Editor's note:In AACE 2015, according to the "diabetes is there racial differences in this topic, from the Johns Hopkins University professo
In AACE 2015, according to the "diabetes is there racial differences in this topic, from the Johns Hopkins University professor Selvin Elizabeth and then ADA chairman of the West Memphis Methodist University Hospital Samuel Dagogo-Jack professor and Affirmative respectively to the attitude of the report, discussed the influence on the depth of racial diabetes epidemic, and whether it should be on the basis of race to develop diagnostic criteria of HbA1c. Although it is not included on yellow, but can still provide us some reference, I published as follows.
Are there racial differences in the prevalence of diabetes? Yes
Elizabeth Selvin professor of Johns Hopkins University
There was a difference in the prevalence of diabetes among different races
Is it true that there are racial differences in the prevalence of diabetes? The result is positive. There is no denying the fact that some data on the prevalence of diabetes and its complications are not reliable. Some of the data published in previous studies on diabetes prevalence are largely based on patient self-report, and the results are not entirely consistent, so many data are not reliable. Although there are differences in detection and methodology in the diagnosis of diabetes, several large studies in recent years have found that there is indeed a difference in the prevalence of the disease, which is sufficient to cause concern.
In 2010, the American adult diabetes epidemiology study showed that the burden of diabetes on different populations was not equal (prevalence: 8.6% for whites, blacks for blacks, and Mexicans for 11.6%). The National Institutes of health and Nutrition Association survey shows that there are differences in blood glucose control among different ethnic groups, in general, the highest rate of white HbA1c control, while the lowest in Mexico. In 2011, studies have shown that three different people diagnosed diabetes of different age, later than blacks and white Americans in Mexico (55 years old vs.49 years old vs.49 years old).
In diabetic complications, there were differences among different races. 2013 study of the prevalence of ESRD in the end of the year showed that the prevalence of end-stage renal disease was still higher than that of white people. The 2005-2008 Institute of nutrition survey found that the prevalence of diabetic retinopathy among blacks and Mexico Americans was also higher than that of whites. In recent years, although the overall rate of hospitalization related to diabetes has decreased, the rate of black hospitalization is higher than that of white people. 2000, published in the Journal JAMA an article on the atherosclerosis risk in communities (ARIC) study of the research object according to gender, and adjust some factors related to the risk of them still compared with whites, black men and women's diabetes prevalence rate is relatively high.
The reasons for the differences in the prevalence of diabetes among whites and blacks may include genetics, American history, environment, behavior, health care, and some preventive measures. The study found that 75% of blacks and 46% of low-income people have lower rates of healthy food intake than whites, and when they live in a similar environment, the prevalence of diabetes is closer.
Are there any racial differences in specific biomarkers of diabetes, particularly HbA1c?
In addition to the diagnosis of diabetes according to blood glucose levels, in 2010 ADA pointed out that HbA1c> 6.5% can also be diagnosed with diabetes, but the detection of HbA1c requires special methods and the need for further standardization, more stringent requirements. Therefore, the application of HbA1c in the diagnosis of diabetes is still controversial. The main reasons include: the standard kit is not enough, anemia, pregnancy, red cells decreased, HbA1c as diagnosis index data and testing costs etc.. But compared with fasting blood glucose, HbA1c can better predict the incidence of diabetes, which has nothing to do with race. The ARIC study found, the black HbA1c is higher than that of whites, which may be related to blood glucose and other nonglycemic factors, such as the life of red blood cells, red blood cell permeability, hemoglobin and blood glucose, combined with genetic and biochemical methods. However, some studies have found that there is no racial difference in the incidence of diabetes complications, so the conclusion is not HbA1c.
The high level of black HbA1c suggests that the incidence of diabetes mellitus and its complications is high, so it is necessary to improve the way of medical care and behavior, but it is not necessary to set up new therapeutic targets and diagnostic criteria. What I'm worried about is that people may think that the range of HbA1c in different ethnic groups should be different because of non blood glucose, which can lead to over diagnosis of diabetes. For now, there is no evidence to support this view.
Compared with whites, blacks had higher HbA1c levels. The relationship between HbA1c and cardiovascular disease, nephropathy and diabetic retinopathy. HbA1c predicts that clinical outcomes are similar to fasting blood glucose levels and may be more likely to be associated with fasting blood glucose. There is no conclusive evidence that the HbA1c range of different ethnic groups is different.
Prof. Selvin: I think the key thing I want to say in this debate is that diabetes is widespread, but the burden on different populations is not exactly the same. Compared with other ethnic groups, there were significant differences in the prevalence of diabetes among certain ethnic groups. This will undoubtedly have an important impact on the study of diabetes, how to understand the prevalence of diabetes and how to manage diabetes from a public health perspective.
International Diabetes: does that mean the need for targeted diabetes management?
Prof. Selvin: I don't think there is any evidence that the specific biomarkers of different races are different because of the non glycemic factors. We can't come to the conclusion that. Therefore, the current treatment of patients should be treated equally, for each patient are actively managed. What I'm worried about is that people may think that the HbA1c range of different ethnic groups should be different because of the non blood glucose. For now, there is no evidence to support this view.
International Diabetes: what are the disadvantages of the above views? Why do you worry about it?