As the insulin assay is expensive and often unavailable in low income countries, the triglyceride-glucose index (TyG) is undergoing global evaluation as both a surrogate marker of insulin resistance (IR) and predictor of cardiovascular disease (CVD). Yet the value of the TyG in African-born populations is uncertain. Therefore, in 555 African-born Blacks currently living in the Washington, DC area (Age: 39±0.4y (mean±SE), Male: 65% (358/555), BMI: 27.7±0.2 kg/m2) we determined: 1) ability of TyG to predict the presence of IR; and 2) correlations between TyG and four lipid parameters, specifically HDL-C and LDL-C, LDL-particle size and LDL-number. Fasting lipid profiles and OGTT were performed. IR was defined by the lowest quartile of the Matsuda Index (≤2.85). Ability of TyG to predict IR was assessed with AUC-ROC curve. Pearson correlations were performed between the lipids and both TyG and Matsuda Index. Diabetes, prediabetes and normal glucose tolerance occurred in 7% (37/555), 31% (173/555) and 62% (345/555) resp. AUC-ROC for the prediction of IR by TyG was 0.75±0.02. Correlations between the lipids and both TyG and Matsuda Index were highly significant (Table). But correlations with each lipid were stronger with TyG than Matsuda Index. Overall, TyG is marker of IR in Africans and may be better than Matsuda Index in predicting CVD because of stronger correlations with atherogenic lipids. Disclosure C.Worthy: None. J.Gatete: None. J.Hurston: None. B.R.Schenk: None. L.Mabundo: None. C.Dubose: None. R.Jagannathan: None. A.E.Sumner: None.
A1C represents glycated hemoglobin A and is a non-fasting measure of average glycemia which has been used since 2010 to diagnose abnormal glucose tolerance (Abnl-GT) (a summary term for diabetes and prediabetes). However, A1C may not correlate with average glucose in the presence of anemia, G6PD deficiency and certain hemoglobinopathies. Two non-fasting markers of glycemia which have been proposed as alternatives to A1C are fructosamine (FA) and glycated albumin (GA). FA is a measure of all plasma glycated proteins. Whereas GA is a subfraction of FA. Emerging data suggests that in the diagnosis of Abnl-GT, GA is superior to FA. Critical to the value of a diagnostic test is assessing reproducibility. Therefore, we examined the reproducibility of A1C, FA and GA by performing all three tests 9±4d (mean±SD) apart in 209 African-born Blacks living in the Washington, DC area. Diagnostic sensitivity of A1C, FA and GA for the detection of Abnl-GT was determined by thresholds at the upper quartile of each, specifically ≥5.7%, 235 umol/L and 14.6%, respectively. A1C was assessed by high performance liquid chromatography, FA by colorimetric nitroblue tetrazolium assay and GA by enzymatic assay. Coefficients of variation (CV) were calculated. Kappa statistic (k-statistic) was used to measure diagnostic reproducibility. Strength of agreement by k-statistic is: slight: 0.0 to 0.20, fair: 0.21-0.40, moderate: 0.41-0.60, substantial: 0.61-0.80; excellent: 0.81-1.0. The CV for A1C, FA and GA were: 2%, 3% and 2% respectively, and the k-statistics were: 0.86, 0.59, 0.89 respectively. In short, the diagnostic agreement between A1C and GA on different days was excellent but only moderate for FA. This may explain why GA appears to be a better measure of Abnl-GT than FA. Variation in FA may be greater than the variation in GA because FA encompasses all plasma proteins rather than specifically albumin. Disclosure J.Gatete: None. B.R.Schenk: None. J.Hurston: None. C.Dubose: None. L.Mabundo: None. C.Worthy: None. R.Jagannathan: None. D.B.Sacks: Other Relationship; Sebia, Trinity. A.E.Sumner: None.
Achieving early diagnosis of type 2 diabetes (T2D) in Africans is challenging. The Glucola used in the OGTT is expensive and unavailable in most African countries. Alternatives to the OGTT are fasting plasma glucose (FPG) and A1C, but they have a low diagnostic sensitivity in Africans. As an alternative to the Glucola (75g glucose) used in the OGTT, we developed the Pastry Sugar Tolerance Test (PSTT) with pastry sugar (75g glucose powder) dissolved in hot water. Pastry sugar is inexpensive and widely available in Africa. Hence, our aim was to determine the diagnostic agreement between (1) OGTT and PSTT; (2) OGTT and A1C; (3) OGTT and FPG in the detection of T2D in 48 African-born Blacks living in America (male: 67%; age: 41±10y (mean±SD)). At Visit 1, an OGTT, A1C and FPG were performed. At Visit 2, which occurred 8±3 days later, a PSTT was performed (Fig). ADA criteria were used for the OGTT, A1C≥6.5% and FPG≥126 mg/dL. Agreement between tests was determined by κ-statistic. T2D, prediabetes and normal glucose tolerance occurred in 8% (4/48), 31% (15/48) and 61% (29/48), resp. All individuals with T2D were detected by both the OGTT and PSTT (κ=0.99). Yet, A1C only detected 50% (2/4) (κ=0.65), and FPG only detected 25% (1/4) (κ=0.38) of Africans with T2D. This pilot study suggests that in the detection of T2D, agreement between the PSTT and the OGTT may be both excellent and superior to A1C and FPG. Disclosure B.R.Schenk: None. A.E.Sumner: None. J.Hurston: None. J.Gatete: None. C.Dubose: None. L.Mabundo: None. S.Yang: None. C.Worthy: None. A.B.Courville: None. R.Jagannathan: None.
In African immigrants, the relationship between obesity and body size dissatisfaction and cardiometabolic health is unknown. Hence, we assessed body size dissatisfaction and cardiometabolic health in 352 African-born Blacks living in the Washington DC area (female: 39% (137/352) age 40±11y (mean±SD)). Using the Stunkard Figure Rating Scale, participants ranked their perceived body size and wish body size. Body size dissatisfaction was defined as the difference between perceived and wish body size. Adverse cardiometabolic health was determined by the presence of type 2 diabetes (T2D) or elevated BP (BP≥120/80) or elevated non-HDL cholesterol levels. Obesity prevalence was 27% (94/352) and higher in women than men (38% (52/137) vs 20% (42/215) P<0.01). Body size dissatisfaction was also higher in women than men (83% vs 69% P<0.01). However, among participants with obesity there was no sex difference in body size dissatisfaction (94% vs 91% P=0.49). Persons with obesity judged themselves to be: Too Large (92%) Just Right (7%) or Too Small (1%) (Figure). Obesity was associated with a higher prevalence of T2D (14% vs 5% P<0.01) elevated BP (51% vs 41% P=0.02) and higher non-HDL cholesterol (121±34 vs 113±33 mg/dL P=0.06). Obesity is viewed negatively by African immigrants and is associated with poor cardiometabolic health. Disclosure J.Hurston: None. C.C.Worthy: None. E.Shoup: None. J.Gatete: None. B.R.Schenk: None. L.Mabundo: None. C.Dubose: None. R.Jagannathan: None. M.F.Horlyck-romanovsky: None. A.E.Sumner: None.
In low and middle-income countries in Africa, β-cell-failure in the absence of obesity is increasingly recognized as a frequent cause of type 2 diabetes (DM) . DM risk scores assume that insulin resistance (IR) is the primary cause of DM. Therefore, their ability to detect DM due to β-cell-failure is unknown. In 529 African-born Blacks living in the United States (age 38± (mean±SD) ; 64% male; BMI 28±5 kg/m2) , we assessed (1) DM prevalence, (2) prevalence of DM due to IR versus β-cell failure; and (3) the ability of six risk scores (Cambridge, FINDRISC, Kuwaiti, Omani, Rotterdam, and SUNSET) to detect previously undiagnosed DM due to either IR or β-cell-failure. DM was diagnosed by OGTT and/or HbA1c ≥6.5%. IR was defined by lowest quartile of the Matsuda index (≤2.04) . DM due to β-cell-failure required DM in the absence of IR. Data on BP, BMI, waist circumference (WC) , health behaviors, and medical history were collected. Area under the Receiver Operator Characteristics Curve (AROC) assessed discriminatory ability of each score. Criteria for AROC: no discrimination=0.50; poor=0.50-0.69; acceptable=0.70-0.79; excellent=0.80-0.89; outstanding=≥0.90. DM prevalence was 9% (46/529) . DM was due to IR in 57% (26/46) and β-cell-failure in 44% (20/46) . The IR group had higher BMI (31±5 vs. 27±4 kg/m2 P<0.001) , and higher WC (101±vs. 91±cm P<0.001) . Scores had poor to excellent detection of diabetes due to IR (AROC=0.67-0.81) . In contrast, detection of diabetes due to β-cell-failure had an AROC score in the range of no discrimination or poor (AROC=0.49-0.62) . In summary, DM risk scores perform well for the detection of undiagnosed DM in Africans when the etiology is IR. However, scores fail to detect DM due to β-cell failure. Therefore, scores which evaluate DM risk when the cause is β-cell failure are urgently needed. Disclosure A.Wentzel: None. A.Patterson: None. M.Duhuze-karera: None. Z.C.Waldman: None. B.R.Schenk: None. L.Mabundo: None. C.Dubose: None. A.E.Sumner: None. M.F.Horlyck-romanovsky: None.
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