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HbA1c Measures Higher in South Asians Than White Europeans


July 27, 2012 — Three measures of blood sugar — glycated hemoglobin (HbA1c) levels, fasting plasma glucose (FPG), and 2-hour β-plasma glucose (2hrPG) — were higher on average in South Asians than white Europeans regardless of other factors associated with glycemic control, according to results from a new study published online June 14 and in the August print issue of Diabetes Care.
Samiul A. Mostafa, MBCHB, from the Department of Cardiovascular Sciences, University of Leicester, United Kingdom, and colleagues analyzed screening data from 6040 people aged 40 to 75 years between 2005 and 2009. The data included 1352 South Asians and 4688 white Europeans.
The analysis showed HbA1c glucose levels to be significantly associated with ethnicity, FPG, 2hrPG, and homeostasis model assessment of β-cell function (P = .001), age and sex (P = .01), and fasting insulin and potassium (P = .05). When these and other risk factors were adjusted for, South Asians had higher levels, compared with white Europeans, of HbA1c (6.22% and 6.02%, respectively; mean difference, 0.19%; 95% confidence interval [CI], 0.11 - 0.27; P < .001), FPG (5.15 and 5.30 mmol/L, respectively; mean difference, 0.15 mmol/L; 95% CI, 0.09 - 0.21; P < .001), and 2hrPG (5.82 and 6.57 mmol/L, respectively; mean difference, 0.75 mmol/L; 95% CI, 0.59 - 0.92; P < .001).
Earlier studies have shown higher HbA1c levels to be independent of factors associated with glycemic control among blacks (by from 0.2% to 0.4%), Hispanics (by from 0.1% to 0.3%), and Southeast Asians (by from 0.2% to 0.3%). The authors say this study is the first to demonstrate the effect in South Asians.
The authors note that international organizations recommend the use of ethnic-specific targets for South Asians for body mass index, waist size, and metabolic syndrome, but not for HbA1c levels. A smaller percentage of South Asians with diabetes hit glycemic targets compared with white Europeans.
"Because our study demonstrates independently higher HbA1c, FPG, and 2hrPG levels in South Asians, this result may be partially explained by factors related to glycemia," the authors conclude. "Future research should address the relationship between HbA1c and the onset of diabetes complications, including prevalent retinopathy, between South Asians and white Europeans in well-designed outcome studies to determine if ethnic-specific cut points are required for diabetes diagnosis in South Asians."
The study was funded by the United Kingdom (UK) National Health Service Department of Health. Dr. Mostafa and a coauthor have received fellowships from Novo Nordisk UK Research Foundation; 2 coauthors have received research funds and honoraria for speaking at meetings and serving on advisory boards for Astra Zeneca, Eli Lilly, sanofi aventis, Merck Sharp & Dohme, Novo Nordisk, Bristol-Myers Squibb, Boehringer Ingelheim, Roche, Novartis, Pfizer, and/or Servier. Two of the researchers serve as members of the National Institute for Health and Clinical Excellence Public Health Guidance on Prevention of Type 2 Diabetes Among People With Prediabetes and are advisors to the UK Department of Health for the NHS Health Checks Programme. .The other authors have disclosed no relevant financial relationships.

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