Can HbA1c Alone Be Safely Used to Guide Insulin Therapy in African Youth with Type 1 Diabetes?
Authors' conclusion
The use of non-African-derived reference data to estimate MBG from HbA1c generally led to the overestimation of MBG in the East African patients. This may put the East African and other African patients at higher risk for hypoglycemia when the management is primarily based on achieving target HbA1c in the absence of the corresponding glucose data.
Study context
- Population
- Youth with T1D: East African (Kenya, Uganda) and White youth aged 3–18 years in New Orleans, USA; Mean blood glucose (MBG) by CGM
- Participants
- 54 vs 89
- Exposure
- HbA1c–MBG relationship in East African youth vs non-African references
- East Africann = 54
- NOLAn = 89reference
- Outcome
- Relationship of HbA1c vs MBG (CGM) compared with ADAG and GMI reference data
Methodological detailsCGM-based, comparison with A1c-derived average glucose (ADAG) and glucose management indicator (GMI) reference data
- CGM-based
- Comparison with ADAG and GMI reference data
Main finding
As reported in the abstract
HbA1c vs MBG
- Regression equation, African cohort
- MBG (mg/dL) = 32.0 + 16.73 × HbA1c (%), r = 0.55, p < 0.0001
- MBG at HbA1c = 9% (74.9 mmol/mol), East African
- 183 mg/dL (10.1 mmol/L)
- MBG at HbA1c = 9%, ADAG
- 212 mg/dL (11.7 mmol/L)
- MBG at HbA1c = 9%, GMI
- 237 mg/dL (13.1 mmol/L)
- MBG at HbA1c = 9%, NOLA
- 249 mg/dL (13.8 mmol/L)
Observational data: associations, not effects.
Further findings
- A reference table of HbA1c vs MBG from the East African patients was generated
Safety
Serious hypoglycemia in the year prior to the study (reported)
- Reported occurrence of serious hypoglycemia among the African patients
- 21%
Original publication
Can HbA1c Alone Be Safely Used to Guide Insulin Therapy in African Youth with Type 1 Diabetes? Pediatr Diabetes. Published 24 April 2023. doi:10.
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