While people with diabetes can still live life like the average Joe, there are downsides of having to manage this infuriating disease.
Physicians diagnose diabetes using one or more of the following tests: fasting blood glucose, A1C levels, oral glucose tolerance test, and/or random plasma glucose. From my experience, the diagnosis of diabetes is typically based on A1C levels. However, this test may provide false diagnosis among patients with iron deficiency, renal disease, hemolytic anemia, and hepatic problems. Adding to this list is hemoglobinopathies.
A study published yesterday in the Journal of American Medical Association (JAMA) highlighted the potential under-diagnosis of diabetes among African American with sickle cell trait.
Before diving into their findings, let’s take a closer look at sickle cell disease.
What is Sickle Cell Anemia?
Sickle cell disease is an inherited genetic anemia that affects a person from birth. While normal red blood cells are flexible and round, and can swiftly navigate in the blood, “sickle” red blood cells are hard, sticky, and are shaped like a crescent. As a result, people with this condition may experience blood clogs and painful jabs at times.
Do not confuse sickle cell anemia with sickle cell trait: consider the latter a friendly version of the disease. Having the sickle cell trait means that the person inherited one sickle cell gene and one normal cell gene from his parents. Hence, people with sickle cell trait do not have the full-fledged disease, but are a carrier of the trait. Up to a tenth of African Americans carry this condition compared to only 1% of Caucasians. Unfortunately, a cure is unavailable at the moment.
Diabetes & Sickle Cell Trait
The red blood cells of people without sickle cell trait contain about 97% of HbA compared to 60% to 70% found in people with it. Researchers believe that this observation is explained by a shorter life span of red blood cells in people with this trait, thus reducing the period in which glucose can grab hold of hemoglobin. However, the authors emphasized that “this hypothesis remains limited and conflicting.”
According to the findings of Lacy and her colleagues, the levels of HbA1c were “statistically significantly lower among participants with vs. without SCT [sickle cell trait].” They also noticed that higher blood sugar resulted in a greater discrepancy. The HbA1c test was conducted using a method that reported to be suitable for people with sickle cell anemia. However, the prevalence of diabetes among people with sickle cell trait was close to half of that seen among those without it (29.2% vs. 48.6%). This news is staggering since more African Americans suffer from diabetes and experience greater diabetes-related complications compared to Caucasians.
Bottom line: African Americans are more likely to be affected by sickle cell trait, a hemoglobin variant that can skew your HbA1c results.
African Americans: Take Note!
In another study, the authors found that a level of HbA1c of 7.4% measured in black people corresponds to an HbA1c value of 7.0%. This finding is crucial for managing blood sugar levels as pushing African American patients to achieve the same glycemic goal as Caucasian patients may put them at risk of hypoglycemia.
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CDC. URL Link. Accessed February 8, 2017.
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