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Impact of Rare and Common Genetic Variants on Diabetes Diagnosis by Hemoglobin A1c in Multi-Ancestry Cohorts: The Trans-Omics for Precision Medicine Program.

Chloé Sarnowski | Aaron Leong | Laura M Raffield | Peitao Wu | Paul S de Vries | Daniel DiCorpo | Xiuqing Guo | Huichun Xu | Yongmei Liu | Xiuwen Zheng | Yao Hu | Jennifer A Brody | Mark O Goodarzi | Bertha A Hidalgo | Heather M Highland | Deepti Jain | Ching-Ti Liu | Rakhi P Naik | Jeffrey R O'Connell | James A Perry | Bianca C Porneala | Elizabeth Selvin | Jennifer Wessel | Bruce M Psaty | Joanne E Curran | Juan M Peralta | John Blangero | Charles Kooperberg | Rasika Mathias | Andrew D Johnson | Alexander P Reiner | Braxton D Mitchell | L Adrienne Cupples | Ramachandran S Vasan | Adolfo Correa | Alanna C Morrison | Eric Boerwinkle | Jerome I Rotter | Stephen S Rich | Alisa K Manning | Josée Dupuis | James B Meigs | TOPMed Diabetes Working Group | TOPMed Hematology Working Group | TOPMed Hemostasis Working Group | National Heart, Lung, and Blood Institute TOPMed Consortium
American journal of human genetics | 2019

Hemoglobin A1c (HbA1c) is widely used to diagnose diabetes and assess glycemic control in individuals with diabetes. However, nonglycemic determinants, including genetic variation, may influence how accurately HbA1c reflects underlying glycemia. Analyzing the NHLBI Trans-Omics for Precision Medicine (TOPMed) sequence data in 10,338 individuals from five studies and four ancestries (6,158 Europeans, 3,123 African-Americans, 650 Hispanics, and 407 East Asians), we confirmed five regions associated with HbA1c (GCK in Europeans and African-Americans, HK1 in Europeans and Hispanics, FN3K and/or FN3KRP in Europeans, and G6PD in African-Americans and Hispanics) and we identified an African-ancestry-specific low-frequency variant (rs1039215 in HBG2 and HBE1, minor allele frequency (MAF) = 0.03). The most associated G6PD variant (rs1050828-T, p.Val98Met, MAF = 12% in African-Americans, MAF = 2% in Hispanics) lowered HbA1c (-0.88% in hemizygous males, -0.34% in heterozygous females) and explained 23% of HbA1c variance in African-Americans and 4% in Hispanics. Additionally, we identified a rare distinct G6PD coding variant (rs76723693, p.Leu353Pro, MAF = 0.5%; -0.98% in hemizygous males, -0.46% in heterozygous females) and detected significant association with HbA1c when aggregating rare missense variants in G6PD. We observed similar magnitude and direction of effects for rs1039215 (HBG2) and rs76723693 (G6PD) in the two largest TOPMed African American cohorts, and we replicated the rs76723693 association in the UK Biobank African-ancestry participants. These variants in G6PD and HBG2 were monomorphic in the European and Asian samples. African or Hispanic ancestry individuals carrying G6PD variants may be underdiagnosed for diabetes when screened with HbA1c. Thus, assessment of these variants should be considered for incorporation into precision medicine approaches for diabetes diagnosis.

Pubmed ID: 31564435 RIS Download

Associated grants

  • Agency: NHLBI NIH HHS, United States
    Id: R01 HL120393
  • Agency: NHLBI NIH HHS, United States
    Id: R01 HL131136
  • Agency: NIDDK NIH HHS, United States
    Id: R03 DK118305
  • Agency: NHGRI NIH HHS, United States
    Id: L30 HG009840
  • Agency: NIDDK NIH HHS, United States
    Id: P30 DK079626
  • Agency: NHLBI NIH HHS, United States
    Id: U01 HL137181
  • Agency: NHLBI NIH HHS, United States
    Id: T32 HL129982
  • Agency: NIDDK NIH HHS, United States
    Id: K24 DK080140
  • Agency: NIDDK NIH HHS, United States
    Id: U01 DK078616
  • Agency: NIDDK NIH HHS, United States
    Id: U01 DK105554
  • Agency: NHLBI NIH HHS, United States
    Id: R01 HL117626
  • Agency: NHLBI NIH HHS, United States
    Id: T32 HL007055
  • Agency: Medical Research Council, United Kingdom
    Id: MC_QA137853
  • Agency: NIDDK NIH HHS, United States
    Id: K01 DK107836
  • Agency: NHLBI NIH HHS, United States
    Id: U01 HL130114
  • Agency: Medical Research Council, United Kingdom
    Id: MC_PC_17228
  • Agency: NIDDK NIH HHS, United States
    Id: UM1 DK078616

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RRID:SCR_012815

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