![]() HbA 1c criteria inadequately characterizes glycemic status among heterogeneous African descent populations. Compared with OGTT, HbA 1c tests in 4 studies of Africans found that HbA 1c of 5.7% to less than 6.5% or HbA 1c of 6.5% or higher leads to underdiagnosis. In one study of Afro-Caribbean people, HbA 1c of 6.5% or higher detected fewer type 2 diabetes cases because of a greater risk of false negatives. ![]() Three studies of African Americans found that HbA 1c of 5.7% to less than 6.5% or HbA 1c of 6.5% or higher generally increased risk of overdiagnosis compared with OGTT or previous diagnosis. In 5 studies of African American people, the HbA 1c test increased risk of false positives compared with White populations, regardless of glycemic status. We classified study results by the risk of false positives and risk of false negatives in assessing glycemic status. HbA 1c results were compared with other ethnic groups or validated against the oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), or previous diagnosis. After review of titles, abstracts, and full texts, 12 met our criteria. We conducted a scoping review of US-based evidence documenting HbA 1c performance to assess glycemic status among African American, Afro-Caribbean, and African people.Ī 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. Current glycated hemoglobin A 1c (HbA 1c) cutoffs (5.7% to <6.5% for prediabetes ≥6.5% for type 2 diabetes) may perform suboptimally in evaluating glycemic status among African descent groups. AbstractĪfrican descent populations in the United States have high rates of type 2 diabetes and are incorrectly represented as a single group. To ensure early type 2 diabetes detection, heterogeneity within African descent groups must be recognized, and more reliable testing strategies must be identified. Type 2 diabetes screening and diagnostic tests must account for genetic, biochemical, and socioeconomic factors. ![]() What are the implications for public health practice? It identifies gaps in the scientific literature, especially among Afro-Caribbeans. This review demonstrates that current HbA 1c cutoffs overestimate glycemic status in African Americans and underestimate glycemic status in Afro-Caribbeans and Africans. ![]() Studies show that glycated hemoglobin A 1c (HbA 1c) underperforms as a screening and diagnostic tool among ethnic cohorts of this population. Type 2 diabetes disproportionately affects African descent groups, yet contributing factors are often overlooked. ![]()
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