{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T04:08:54Z","timestamp":1754107734280,"version":"3.41.2"},"reference-count":30,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["098051"],"award-info":[{"award-number":["098051"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/K013491\/1"],"award-info":[{"award-number":["MR\/K013491\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>South Africa has a high burden of HIV infection and anaemia. These conditions may cause HbA<jats:sub>1c<\/jats:sub> to over\u2010 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<jats:sub>1c<\/jats:sub>, and implications for the detection and diagnosis of diabetes, in a black South African population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Research design and methods<\/jats:title><jats:p>In this population\u2010based cross\u2010sectional study in eThekwini municipality (Durban), South Africa, we assessed HbA<jats:sub>1c<\/jats:sub> 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<jats:sub>1c<\/jats:sub> by anaemia (comparator: no anaemia), or HIV and ART (comparator: no HIV) status. HbA<jats:sub>1c<\/jats:sub>\u2010based diabetes prevalence was compared with OGTT\u2010based prevalence among individuals with anaemia and with untreated and ART\u2010treated HIV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In adjusted analyses, normocytic and microcytic anaemia were associated with higher HbA<jats:sub>1c<\/jats:sub> compared with no anaemia, whereas macrocytic anaemia and ART\u2010treated HIV were associated with lower HbA<jats:sub>1c<\/jats:sub> compared with no anaemia and no HIV, respectively. However, magnitudes of association were small (range: <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/dme14605-math-0001.png\" xlink:title=\"urn:x-wiley:07423071:media:dme14605:dme14605-math-0001\"\/>\u00a0=\u00a0\u22123.4\u00a0mmol\/mol or \u22120.31%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001 [macrocytic anaemia] to <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/dme14605-math-0002.png\" xlink:title=\"urn:x-wiley:07423071:media:dme14605:dme14605-math-0002\"\/>=\u00a02.1\u00a0mmol\/mol or 0.19%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001 [microcytic anaemia]). There was no significant difference in diabetes prevalence based on HbA<jats:sub>1c<\/jats:sub> or OGTT among individuals with anaemia (2.9% vs. 3.3%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.69), untreated HIV (1.6% vs. 1.6% <jats:italic>p<\/jats:italic>\u00a0=\u00a01.00) or ART\u2010treated HIV (2.9% vs. 1.2%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.08).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results suggest that anaemia and HIV status appear unlikely to materially affect the utility of HbA<jats:sub>1c<\/jats:sub> for diabetes detection and diagnosis in this population. Further studies are needed to examine these associations in sub\u2010Saharan African populations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14605","type":"journal-article","created":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T11:26:48Z","timestamp":1621855608000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["HIV infection and anaemia do not affect HbA<sub>1c<\/sub> for the detection of diabetes in black South Africans: Evidence from the Durban Diabetes Study"],"prefix":"10.1111","volume":"38","author":[{"given":"Thomas R.","family":"Hird","sequence":"first","affiliation":[{"name":"Department for Health University of Bath Bath UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uttara","family":"Partap","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Cambridge Cambridge UK"},{"name":"Wellcome Sanger Institute Hinxton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pravi","family":"Moodley","sequence":"additional","affiliation":[{"name":"School of Laboratory Medicine and Medical Sciences University of KwaZulu\u2010Natal Durban South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fraser J.","family":"Pirie","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology Nelson R. Mandela School of Medicine University of KwaZulu\u2010Natal Durban South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tonya M.","family":"Esterhuizen","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"O'Leary","sequence":"additional","affiliation":[{"name":"Formerly of the Research and Policy Department Office of Strategy Management eThekwini Municipality Durban South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark I.","family":"McCarthy","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology and Metabolism University of Oxford Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth H.","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Cambridge Cambridge UK"},{"name":"Wellcome Sanger Institute Hinxton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manjinder S.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0517-1784","authenticated-orcid":false,"given":"Ayesha A.","family":"Motala","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology Nelson R. Mandela School of Medicine University of KwaZulu\u2010Natal Durban South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,6,8]]},"reference":[{"volume-title":"IDF Diabetes Atlas","year":"2019","author":"International Diabetes Federation","key":"e_1_2_8_2_1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0161966"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0043336"},{"key":"e_1_2_8_5_1","first-page":"1","volume-title":"Definition, Diagnosis, and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. Part 1. 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