可能是平均血糖的有偏差测量指标，并且不愿意严格研究这一假设将减缓科学进步，并有可能造成巨大危害。在下面的反方叙述中，塞尔文博士认为，没有令人信服的证据表明HbA1c作为高血糖测量指标的有效性存在种族差异，而且种族是疾病风险潜在病因差异的一个糟糕替代指标。
——威廉·T·塞法卢
《糖尿病护理》主编
