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Ethnic disparities found in HbA1c test

A new study released by the Children's Hospital of New Orleans has found that black children have statistically significantly higher HbA1c scores than white children.

If the higher HbA1c levels found in black children are a factor of ethnicity, not actual elevated levels of blood glucose, they could have a potentially dangerous effect when treating diabetes based upon glycated haemoglobin or HbA1c. The researchers acknowledge such ethnic disparity has already been shown in previous studies in adults.

Potentially dangerous

Led by Dr. Stuart A. Chalew, a professor of paediatrics at Louisiana State University Health Sciences Center, the six-year study tracked 276 children who averaged 12.5 years old and who had had Type 1 diabetes for an average of five years. The researchers looked at results of the HbA1c screening test (known as the A1c test in the US), which is an indicator of blood glucose levels over the previous two to three months.

WHO to revise HbA1c

The World Health Organisation (WHO) is revising global advice on diabetes diagnosis, which includes an update on diabetes classification and the use of glucose intolerance, HbA1c and risk scores in diagnosing, screening and predicting diabetes.  “The American Diabetes Association (ADA) has already considered the use of HbA1c for diagnosis and have published a cut-off for screening for diabetes with an HbA1c of 6.5%. Diabetes UK's current position on this is that we are concerned whether this is the correct cut-off level without having the opportunity to review the evidence on which the ADA has based this decision," said Simon O’Neill, Director of Care, Information and Advocacy at Diabetes UK.

Call for careful examination of new recommendations 

“We are aware that the WHO is also reviewing this issue and are expecting them to publish their recommendations on HbA1c as a screening method in the near future. “The new WHO recommendations will need to be discussed and examined carefully once published. Our understanding is that the WHO will set a single diagnostic cut-off point and therefore we do not expect to see different diagnostic levels for different groups. However, as with current diagnostic criteria, clinicians will need to use their clinical judgement to use varying screening criteria for different groups. For example, people of South Asian descent should be tested at an earlier age and lower BMI than people of a Caucasian background. As with all diagnoses, any diagnosis should be based on the most suitable tests for that population. “Diabetes UK currently recommends the use of WHO diagnostic recommendations and will continue to do so until these are amended.”

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