Effect of age and race/ethnicity on HbA1c levels in people without known diabetes mellitus: Implications for the diagnosis of diabetes

AimsTo determine if age and race/ethnicity affect HbA1c levels independent of glycemia.MethodsWe analyzed 2712 individuals from the NHANES III population 40–74 years old without diabetes history.ResultsHbA1c levels increased by 0.10% per decade in people with NGT and 0.07% in those with IFG and/or IGT, independent of fasting and 2-h glucose on OGTT's. Compared to non-Hispanic whites, HbA1c levels increased by 0.12% (NGT) and 0.10% (IFG/IGT) in Mexican-Americans and 0.21% (NGT) and 0.35% (IFG/IGT) in non-Hispanic blacks, independent of glycemia. At HbA1c levels of ≥6.5%, ≥7.0% and 6.5–6.9%, diabetes diagnosed by current FPG/OGTT criteria occurred in 82%, 94% and 65%, respectively. In non-Hispanic blacks with HbA1c levels of 6.5–6.9%, 68% of those 40–74 years old and 87% of those over 64 years old would not have diabetes by FPG/OGTT criteria. Over 90% of all race/ethnicity groups would have diabetes with HbA1c levels ≥7.0%.ConclusionsBecause many people, especially older non-Hispanic blacks, with HbA1c levels of 6.5–6.9% would not have diabetes by current FPG/OGTT criteria and clinical retinopathy and nephropathy are very unusual in patients whose HbA1c levels are kept <7.0%; we recommend an HbA1c level of ≥7.0% to diagnose diabetes.