Racial differences in measures of glycemia in the Vitamin D and Type 2 Diabetes (D2d) Study: a secondary analysis of a randomized trial.

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM BMJ Open Diabetes Research & Care Pub Date : 2024-02-12 DOI:10.1136/bmjdrc-2023-003613
Erin S LeBlanc, Anastassios G Pittas, Jason Nelson, Ranee Chatterjee, Neda Rasouli, Mary K Rhee, Richard E Pratley, Cyrus V Desouza, Lisa M Neff, Anne M Peters, Samuel Dagogo-Jack, Daniel S Hsia
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Abstract

Introduction: Understanding how race may influence the association between A1c and glycemia can improve diabetes screening. We sought to determine whether, for a given A1c level, glucose levels during an oral glucose tolerance test (OGTT) differed by race.

Research design and methods: From data collected at 22 US clinical sites, we conducted a cross-sectional study of concurrently measured A1c and OGTT and observational longitudinal follow-up of the subset with high-risk pre-diabetes. Numerical integration methods were used to calculate area under the glycemic curve (AUCglu) during OGTT and least squares regression model to estimate A1c for a given AUCglu by race, controlling for potential confounders.

Results: 1016 black, 2658 white, and 193 Asian persons at risk of diabetes were included in cross-sectional analysis. Of these, 2154 with high-risk pre-diabetes were followed for 2.5 years. For a given A1c level, AUCglu was lower in black versus white participants. After adjustment for potential confounders, A1c levels for a given AUCglu quintile were 0.15-0.20 and 0.02-0.19 percentage points higher in black and Asian compared with white participants, respectively (p<0.05). In longitudinal analyses, black participants were more likely to be diagnosed with diabetes by A1c than white participants (28% vs 10%, respectively; p<0.01). Black and Asian participants were less likely to be diagnosed by fasting glucose than white participants (16% vs 15% vs 37%, respectively; p<0.05). Black participants with A1c levels in the lower-level quintiles had greater increase in A1c over time compared with white participants.

Conclusions: Use of additional testing beyond A1c to screen for diabetes may better stratify diabetes risk in the diverse US population.

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维生素 D 和 2 型糖尿病 (D2d) 研究中血糖测量的种族差异:随机试验的二次分析。
导言:了解种族如何影响 A1c 与血糖之间的关联可以改善糖尿病筛查。我们试图确定在给定的 A1c 水平下,口服葡萄糖耐量试验(OGTT)中的血糖水平是否因种族而异:根据在美国 22 个临床机构收集的数据,我们对同时测量的 A1c 和 OGTT 进行了横断面研究,并对高风险糖尿病前期患者进行了观察性纵向跟踪。我们使用数值积分方法计算 OGTT 期间的血糖曲线下面积(AUCglu),并使用最小二乘法回归模型估算给定 AUCglu 下不同种族的 A1c,同时控制潜在的混杂因素:横断面分析纳入了 1016 名黑人、2658 名白人和 193 名亚裔糖尿病高危人群。其中,2154 名高风险糖尿病前期患者接受了为期 2.5 年的随访。在给定的 A1c 水平下,黑人参与者的 AUCglu 低于白人参与者。在对潜在的混杂因素进行调整后,黑人和亚裔参与者的给定 AUCglu 五分位数的 A1c 水平分别比白人参与者高 0.15-0.20 和 0.02-0.19 个百分点(p 结论:使用 A1c 以外的其他检测方法筛查糖尿病可能会更好地对美国不同人群的糖尿病风险进行分层。
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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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