ArticleDiabetes care2016
Are There Clinical Implications of Racial Differences in HbA1c? A Difference, to Be a Difference, Must Make a Difference.
Article in Diabetes care, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
46 citing papers in PubMed, 2 syntheses or guidelines pooled it, 96 citations in OpenAlex.
- American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022Guideline
- Effect of ethnicity on HbA1c levels in individuals without diabetes: Systematic review and meta-analysis.PloS one · 2017Pooled it
- The Associations of Mean Glucose and Time in Range from Continuous Glucose Monitoring with HbA1c in Adults with Type 2 Diabetes.Diabetes technology & therapeutics · 2023Trial
- Criteria for prediabetes and posttransplant diabetes mellitus after kidney transplantation: A 2-year diagnostic accuracy study of participants from a randomized controlled trial.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2022Trial
- Hemoglobin glycation index, calculated from a single fasting glucose value, as a prediction tool for severe hypoglycemia and major adverse cardiovascular events in DEVOTE.BMJ open diabetes research & care · 2021Trial
- Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study.Scientific reports · 2021Trial
- The predictive value of glycated albumin and hemoglobin A1c for all-cause and cardiovascular mortality in chronic kidney disease patients.Diabetology & metabolic syndrome · 2026Article
- 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2026.Diabetes care · 2026Review
- Effects of Prediabetes on Ventricular Repolarization Markers in Electrocardiography.Reviews in cardiovascular medicine · 2025Article
- Determination of Glucose-Independent Racial Disparity in HbA1c for Youth With Type 1 Diabetes in the Era of Continuous Glucose Monitoring.Journal of diabetes science and technology · 2025Article
- 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025.Diabetes care · 2025Review
- Continuous Insulin Therapy to Prevent Post-Transplant Diabetes Mellitus: A Randomized Controlled Trial.Kidney medicine · 2024Article
- Prediabetes Prevalence by Adverse Social Determinants of Health in Adolescents.JAMA network open · 2024Article
- Mathematical model for assessing glycemic control in type 2 diabetes mellitus.Bioinformation · 2024Article
- Achieving prediabetes reversal in China: a nationwide longitudinal study on the role of blood glucose and lipid management in middle-aged and elderly adults.Frontiers in endocrinology · 2024Article
- 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024.Diabetes care · 2024Review
- Racial/ethnic and socioeconomic disparities in achievement of treatment goals within a clinical trial: a secondary analysis of the ACCORD trial.Diabetologia · 2023Article
- Racial and Ethnic Differences in the Association Between Mean Glucose and Hemoglobin A1c.Diabetes technology & therapeutics · 2023Article
- 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023.Diabetes care · 2023 · on this mapReview
- 6. Glycemic Targets: Standards of Care in Diabetes-2023.Diabetes care · 2023 · on this mapReview
Corrections and comments
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Authors and funding
1 author at 1 institution in 1 country.
Funding
Abstract
Studies that have compared HbA1c levels by race have consistently demonstrated higher HbA1c levels in African Americans than in whites. These racial differences in HbA1c have not been explained by measured differences in glycemia, sociodemographic factors, clinical factors, access to care, or quality of care. Recently, a number of nonglycemic factors and several genetic polymorphisms that operate through nonglycemic mechanisms have been associated with HbA1c Their distributions across racial groups and their impact on hemoglobin glycation need to be systematically explored. Thus, on the basis of evidence for racial differences in HbA1c, current clinical guidelines from the American Diabetes Association state: "It is important to take…race/ethnicity…into consideration when using the A1C to diagnose diabetes." However, it is not clear from the guidelines how this recommendation might be actualized. So, the critical question is not whether racial differences in HbA1c exist between African Americans and whites; the important question is whether the observed differences in HbA1c level are clinically meaningful. Therefore, given the current controversy, we provide a Point-Counterpoint debate on this issue. In the preceding point narrative, Dr. Herman provides his argument that the failure to acknowledge that HbA1c might be a biased measure of average glycemia and an unwillingness to rigorously investigate this hypothesis will slow scientific progress and has the potential to do great harm. In the counterpoint narrative below, Dr. Selvin argues that there is no compelling evidence for racial differences in the validity of HbA1c as a measure of hyperglycemia and that race is a poor surrogate for differences in underlying causes of disease risk.-William T. CefaluEditor in Chief, Diabetes Care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.