Hird Thomas R, Partap Uttara, Moodley Pravi, Pirie Fraser J, Esterhuizen Tonya M, O'Leary Brian, McCarthy Mark I, Young Elizabeth H, Sandhu Manjinder S, Motala Ayesha A
Department for Health, University of Bath, Bath, UK.
Department of Medicine, University of Cambridge, Cambridge, UK.
Diabet Med. 2021 Nov;38(11):e14605. doi: 10.1111/dme.14605. Epub 2021 Jun 8.
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.
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.
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).
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.
南非的艾滋病毒感染和贫血负担较重。这些情况可能导致糖化血红蛋白（HbA）高估或低估血糖水平；然而，在非洲人群中尚未对此进行全面研究。我们评估了南非黑人人群中贫血、艾滋病毒感染和抗逆转录病毒疗法（ART）与HbA的关联，以及对糖尿病检测和诊断的影响。
在南非德班市伊泰夸尼市进行的这项基于人群的横断面研究中，我们对1067名无糖尿病诊断史的参与者进行了HbA评估，并进行了口服葡萄糖耐量试验（OGTT）、艾滋病毒诊断检测和全血细胞计数测量。采用线性回归分析贫血（对照：无贫血）、艾滋病毒感染及ART（对照：无艾滋病毒感染）状态对HbA的影响。比较了贫血患者以及未接受治疗和接受ART治疗的艾滋病毒感染者中基于HbA的糖尿病患病率与基于OGTT的患病率。
在调整分析中，与无贫血相比，正常细胞性贫血和小细胞性贫血与较高的HbA相关，而大细胞性贫血和接受ART治疗的艾滋病毒感染分别与低于无贫血和无艾滋病毒感染的HbA相关。然而，关联程度较小（范围：大细胞性贫血时β=-3.4 mmol/mol或-0.31%，p<0.001；小细胞性贫血时β=2.1 mmol/mol或0.19%，p<0.001）。贫血患者（2.9%对3.3%，p=0.69）、未接受治疗的艾滋病毒感染者（1.6%对1.6%，p=1.00）或接受ART治疗的艾滋病毒感染者（2.9%对1.2%，p=0.08）中，基于HbA或OGTT的糖尿病患病率无显著差异。
我们的结果表明，在该人群中，贫血和艾滋病毒感染状态似乎不太可能对HbA用于糖尿病检测和诊断的效用产生实质性影响。需要进一步研究以考察撒哈拉以南非洲人群中的这些关联。
