2017 Issues   /   Other

Sickle Cell Trait Skews Hemoglobin A1c Results

By U.S. Medicine

PROVIDENCE, RI — Hemoglobin A1c might be underestimating glucose levels in a meaningful percentage of African-American and other patients.

A study published in JAMA points out that HbA1c readings are systematically too low in African-Americans with sickle cell trait, an inherited blood disorder that affects one million to three million Americans and 8% to 10% of African-Americans.1

To determine that, Brown University School of Public Health study retrospectively looked at a cohort of 4,620 African-Americans and found that, for any given fasting or two-hour glucose concentration, individuals with sickle cell trait (SCT) had significantly lower hemoglobin A1c values, 5.72% vs. 6.01%, than those without sickle cell trait.

Drawing from participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study and the Jackson Heart Study (JHS), a study team including researchers from the Providence, RI, VAMC, focused on a cohort that was 61.3% female, mean age 52.3, with 7.9% having SCT.

Results indicate that HbA1c values were statistically significantly lower in those with SCT—5.72%—as opposed to those without—6.01%. Researchers pointed out that their findings were similar in models adjusted for key risk factors and in analyses using 2001 concurrent measures of two-hour glucose and HbA1c concentration for those with SCT vs. without—5.35% compared to 5.65%, a difference of -0.30%.

Furthermore, the study reported that the HbA1c difference by SCT was greater at higher fasting and two-hour glucose concentrations, while the prevalence of prediabetes and diabetes was statistically significantly lower among participants with SCT when defined using HbA1c values.

In 572 observations from participants with SCT and 6,877 observations from participants without SCT, rates were 29.2% vs. 48.6% for prediabetes and 3.8% vs. 7.3% for those with diabetes.

“Among African Americans from 2 large, well-established cohorts, participants with SCT had lower levels of HbA1c at any given concentration of fasting or 2-hour glucose compared with participants without SCT,” study authors concluded. “These findings suggest that HbA1c may systematically underestimate past glycemia in black patients with SCT and may require further evaluation.”

Lacy ME, Wellenius GA, Sumner AE, Correa A, Carnethon MR, Liem RI, Wilson JG, Sacks DB, Jacobs DR Jr, Carson AP, Luo X, Gjelsvik A, Reiner AP, Naik RP, Liu S, Musani SK, Eaton CB, Wu WC. Association of Sickle Cell Trait With


Related Articles

VHA’s Type 1 Diabetes Telehealth Care Saves Time, Money

ATLANTA — About 5% of the United States population has been diagnosed with type 1 diabetes, and the great majority are diagnosed before age 25. Since a diabetes diagnosis prevents enlistment in the military, relatively few veterans have the condition compared to type 2 diabetes, which affects about a fourth of VHA patients.

Shulkin Ousted, White House Physician Nominated for VA Secretary

WASHINGTON — After several weeks of speculation regarding his future in the Trump Administration, VA Secretary David Shulkin, MD’s tenure came to an abrupt end on March 28.


U.S. Medicine Recommends


More From department of veterans affairs

Department of Veterans Affairs (VA)

Shulkin Ousted, White House Physician Nominated for VA Secretary

WASHINGTON — After several weeks of speculation regarding his future in the Trump Administration, VA Secretary David Shulkin, MD’s tenure came to an abrupt end on March 28.

Department of Veterans Affairs (VA)

Congress Seeks More Oversight of VA EHR Program

BRONX, NY — For patients with chronic kidney disease (CKD), living more than 30 miles from their nephrologist is associated with many unfavorable outcomes. They have lower rates of clinic visit adherence, more limited access... View Article

Department of Veterans Affairs (VA)

Congress, VSOs Have Wait-and- See Position on Jackson Nomination

BRONX, NY — For patients with chronic kidney disease (CKD), living more than 30 miles from their nephrologist is associated with many unfavorable outcomes. They have lower rates of clinic visit adherence, more limited access... View Article

Department of Veterans Affairs (VA)

VA Vows to Meet Deadline for Revamp of Veteran Claims Appeal Process

BRONX, NY — For patients with chronic kidney disease (CKD), living more than 30 miles from their nephrologist is associated with many unfavorable outcomes. They have lower rates of clinic visit adherence, more limited access... View Article

Department of Veterans Affairs (VA)

Vets With Respiratory Disease More Responsive to ‘Quit’ Programs

BRONX, NY — For patients with chronic kidney disease (CKD), living more than 30 miles from their nephrologist is associated with many unfavorable outcomes. They have lower rates of clinic visit adherence, more limited access... View Article

Facebook Comment

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up