HIV infection and anaemia do not affect HbA for the detection of diabetes in black South Africans: Evidence from the Durban Diabetes Study.

OBJECTIVE

South Africa has a high burden of HIV infection and anaemia. These conditions may cause HbA to over- or underestimate glycaemia; however, this has not been comprehensively investigated in African populations. We assessed the association of anaemia, HIV infection and antiretroviral therapy (ART) with HbA , and implications for the detection and diagnosis of diabetes, in a black South African population.

RESEARCH DESIGN AND METHODS

In this population-based cross-sectional study in eThekwini municipality (Durban), South Africa, we assessed HbA and conducted oral glucose tolerance tests (OGTTs), HIV diagnostic tests and full blood count measurements among 1067 participants without a history of diabetes diagnosis. Linear regression was used to examine differences in HbA by anaemia (comparator: no anaemia), or HIV and ART (comparator: no HIV) status. HbA -based diabetes prevalence was compared with OGTT-based prevalence among individuals with anaemia and with untreated and ART-treated HIV.

RESULTS

In adjusted analyses, normocytic and microcytic anaemia were associated with higher HbA compared with no anaemia, whereas macrocytic anaemia and ART-treated HIV were associated with lower HbA compared with no anaemia and no HIV, respectively. However, magnitudes of association were small (range:  = -3.4 mmol/mol or -0.31%, p < 0.001 [macrocytic anaemia] to = 2.1 mmol/mol or 0.19%, p < 0.001 [microcytic anaemia]). There was no significant difference in diabetes prevalence based on HbA or OGTT among individuals with anaemia (2.9% vs. 3.3%, p = 0.69), untreated HIV (1.6% vs. 1.6% p = 1.00) or ART-treated HIV (2.9% vs. 1.2%, p = 0.08).

CONCLUSIONS

Our results suggest that anaemia and HIV status appear unlikely to materially affect the utility of HbA for diabetes detection and diagnosis in this population. Further studies are needed to examine these associations in sub-Saharan African populations.