Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda.
Department of Pediatrics, University of Nairobi, Nairobi, Kenya.
Pediatr Diabetes. 2023;2023. doi: 10.1155/2023/1179830. Epub 2023 Apr 24.
The relationship of HbA1c versus the mean blood glucose (MBG) is an important guide for diabetes management but may differ between ethnic groups. In Africa, the patient's glucose information is limited or unavailable and the management is largely guided by HbA1c. We sought to determine if the reference data derived from the non-African populations led to an appropriate estimation of MBG from HbA1c for the East African patients.
We examined the relationship of HbA1c versus MBG obtained by the continuous glucose monitoring in a group of East African youth having type 1 diabetes in Kenya and Uganda ( = 54) compared with the data obtained from A1c-derived average glucose (ADAG) and glucose management indicator (GMI) studies. A self-identified White (European heritage) population of youth ( = 89) with type 1 diabetes, 3-18 years old, living in New Orleans, LA, USA metropolitan area (NOLA), was studied using CGM as an additional reference.
The regression equation for the African cohort was MBG (mg/dL) = 32.0 + 16.73 × HbA1c (%), = 0.55, < 0.0001. In general, the use of the non-African references considerably overestimated MBG from HbA1c for the East African population. For example, an HbA1c = 9% (74.9 mmol/mol) corresponded to an MBG = 183 mg/dL (10.1 mmol/L) in the East African group, but 212 mg/dL (11.7 mmol/L) using ADAG, 237 mg/dL (13.1 mmol/L) using GMI and 249 mg/dL (13.8 mmol/L) using NOLA reference. The reported occurrence of serious hypoglycemia among the African patients in the year prior to the study was 21%. A reference table of HbA1c versus MBG from the East African patients was generated.
The use of non-African-derived reference data to estimate MBG from HbA1c generally led to the overestimation of MBG in the East African patients. This may put the East African and other African patients at higher risk for hypoglycemia when the management is primarily based on achieving target HbA1c in the absence of the corresponding glucose data.
糖化血红蛋白(HbA1c)与平均血糖(MBG)的关系是糖尿病管理的重要指南,但在不同种族之间可能存在差异。在非洲,患者的血糖信息有限或无法获得,治疗主要依赖于 HbA1c。我们旨在确定从非非洲人群中得出的参考数据是否能适当地从 HbA1c 估算东非患者的 MBG。
我们研究了肯尼亚和乌干达的一群患有 1 型糖尿病的东非青少年(n=54)的连续血糖监测中 HbA1c 与 MBG 的关系,并与 A1c 衍生平均血糖(ADAG)和血糖管理指标(GMI)研究的数据进行了比较。还使用连续血糖监测研究了来自美国新奥尔良(LA)大都市地区(NOLA)的自我认定为白人(欧洲血统)的 1 型糖尿病青少年(n=89)作为附加参考。
非洲队列的回归方程为 MBG(mg/dL)=32.0+16.73×HbA1c(%),=0.55,<0.0001。一般来说,使用非非洲参考值会大大高估东非人群的 HbA1c 对应的 MBG。例如,HbA1c=9%(74.9mmol/mol)对应于东非组的 MBG=183mg/dL(10.1mmol/L),但使用 ADAG 为 212mg/dL(11.7mmol/L),使用 GMI 为 237mg/dL(13.1mmol/L),使用 NOLA 参考值为 249mg/dL(13.8mmol/L)。研究前一年报告东非患者严重低血糖的发生率为 21%。生成了一个来自东非患者的 HbA1c 与 MBG 的参考表。
使用非非洲衍生的参考数据估算 HbA1c 对应的 MBG 通常会高估东非患者的 MBG。这可能使东非和其他非洲患者在缺乏相应血糖数据的情况下,主要基于实现目标 HbA1c 进行治疗时,面临更高的低血糖风险。