Improved Detection of Abnormal Glucose Tolerance in Africans: The Value of Combining Hemoglobin A 1c With Glycated Albumin

• Published in: Diabetes care Vol. 43; no. 10; p. 2607
• Main Authors: Hobabagabo, Arsene F, Osei-Tutu, Nana H, Hormenu, Thomas, Shoup, Elyssa M, DuBose, Christopher W, Mabundo, Lilian S, Ha, Joon, Sherman, Arthur, Chung, Stephanie T, Sacks, David B, Sumner, Anne E
• Format: Journal Article
• Language: English
• Published: United States 01.10.2020
• Subjects: Adult; Africa - ethnology; Aged; Biomarkers - analysis; Biomarkers - blood; Black or African American; Black People - ethnology; Blood Glucose - analysis; Female; Fructosamine - analysis; Fructosamine - blood; Glucose Intolerance - diagnosis; Glucose Intolerance - epidemiology; Glucose Intolerance - ethnology; Glucose Tolerance Test - methods; Glucose Tolerance Test - standards; Glycated Hemoglobin - analysis; Glycated Serum Albumin; Glycation End Products, Advanced; Humans; Male; Middle Aged; Obesity - blood; Obesity - complications; Obesity - diagnosis; Obesity - ethnology; Predictive Value of Tests; Quality Improvement; Reproducibility of Results; Serum Albumin - analysis; United States - epidemiology; Young Adult; United States; Africa
• ISSN: 1935-5548

In African-born Blacks living in America, we determined by BMI category ) prevalence of abnormal glucose tolerance (Abnl-GT) and ) diagnostic value and reproducibility of hemoglobin A (HbA ), fructosamine, and glycated albumin (GA). Participants ( = 416; male, 66%; BMI 27.7 ± 4.5 kg/m [mean ± SD]) had an oral glucose tolerance test with HbA , GA, and fructosamine assayed. These glycemic markers were repeated 11 ± 7 days later. Abnl-GT diagnosis required 0 h ≥5.6 mmol/L (≥100 mg/dL) and/or 2 h ≥7.8 mmol/L (≥140 mg/dL). Thresholds for HbA , GA, and fructosamine were the values at the 75th percentile for the population (39 mmol/mol [5.7%], 14.2%, and 234 μmol/L, respectively). Abnl-GT prevalence in the nonobese was 34% versus 42% in the obese ( = 0.124). Reproducibility was excellent for HbA and GA (both κ ≥ 0.8), but moderate for fructosamine (κ = 0.6). Focusing on HbA and GA in the nonobese, we found as single tests the sensitivities of HbA and GA were 36% versus 37% ( = 0.529). Combining HbA and GA, sensitivity increased to 58% because GA identified 37% of Africans with Abnl-GT not detected by HbA ( value for both tests vs. HbA alone was <0.001). For the obese, sensitivities for HbA , GA, and the combined tests were 60%, 27%, and 67%, respectively. Combined test sensitivity did not differ from HbA alone ( = 0.25) because GA detected only 10% of obese Africans with Abnl-GT not detected by HbA . Adding GA to HbA improves detection of Abnl-GT in nonobese Africans.