Bismillah, alhamdulillah: a very interesting though small study which compared the average glucose measured in two ways between  ‘black’ and ‘white’ Americans.  Continuous glucose montors measured glucose levels for 90 days in 104 patients and compared this to the HbA1c. They also looked at the glycosylation rate of other proteins such as albumin and reversed the question by looking at the variability of glucose within each group at a given HbA1c see the degree of variation. 

The conclusion was that ‘black’ Americans glycosylate their Hb by around a half percent more than ‘whites’ for a similar average glucose. But other proteins such as albumin had the same glycosylation rate. Also the intergroup variability of average glucose measured with continuous monitoring was quite high for a given HbA1c. 

This will not come as a surprise to the astute clinician who will have noticed this especially when serving patients of a variable genetic background. I personally think the red cell membrane permeability to glucose is a big factor and perhaps genetic minor variations in Hb are key factors. 

My take home message is that we may have to reappraise the way we use HbA1c across different populations and begin to see the HbA1c targets in a more relative light rather than an absolute one – especially in the light of plasma glucose levels.

Have a listen to the podcast:

Duration: 06:04
Published: Wed, 17 Aug 2016 10:31:31 EDT

Dr Richard Bergenstal describes a study designed to answer a question that has puzzled the medical community in recent years.


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