366-P: Mean Blood Glucose–Independent Racial Disparity in HbA1c and Higher Risk for Severe Hypoglycemia Is Evident among Participants in the Diabetes Control and Complications Trial

IF 6.2 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes Pub Date : 2024-06-21 DOI:10.2337/db24-366-p

STUART CHALEW, ROBERT J. MCCARTER

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引用次数: 0

Abstract

Introduction: HbA1c target levels are often used as a treatment goal for patients with diabetes. Many recent studies indicate that HbA1c overestimates mean blood glucose (MBG) among Non-Hispanic Black (NHB) patients compared to Non-Hispanic White (NHW). We hypothesized that this disparity could be associated with greater risk of hypoglycemia in NHB patients especially where management is primarily based on a treat to HbA1c target. To assess this possibility we analyzed multiyear repeated-measures data from the Diabetes Control and Complications Trial (DCCT). Methods: Publicly available DCCT data was analyzed using mixed effects general linear modeling to evaluate the differences in HbA1c vs MBG for NWB (n=29) and NHW (n=1391) patients accounting for within patient correlation of HbA1c as well as MBG across multiple assessments. The model also controlled for age, diabetes duration, visit year and quarter, body mass index, study group and stratum. as well as interactive and nonlinear effects. Risk for severe hypoglycemia by ethnicity was separately determined. Results: Over the course of the DCCT, NHB pts had higher HbA1c than NHW patients at any given level of MBG, with greatest difference at lower MBG levels (p=0.001). The difference between groups in HbA1c by MBG adjusted for covariables was 0.51 at MBG of 150 mg/dl (p<0.03) and 0.39 at MBG of 450 mg/dl (p=0.09) Severe hypoglycemia increased with decreasing HbA1c. Relative risk for severe hypoglycemia for NHB was 1.92 compared to NHW (p=0.02). Conclusions: Among patients in the DCCT, HbA1c overpredicted MBG among NHB and was associated with greater risk for severe hypoglycemia. Predominant reliance on target HbA1c for management of diabetes may contribute to higher risk for hypoglycemia among NHB patients. Disclosure S. Chalew: None. R.J. McCarter: None. Funding National Intitutes of Health (1R21DK118643-O1A1)

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366-P：糖尿病控制与并发症试验参与者的平均血糖与 HbA1c 和严重低血糖风险的种族差异显而易见

导言HbA1c 目标值通常被用作糖尿病患者的治疗目标。最近的许多研究表明，与非西班牙裔白人（NHW）相比，非西班牙裔黑人（NHB）患者的 HbA1c 高估了平均血糖（MBG）。我们假设这种差异可能与非西班牙裔黑人患者发生低血糖的更大风险有关，尤其是在管理主要基于 HbA1c 目标治疗的情况下。为了评估这种可能性，我们分析了糖尿病控制与并发症试验（DCCT）的多年重复测量数据。方法：使用混合效应一般线性模型对公开的 DCCT 数据进行了分析，以评估 NWB（n=29）和 NHW（n=1391）患者 HbA1c 与 MBG 的差异，并考虑了患者内部 HbA1c 和 MBG 在多次评估中的相关性。该模型还控制了年龄、糖尿病病程、就诊年份和季度、体重指数、研究组和分层以及交互和非线性效应。按种族分别确定了严重低血糖的风险。研究结果在 DCCT 的整个过程中，在任何给定的 MBG 水平下，NHB 患者的 HbA1c 都高于 NHW 患者，在较低的 MBG 水平下差异最大（p=0.001）。经协变因素调整的 MBG 组间 HbA1c 差异在 MBG 为 150 mg/dl 时为 0.51（p<0.03），在 MBG 为 450 mg/dl 时为 0.39（p=0.09）。与 NHW 相比，NHB 发生严重低血糖的相对风险为 1.92（p=0.02）。结论：在 DCCT 患者中，HbA1c 对 NHB 的 MBG 预测过高，并且与更高的严重低血糖风险相关。主要依赖目标 HbA1c 进行糖尿病管理可能会导致 NHB 患者发生低血糖的风险更高。披露 S. Chalew：无。R.J. McCarter：无。资助美国国立卫生研究院 (1R21DK118643-O1A1)

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来源期刊

Diabetes 医学-内分泌学与代谢

CiteScore

12.50

自引率

2.60%

发文量

1968

审稿时长

1 months

期刊介绍： Diabetes is a scientific journal that publishes original research exploring the physiological and pathophysiological aspects of diabetes mellitus. We encourage submissions of manuscripts pertaining to laboratory, animal, or human research, covering a wide range of topics. Our primary focus is on investigative reports investigating various aspects such as the development and progression of diabetes, along with its associated complications. We also welcome studies delving into normal and pathological pancreatic islet function and intermediary metabolism, as well as exploring the mechanisms of drug and hormone action from a pharmacological perspective. Additionally, we encourage submissions that delve into the biochemical and molecular aspects of both normal and abnormal biological processes. However, it is important to note that we do not publish studies relating to diabetes education or the application of accepted therapeutic and diagnostic approaches to patients with diabetes mellitus. Our aim is to provide a platform for research that contributes to advancing our understanding of the underlying mechanisms and processes of diabetes.