Division of Pediatric Endocrinology/Diabetes, LSUHSC, School of Medicine, Children's Hospital of New Orleans, New Orleans, Louisiana, USA.
Pediatr Diabetes. 2020 Jun;21(4):615-620. doi: 10.1111/pedi.13002. Epub 2020 Mar 10.
Black patients have higher HbA1c than Whites even after adjustment for mean blood glucose (MBG). Decreased iron status has been associated with increased HbA1c independently of glucose. We hypothesized that decreased iron status might account for higher HbA1c in Black patients.
Pediatric patients with T1D in the Diabetes Center at Children's Hospital of New Orleans who self-identified as either Black or White were recruited for the study. At the time of their clinic visit labs were obtained for ferritin (Fer), soluble transferrin receptor (sTfR), HbA1c, and CBC. MBG was derived from patient's home glucose meter records over the last 30 days. Total body iron (TBI) and sTfr/log Fer (R/lFer) were calculated.
A total of 80 (35 Blacks/45 Whites; 41 female/39 male) patients were recruited. Unadjusted levels of HbA1c, MBG, sTfR, Fer, RDW-CV, and RDW-SD were all higher in Blacks than Whites. TBI and R/lFer were not different between groups. Fer was correlated with Hb, MBG but not HbA1c. sTfR was correlated with HbA1c, MCV, MCH, and RDW-SD. In multiple variable analysis with HbA1c as the dependent variable, race and MBG were statistically significant in the model. However, measures of iron status: Fer, sTfR, R/lFer and TBI were not statistically influential.
After adjustment for race, MBG and RDW-CV, iron indices were not statistically significant independent predictors of HbA1c levels. These observations indicate that factors besides iron status and CBC indices contribute to MBG-independent racial disparity in HbA1c.
即使在调整平均血糖（MBG）后，黑人患者的 HbA1c 也高于白人。铁状态下降与 HbA1c 升高独立相关，而与葡萄糖无关。我们假设铁状态下降可能是导致黑人患者 HbA1c 升高的原因。
新奥尔良儿童医院糖尿病中心的 T1D 患儿自我认同为黑人或白人，招募他们参加这项研究。在就诊时，采集铁蛋白（Fer）、可溶性转铁蛋白受体（sTfR）、HbA1c 和 CBC 等实验室检查结果。MBG 来源于患者过去 30 天的家庭血糖仪记录。计算总铁量（TBI）和 sTfr/log Fer（R/lFer）。
共招募了 80 名（35 名黑人/45 名白人；41 名女性/39 名男性）患者。未调整的 HbA1c、MBG、sTfR、Fer、RDW-CV 和 RDW-SD 水平在黑人中均高于白人。两组间 TBI 和 R/lFer 无差异。Fer 与 Hb、MBG 相关，但与 HbA1c 无关。sTfR 与 HbA1c、MCV、MCH 和 RDW-SD 相关。在以 HbA1c 为因变量的多变量分析中，种族和 MBG 在模型中具有统计学意义。然而，铁状态的测量值：Fer、sTfR、R/lFer 和 TBI 对 HbA1c 水平没有统计学影响。
在调整种族、MBG 和 RDW-CV 后，铁状态指标并不是 HbA1c 水平的统计学上显著的独立预测因素。这些观察结果表明，除了铁状态和 CBC 指标外，还有其他因素导致 HbA1c 方面存在与 MBG 无关的种族差异。
