@article{78907a2692ae46bf86dacd80f37a76ac,
title = "HIV infection and anaemia do not affect HbA1c for the detection of diabetes in black South Africans - evidence from the Durban Diabetes Study",
abstract = "Objective: South Africa has a high burden of HIV infection and anaemia. These conditions may cause HbA 1c to over- or underestimate glycaemia; however, this has not been comprehensively investigated in African populations. We assessed the association of anaemia, HIV infection and antiretroviral therapy (ART) with HbA 1c, and implications for the detection and diagnosis of diabetes, in a black South African population. Research design and methods: In this population-based cross-sectional study in eThekwini municipality (Durban), South Africa, we assessed HbA 1c and conducted oral glucose tolerance tests (OGTTs), HIV diagnostic tests and full blood count measurements among 1067 participants without a history of diabetes diagnosis. Linear regression was used to examine differences in HbA 1c by anaemia (comparator: no anaemia), or HIV and ART (comparator: no HIV) status. HbA 1c-based diabetes prevalence was compared with OGTT-based prevalence among individuals with anaemia and with untreated and ART-treated HIV. Results: In adjusted analyses, normocytic and microcytic anaemia were associated with higher HbA 1c compared with no anaemia, whereas macrocytic anaemia and ART-treated HIV were associated with lower HbA 1c compared with no anaemia and no HIV, respectively. However, magnitudes of association were small (range: (Formula presented.) = −3.4 mmol/mol or −0.31%, p < 0.001 [macrocytic anaemia] to (Formula presented.) = 2.1 mmol/mol or 0.19%, p < 0.001 [microcytic anaemia]). There was no significant difference in diabetes prevalence based on HbA 1c or OGTT among individuals with anaemia (2.9% vs. 3.3%, p = 0.69), untreated HIV (1.6% vs. 1.6% p = 1.00) or ART-treated HIV (2.9% vs. 1.2%, p = 0.08). Conclusions: Our results suggest that anaemia and HIV status appear unlikely to materially affect the utility of HbA 1c for diabetes detection and diagnosis in this population. Further studies are needed to examine these associations in sub-Saharan African populations. ",
keywords = "AIDS, Africa, HIV, South Africa, anaemia, anti-HIV agents, glucose tolerance test, glycated haemoglobin A",
author = "Hird, {Thomas R} and Uttara Partap and Pravi Moodley and Pirie, {Fraser J} and Esterhuizen, {Tonya M} and Brian O'Leary and McCarthy, {Mark I} and Young, {Elizabeth H} and Sandhu, {Manjinder S} and Motala, {Ayesha A}",
note = "Funding Information: The study was supported by the Wellcome Trust (grant number 098051), the African Partnership for Chronic Disease Research (Medical Research Council UK partnership grant number MR/K013491/1), the National Institute for Health Research Cambridge Biomedical Research Centre (UK), Novo-Nordisk (South Africa), Sanofi-Aventis (South Africa) and MSD Pharmaceuticals (Pty) Ltd (Southern Africa). MSS, AAM, FJP and EHY conceived the idea for the study. TRH analysed the data and, with UP, wrote the manuscript. FJP, TME, BO, PM, MIMcC, UP, EHY, MSS and AAM contributed to discussion, and reviewed and edited the manuscript. TRH, MSS and AAM are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The study was supported by the Wellcome Trust (grant number 098051), the African Partnership for Chronic Disease Research (Medical Research Council UK partnership grant number MR/K013491/1), the National Institute for Health Research Cambridge Biomedical Research Centre (UK), Novo-Nordisk (South Africa), Sanofi-Aventis (South Africa) and MSD Pharmaceuticals (Pty) Ltd (Southern Africa). The authors would like to thank the study participants for their cooperation and express their gratitude to Nonhlanhla Nombula, the field coordinator, the field team staff and Mahlomola Lengolo, for his support of the field team during data collection. Funding Information: MMcC was a Wellcome Investigator. He has served on advisory panels for Pfizer, NovoNordisk, Zoe Global; has received honoraria from Merck, Pfizer, NovoNordisk and Eli Lilly; has received research funding from Abbvie, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, NovoNordisk, Pfizer, Roche, Sanofi Aventis and Servier Takeda. As of June 2019, MMcC is an employee of Genentech, and holds stock in Roche. No other authors have any potential conflicts of interest to declare. Funding Information: The study was supported by the Wellcome Trust (grant number 098051), the African Partnership for Chronic Disease Research (Medical Research Council UK partnership grant number MR/K013491/1), the National Institute for Health Research Cambridge Biomedical Research Centre (UK), Novo‐Nordisk (South Africa), Sanofi‐Aventis (South Africa) and MSD Pharmaceuticals (Pty) Ltd (Southern Africa). Funding Information: MSS, AAM, FJP and EHY conceived the idea for the study. TRH analysed the data and, with UP, wrote the manuscript. FJP, TME, BO, PM, MIMcC, UP, EHY, MSS and AAM contributed to discussion, and reviewed and edited the manuscript. TRH, MSS and AAM are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The study was supported by the Wellcome Trust (grant number 098051), the African Partnership for Chronic Disease Research (Medical Research Council UK partnership grant number MR/K013491/1), the National Institute for Health Research Cambridge Biomedical Research Centre (UK), Novo‐Nordisk (South Africa), Sanofi‐Aventis (South Africa) and MSD Pharmaceuticals (Pty) Ltd (Southern Africa). The authors would like to thank the study participants for their cooperation and express their gratitude to Nonhlanhla Nombula, the field coordinator, the field team staff and Mahlomola Lengolo, for his support of the field team during data collection. ",
year = "2021",
month = nov,
day = "30",
doi = "10.1111/dme.14605",
language = "English",
volume = "38",
journal = "Diabetic Medicine",
issn = "0742-3071",
publisher = "Wiley-Blackwell",
number = "11",
}
