IntroductionAfrican descent populations in the United States have high rates of type 2 diabetes and are incorrectly represented as a single group. Current glycated hemoglobin A1c (HbA1c) cutoffs (5.7% to
Methods A PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) search (January 2020) yielded 3,238 articles published from January 2000 through January 2020. After review of titles, abstracts, and full texts, 12 met our criteria. HbA1c results were compared with other ethnic groups or validated against the oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), or previous diagnosis. We classified study results by the risk of false positives and risk of false negatives in assess- ing glycemic status.
Results In 5 studies of African American people, the HbA1c test increased risk of false positives compared with White populations, regard- less of glycemic status. Three studies of African Americans found that HbA1c of 5.7% to less than 6.5% or HbA1c of 6.5% or higher generally increased risk of overdiagnosis compared with OGTT or previous diagnosis. In one study of Afro-Caribbean people, HbA1c of 6.5% or higher detected fewer type 2 diabetes cases because of a greater risk of false negatives. Compared with OGTT, HbA1c tests in 4 studies of Africans found that HbA1c of 5.7% to less than 6.5% or HbA1c of 6.5% or higher leads to underdiagnosis.
Conclusion HbA1c criteria inadequately characterizes glycemic status among heterogeneous African descent populations. Research is needed to determine optimal HbA1c cutoffs or other test strategies that ac- count for risk profiles unique to African American, Afro- Caribbean, and African people living in the United States.