Illustration showing how minority patient groups face a higher risk of inaccurate A1C test results due to hemoglobin variants.

Inaccurate A1C test results can disproportionately affect certain minority populations due to hemoglobin variants and other biological factors. As a result, minority patient groups may face a higher risk of both developing diabetes and receiving inaccurate A1C readings.

Inaccurate A1C Test Results Occur in Minority Populations

Racial and ethnic disparities remain a persistent challenge in diabetes prevalence across the United States. With this comes recognition of health disparities among these populations, one of these differences being the rates of diagnosed diabetes. According to the ADA, 11.3% of all U.S. adults have diabetes. Communities of color experience the highest rates of diabetes.

The ADA also reported the rates of diagnosed diabetes in adults by race/ethnic background are:
  • 13.6% of American Indians/Alaskan Native adults
  • 12.1% of non-Hispanic Black adults
  • 11.7% of Hispanic adults
  • 9.1% of Asian American adults
  • 6.9% of non-Hispanic White adults
The statistics highlight disproportionately high rates of diabetes, revealing underlying healthcare inequities across the country. As a result, minority populations also report higher rates of diabetes risk factors such as albuminuria, retinopathy, stroke, amputations, and end-stage renal disease, as compared to White patients.

Despite having a higher likelihood of developing diabetes and associated complications, minority patients are less likely to receive preventative care. Gaps in healthcare access and diabetes prevention include regular A1C testing, annual cholesterol screenings, eye examinations, and more.

Even when non-white patients follow care guidelines, mistakes in accuracy can occur, such as in A1C tests. A study in the National Library of Medicine highlights how disparities in A1C readings can lead to misdiagnoses and ineffective treatment plans—particularly impacting underserved communities.

Effects of Hemoglobin Variants on A1C Test Results – Which Populations Are Most At-Risk of Receiving Inaccurate Readings?

Individuals with certain hemoglobin variants—often associated with specific racial or ethnic backgrounds—may receive inaccurate A1C test results depending on the testing method used. Laboratory machines and point-of-care devices use many different testing methods to measure A1C. While laboratory machines are considered more accurate than point-of-care devices, these protein-based measuring methods have the fundamental imperfection of having a hemoglobin variant interference effect.

Black, Hispanic, and Asian Americans report the highest rates of hemoglobin variants, increasing the potential for receiving inaccurate A1C readings.

Populations with the Highest Rates of Hemoglobin Variants in the U.S.

Hemoglobin VariantPrevalence in the U.S.
Hemoglobin S (HbS)
  • 1 in 13 African Americans
  • 1 in 100 Hispanic Americans/Latinos
    • Hemoglobin C (HbC)
  • 2.3% of African Americans
    • Hemoglobin E (HbE)
  • Higher risk for people of Southeast Asian descent
    • Source: NIDDK

    In addition, the Black population has a higher rate of sickle cell disease (one type of hemoglobinopathy). About 1 in 13 Black babies is born with a sickle cell trait. ADA guidelines do not recommend people with sickle cell disease test A1C, because results are significantly inaccurate.

    A lack of A1C accuracy can lead to delayed diagnosis, misdiagnosis, and incorrect updates on one’s health status.

    According to the ADA, “In the U.S., Black people are 2x as likely as their white counterparts to die of diabetes. They are 3x as likely to end up hospitalized for diabetes-related complications. They are more than 2x as likely to undergo a diabetes-related leg or foot amputation. And they are more than 3x as likely to have end-stage kidney disease.”
    By raising awareness about hemoglobin variants and the associated risk of test inaccuracies, in addition to increasing access to diabetes education initiatives around preventive care, the U.S. healthcare system can seek to overcome critical disparities in healthcare.

    Orange Biomed’s New A1C Testing Method: Key Commitment to Diversity

    The Orange Biomed team is committed to promoting healthcare equity for all patient populations. We strive to support the racially diverse population of people with diabetes.

    Therefore, we have developed a portable A1C testing solution, free from hemoglobin variant interference, providing more accessible and accurate results for people of diverse backgrounds.

    OBM rapid A1c is a new, more accurate method of testing, anticipated to be released soon. The company stands behind our commitment to racial diversity. Learn more about OBM rapid A1c here.

    Sources: