Clinical Affairs, Abbott Diabetes Care, Alameda, California, USA.
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
BMJ Open Diabetes Res Care. 2024 Mar 4;12(2):e003470. doi: 10.1136/bmjdrc-2023-003470.
Identify non-glycemic factors affecting the relationship between fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c), in order to refine diabetes diagnostic criteria.
Relationship between FPG-HbA1c was assessed in 12 531 individuals from 2001 to 2018 US National Health and Nutrition Examination Survey. Using a recently described method, FPG and HbA1c were used to calculate apparent glycation ratio (AGR) of red blood cells for different subgroups based on age, race, and gender.
At an FPG of 7 mmol/L, black individuals had a higher HbA1c (p<0.001, mean: 50.2 mmol/mol, 95% CI (49.8 to 50.4)) compared with white individuals (47.4 mmol/mol (47.2 to 47.5)). This corresponds to NGSP (National Glycohemoglobin Standardization Program) units of 6.7% and 6.5% for black versus white individuals, respectively. Similarly, individuals under 21 years had lower HbA1c (p<0.001, 47.9 mmol/mol (47.7 to 48.1), 6.5%) compared with those over 50 years (48.3 mmol/mol (48.2 to 48.5), 6.6%). Differences were also observed between women (p<0.001, 49.2 mmol/mol (49.1 to 49.3), 6.7%) and men (47.0 mmol/mol (46.8 to 47.1), 6.5%). Of note, the difference in HbA1c at FPG of 7 mmol/L in black females over 50 and white males under 21 years was 5 mmol/mol (0.46%). AGR differences according to race (p<0.001), age (p<0.001), and gender (p<0.001) explained altered glucose-HbA1c relationship in the analyzed groups.
FPG-HbA1c relationship is affected by non-glycemic factors leading to incorrect diagnosis of diabetes in some individuals and ethnic groups. Assessment of AGR helps understand individual-specific relationship between glucose levels and HbA1c, which has the potential to more accurately diagnose and manage diabetes.
确定影响空腹血糖（FPG）与糖化血红蛋白（HbA1c）之间关系的非血糖因素，以完善糖尿病诊断标准。
评估了 2001 年至 2018 年美国国家健康和营养调查中 12531 名个体的 FPG-HbA1c 关系。使用最近描述的方法，根据年龄、种族和性别，为不同亚组的红细胞计算表观糖化比（AGR）。
在 FPG 为 7mmol/L 时，黑人个体的 HbA1c 较高（p<0.001，平均值：50.2mmol/mol，95%CI（49.8 至 50.4）），与白人个体（47.4mmol/mol（47.2 至 47.5））相比。这相当于 NGSP（国家糖化血红蛋白标准化计划）单位黑人分别为 6.7%和 6.5%，白人分别为 6.5%和 6.7%。同样，21 岁以下个体的 HbA1c 较低（p<0.001，47.9mmol/mol（47.7 至 48.1），6.5%），与 50 岁以上个体相比（48.3mmol/mol（48.2 至 48.5），6.6%）。女性（p<0.001，49.2mmol/mol（49.1 至 49.3），6.7%）和男性（47.0mmol/mol（46.8 至 47.1），6.5%）之间也存在差异。值得注意的是，50 岁以上黑人女性和 21 岁以下白人男性的 FPG 为 7mmol/L 时，HbA1c 差异为 5mmol/mol（0.46%）。根据种族（p<0.001）、年龄（p<0.001）和性别（p<0.001）的 AGR 差异解释了分析组中葡萄糖-HbA1c 关系的改变。
FPG-HbA1c 关系受非血糖因素影响，导致某些个体和人群中糖尿病诊断不正确。评估 AGR 有助于了解个体特定的血糖水平与 HbA1c 之间的关系，这有可能更准确地诊断和管理糖尿病。
