Distribution of HbA1c Levels For Children and Young Adults in the U.S.
Open accessAbstract
OBJECTIVE—To describe the distribution of HbA1c levels among children and young adults in the U.S. and to evaluate the effects of age, sex, race/ethnicity, socioeconomic status, parental history of diabetes, overweight, and serum glucose on HbA1c levels. RESEARCH DESIGN AND METHODS—We analyzed HbA1c data from the Third National Health and Nutrition Examination Survey, 1988–1994, for 7,968 participants aged 5–24 years who had not been treated for diabetes. After adjusting for the complex sample design, we compared the distributions of HbA1c in subgroups and developed multiple linear regression models to examine factors associated with HbA1c. RESULTS—Mean HbA1c level was 4.99% (SD 0.50%) and varied from 4.93% (95% CI ±0.04) in non-Hispanic whites to 5.05% (±0.02) in Mexican-Americans to 5.17% (±0.02) in non-Hispanic blacks. There were very small differences among subgroups. Within each age- group, among men and women, among overweight and nonoverweight subjects, and at any level of education, mean HbA1c levels were higher in non-Hispanic blacks than in non-Hispanic whites. After adjusting for confounders, HbA1c levels for non-Hispanic blacks (5.15%, 95% CI ±0.04) and Mexican-Americans (5.01%, ±0.04) were higher than those for non-Hispanic whites (4.93%, ±0.04). CONCLUSIONS—These data provide national reference levels for HbA1c distributions among Americans aged 5–24 years and show statistically significant racial/ethnic differences in HbA1c levels that are not completely explained by demographic and health-related variables.
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Several studies have suggested a relatively higher HbA1c in Black and Hispanic populations than in White populations at the same level of glycemia.
“Several studies have suggested a relatively higher HbA 1c in Black and Hispanic populations than in White populations at the same level of glycemia, although glucose levels have not always been measured comprehensively to be confident that they capture true average glycemia (335,338,339).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [339]
The Statistical analysis (p. 3) reports higher HbA1c in both non-Hispanic Black and Mexican-American youths than in White youths, but its fasting-glucose-adjusted result establishes the difference only for Black youths. The discussion (p. 4) cautions that the differences could reflect higher average glycemia, so the paper does not establish higher HbA1c for both groups at the same true average glycemia. (LLM, conf=0.86)
Experimental — accuracy not yet measuredStudies have found that African American individuals have slightly higher A1C levels than non-Hispanic White or Hispanic people.
“Studies have found that African American individuals have slightly higher A1C levels than non-Hispanic White or Hispanic people (22 -25).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [24]
The Results (p. 2) say HbA1c levels were slightly higher among non-Hispanic Black participants than among non-Hispanic White and Mexican-American participants. The study covered people aged 5–24, however, and compared Mexican-Americans rather than Hispanic people generally; the claim leaves those limits unstated. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThere is controversy regarding the clinical significance of differences in A1C by self-reported race and ethnicity.
“As discussed in section 2, “Diagnosis and Classification of Diabetes,” there is controversy regarding the clinical significance of differences in A1C by self-reported race and ethnicity (9)(10)(11)(12).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [11]
Several studies have suggested relatively higher HbA1c in African American and Hispanic populations than in Caucasian populations at the same level of glycemia.
“Several studies have suggested a relatively higher HbA 1c in African American and Hispanic populations than in Caucasian populations at the same level of glycemia (225,227,228).”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [228]
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References 27 · Cited by 177
Research works printed but not linked: 2
- [14]14. National Center for Health Statistics: Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-1994. In NHANES III: Vital Health Statistics. Vol. 1. 1994
- [27]27. Acton KJ, Burrows NR, Moore K, Querec L, Geiss LS, Engelgau MM: Trend in diabetes prevalence among American Indian and Alaska Native Children, adolescents, and young adults: an increasing burden among younger people. Am J Public Health. In press
- Authors
- Saaddine, J. B., Fagot-Campagna, A., Rolka, D., Narayan, K. M. V., Geiss, L., Eberhardt, M., & Flegal, K. M.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2002-08-01
- Volume
- 25
- Issue
- 8
- Pages
- 1326-1330
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2104335440
- Semantic Scholar
- 77ef277af05ea624b4e213ed57eb43cdd0cf129f
- Cited by
- 177
- References
- 27
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 9 · 2023: 6 · 2022: 5 · 2021: 7 · 2020: 4 · 2019: 7 · 2018: 9 · 2017: 5 · 2016: 8 · 2015: 6 · 2014: 15 · 2013: 9 · 2012: 17
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- HbA1c, glycemic control, children and young adults, racial and ethnic differences, Mexican Americans, non-Hispanic blacks, reference values, socioeconomic status, overweight, serum glucose, NHANES
- MeSH terms
- Adolescent, Adult, Black or African American, Child, Child, Preschool, Diabetes Mellitus, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Male, Nutrition Surveys, Obesity, United States, Mexican Americans, Age Distribution, Sex Distribution, Black People, White People
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