title: Ethnic differences in glycemic markers in patients with type 2 diabetes.
abstract: OBJECTIVE
  Recent studies have reported hemoglobin A1c (HbA1c) differences across ethnic groups that could limit its use in clinical practice. The authors of the A1C-Derived Average Glucose study have advocated to report HbA1c in estimated average glucose (AG) equivalents. The aim of this study was to assess the relationships between HbA1c and the mean of three 7-point self-monitored blood glucose (BG) profiles, and to assess whether estimated AG is an accurate measure of glycemia in different ethnic groups.
  
  
  METHODS
  We evaluated 1,879 participants with type 2 diabetes in the DURABLE trial who were 30 to 80 years of age, from 11 countries, and, according to self-reported ethnic origin, were Caucasian, of African descent (black), Asian, or Hispanic. We performed logistic regression of the relationship between the mean self-monitored BG and HbA1c, and estimated AG, according to ethnic background.
  
  
  RESULTS
  Baseline mean (SD) HbA1c was 9.0% (1.3) (75 [SD, 14] mmol/mol), and mean self-monitored BG was 12.1 mmol/L (3.1) (217 [SD, 55] mg/dL). In the clinically relevant HbA1c range of 7.0-9.0% (53-75 mmol/mol), non-Caucasian ethnic groups had 0.2-0.5% (2-6 mmol/mol) higher HbA1c compared with Caucasians for a given BG level. At the mean self-monitored BG levels≤11.6 mmol/L, estimated AG overestimated the actual average BG; at levels>11.6 mmol/L, estimated AG underestimated the actual BG levels.
  
  
  CONCLUSIONS
  For a given degree of glycemia, HbA1c levels vary among different ethnic groups. Ethnicity needs to be taken into account when using HbA1c to assess glycemic control or to set glycemic targets. Estimated AG is not a reliable marker for mean glycemia and therefore is of limited clinical value.
authors.affiliation: Corresponding author: Bruce H.R. Wolffenbuttel, bwo@umcg.nl.
authors.forename: Bruce H R
authors.initials: BH
authors.lastname: Wolffenbuttel
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Gross
authors.forename: Mala
authors.initials: M
authors.lastname: Dharmalingam
authors.forename: Honghua H
authors.initials: HH
authors.lastname: Jiang
authors.forename: Dana S
authors.initials: DS
authors.lastname: Hardin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D044383:Black People; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D044465:White People
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin