Retinopatía diabética y su relación con los niveles de hemoglobina glucosilada / Diabetic Retinopathy and its Relationship with Glycosylated Hemoglobin Levels

Introducción: La retinopatía diabética es la principal causa de ceguera en personas diabéticas de 20 a 64 años de edad, e incrementa su aparición frente a un mal control de la enfermedad, que se expresa con valores altos de hemoglobina glucosilada (HbA1C). Objetivo: Establecer la relación entre los niveles de hemoglobina glucosilada y la presencia de retinopatía en los pacientes con diabetes mellitus tipo 2. Métodos: Se llevó a cabo un estudio descriptivo, prospectivo y transversal, en el que se obtuvieron, mediante ficha de observación, datos sociodemográficos, de evaluación oftalmológica y niveles de HbA1C, de los pacientes atendidos en consulta externa del Hospital General Isidro Ayora de la ciudad de Loja, Ecuador, en el período febrero-junio de 2018. Se aplicaron medidas de frecuencia y asociación para el análisis estadístico. Resultados: Se incluyeron 160 pacientes: 108 mujeres y 52 hombres, todos de raza mestiza. Se identificó retinopatía en 26,8 por ciento (N = 43) de los pacientes, de quienes 41 por ciento (N = 18) tenía más de 65 años de edad. La media de HbA1C en pacientes sin retinopatía fue de 7,4 por ciento, y en aquellos con retinopatía de 9,8 por ciento en mayor porcentaje de pacientes con valores de HbA1C de 7 por ciento o más presentaron retinopatía diabética, en comparación con aquellos de HbA1C menores a 7 por ciento (p < 0,0001), la retinopatía no proliferativa moderada fue el principal diagnóstico realizado. Conclusiones: El mal control glucémico en las personas con diabetes mellitus tipo 2 se asocia con mayor probabilidad de aparición de lesiones retinianas(AU)

Introduction: Diabetic retinopathy is the main cause of blindness in diabetic people aged 20 to 64 years; it increases its occurrence due to poor control of the disease, expressed by high values of glycosylated hemoglobin (HbA1c). Objective: To establish the relationship between glycosylated hemoglobin levels and the presence of retinopathy in patients with type 2 diabetes mellitus. Methods: A descriptive, prospective and cross-sectional study was carried out, in which sociodemographic data, others from an ophthalmologic evaluation and HbA1c levels were obtained, by means of an observation card, from patients seen in the outpatient clinic of Hospital General Isidro Ayoraof the city of Loja, Ecuador, in the period February-June 2018. Frequency and association measures were applied for statistical analysis. Results: The study included 160 patients: 108 women and 52 men, all of mixed race. Retinopathy was identified in 26.8percent (N=43) of patients, of whom 41percent (N=18) were over 65 years of age. The mean HbA1c in patients without retinopathy was 7.4percent, and 9.8percent in those with retinopathy. A higher percentage of patients with HbA1c values of 7percent more had diabetic retinopathy, compared to those with HbA1C under 7percent (p<0.0001). Moderate nonproliferative retinopathy was the main diagnosis. Conclusions: Poor glycemic control in persons with type 2 diabetes mellitus is associated with increased likelihood of retinal lesions(AU)

Depression scores correlate with glycosylated hemoglobin a levels in type 2 diabetics from a mayan community / Los puntajes de depresión se correlacionan con los niveles de hemoglobina glucosilada en diabéticos tipo 2 de una comunidad maya

Abstract Objective: To assess whether depression and quality of life scores correlate with glycosylated hemoglobin A (HbA1c) levels in type 2 diabetes mellitus (T2DM) patients of predominant Mayan ethnicity, from a rural community in the state of Yucatán, Mexico. Materials and methods: Instruments: for depression, CES-D (cutoff ≥ 16); for quality of life, D-39; criterion for poor glycemic control, HbA1c ≥ 8%. Results: Depression was detected in 36.3% of 33 diabetic subjects (10 men, 23 women), and their HbA1c levels (mean ± SD) were higher (10.7 ± 2.5%) than for those without depression (8.6 ± 2.2%, p = 0.015; unpaired Student's t-test, two-tailed). Depression occurred in 33.3% of diabetics with HbA1c ≥8%, but only in 3.0% of those with HbA1c < 8% (p = 0.027, Fisher's exact test). HbA1c levels positively correlated with CES-D scores (r2 =0.135; p = 0.035; Pearson). D-39 "Anxiety-Worry" (AW) dimension scores were higher in diabetics with depression (43.3 ± 22.2) than in those without depression (17.7 ± 17.8; p = 0.005, Mann-Whitney U-test). A positive correlation was found between CES-D and AW scores (r2 = 0.304; p = 0.001; Pearson). Conclusions: Considering that depression and anxiety have been related to poor self-care for achieving a good glycemic control, we propose the concomitant use of CES-D and D-39, which are validated and easy-to-apply instruments, as screening tests to detect depression and anxiety in T2DM patients residing in rural communities. Therefore, if patients test positive on one or both instruments, they can be referred to a psychiatrist to confirm the diagnosis and provide appropriate therapy. This would help to promote adherence to diabetes control measures and improve their quality of life.

Resumen Objetivo: Evaluar si las puntuaciones de depresión y calidad de vida se correlacionan con los niveles de hemoglobina glucosilada (HbA1c) en pacientes con diabetes mellitus tipo 2 (DM2) de etnia maya predominante, de una comunidad rural en el estado de Yucatán, México. Materiales y Métodos: Instrumentos: para depresión, CES-D (punto de corte ≥ 16); para calidad de vida, D-39; criterio de mal control glucémico, HbA1c ≥ 8%. Resultados: Se detectó depresión en el 36.3% de 33 sujetos diabéticos (10 hombres, 23 mujeres), y sus niveles de HbA1c (media ± DE) fueron más altos (10.7 ± 2.5%) que para los que no tenían depresión (8.6 ± 2.2%, p = 0.015; prueba t de Student, no pareada). La depresión se presentó en el 33.3% de los diabéticos con HbA1c ≥ 8%, pero solo en el 3.0% de aquellos con HbA1c <8% (p = 0.027, prueba exacta de Fisher). Los niveles de HbA1c se correlacionaron positivamente con las puntuaciones CES-D (r2 = 0.135; p = 0.035; Pearson). Los puntajes de la dimensión "Ansiedad-Preocupación" (AW) del D-39 fueron más altos en diabéticos con depresión (43.3 ± 22.2) que en aquellos sin depresión (17.7 ± 17.8; p = 0.005, prueba U de Mann-Whitney). Se encontró una correlación positiva entre las puntuaciones CES-D y AW (r2 = 0.304; p = 0.001; Pearson). Conclusiones: Considerando que la depresión y la ansiedad han sido asociadas a autocuidados inadecuados para alcanzar un buen control glicémico, proponemos el uso concomitante de CES-D y D-39, que son instrumentos validados y de fácil aplicación, como pruebas de cribado para detectar depresión y ansiedad en pacientes con DM2 residentes en comunidades rurales. Por lo tanto, si los pacientes dan positivo en uno o ambos instrumentos, se les puede derivar a un psiquiatra para confirmar el diagnóstico y proporcionar la terapia adecuada. Esto ayudaría a promover el cumplimiento de las medidas de control de la diabetes y a mejorar su calidad de vida.

Perfil clínico de pacientes atendidos con diabetes mellitus tipo 2 en un programa de reversión / Clinical Profile Trial Of Patients Cared With Diabetes Mellitus Type 2 In A Reversion Program

La diabetes es una enfermedad crónica que aparece cuando el páncreas no produce insulina suficiente o cuando el organismo no utiliza eficazmente la insulina que produce. La insulina es una hormona que regula el azúcar en la sangre. El efecto de la diabetes no controlada es la hiperglucemia (aumento del azúcar en la sangre), que con el tiempo daña gravemente muchos órganos y sistemas, especialmente los nervios y los vasos sanguíneos.

Diabetes is a chronic disease that appears when the pancreas does not produce enough insulin or when the body does not use the insulin it produces effectively. Insulin is a hormone that regulates blood sugar. The effect of uncontrolled diabetes is hyperglycemia (increased blood sugar), which over time severely damages many organs and systems, especially nerves and blood vessels.

Factores asociados a la baja adherencia al tratamiento de la diabetes tipo 2: un estudio de corte transversal / Factors associated with low adherence to diabetes type 2 treatment: a cross-sectional study

La diabetes mellitus (DM) es una enfermedad crónica que se define por la hiperglucemia prolongada en el tiempo, que trae como consecuencia daño a nivel microangiopático - macrovascular y representa uno de los mayores problemas de salud pública a nivel mundial. Actualmente, no se ha podido definir en la población chilena los diferentes factores que influyen en la adherencia al tratamiento de los pacientes con DM2. Objetivo: Analizar la asociación entre la baja adherencia terapéutica en personas adultas con DM2 que se atienden en el CESFAM Jean et Marie Thierry y las variables propias del paciente como sexo, edad, presencia de otras enfermedades crónicas y polifarmacia. Materiales y métodos: Se realizó un estudio observacional y analítico de corte transversal, en pacientes con DM2 pertenecientes al CESFAM Jean et Marie Thierry en el año 2019 y 2020. Se recolectaron datos desde la cartola del programa cardiovascular, parte de la ficha clínica, correspondiente a cada paciente con DM2 del CESFAM. Resultados: Se obtuvieron datos de 253 participantes del CESFAM. En total, un 43,87% de los pacientes no fueron adherentes y un 56,13% fue adherente al tratamiento. El promedio de edad fue de 67,3 años y la adherencia en pacientes con enfermedades crónicas concomitantes 44,1%. Conclusión: No hubo una asociación significativa entre las variables estudiadas y la adherencia terapéutica. A pesar de esto, es importante continuar el estudio debido al gran número de pacientes diabéticos no adherentes a su tratamiento.

Diabetes mellitus (DM) is a chronic disease defined as hyperglycemia over a prolonged period leading to damage at the microangiopathic and macrovascular level and is one of the largest public health problems worldwide. Currently, it has not been possible to define the different factors influencing treatment adherence in DM2 patients in the Chilean population. Objectives: Analyze the association between adherence to treatment in adults with DM2 attending CESFAM Jean et Marie Thierry and the patients' variables such as gender, age, concomitant chronic disease and polypharmacy. Material and Methods: In 2019 and 2020 an observational and analytical study was done in a cross section of DM2 patients from CESFAM Jean y Marie Thierry. Data from each of the CESFAM's DM2 patients was collected from the cardiovascular program register in the clinical file. Results: Data was obtained from 253 participants. In total, 43.87% did not adhere to treatment and 56.13% adhered to treatment. The average age was 67.3 years and the adherence in patients with concomitant chronic disease was 44.1%. Conclusion: There was no significant association between the variables studied and adherence to treatment. Despite this, it is important to continue the study because of the large number of diabetics not adhering to treatment.

Sitagliptin in Achieving Better Glycemic Control as added Drug Therapy in Type 2 Diabetes Mellitus

Introduction: Type 2 diabetes mellitus is progressive loss ofglycemic control over a period of time. So the purpose of thepresent study was to evaluate the effectiveness and safety ofthe Sitagliptin as an ‘add-on’ to the ongoing drug therapy inpatients with Type 2 Diabetes Mellitus (T2DM).Material and Methods: It was a randomized, retrospectivepopulation based cohort study done in 259 patients for 36weeks from July’12 – March’13. Patients were randomlydivided into 2 groups. In 1st group, sitagliptin was added andno ongoing drug was withdrawn while in 2nd group sitagliptinwas added and dose of ongoing therapy was reduced to half.Results: The primary efficacy endpoint was reduction inglycated haemoglobin (HbA1C), fasting blood sugar, and 2hour post prandial blood sugar evaluated after 4, 8, 12, 18 and36 weeks. A better glycemic control was observed in 1st groupthan 2nd. Sitagliptin was well tolerated without side effects.Conclusion: Addition of Sitagliptin 100mg once daily as‘add-on’ drug therapy was well tolerated with significantglycemic control in T2DM after 36 weeks.

Effect of double heterozygous hemoglobin on the results of different glycosylated hemoglobin detection systems / 临床检验杂志

Objective@#To investigate the effects of glycosylated hemoglobin A1c (HbA1c) from the patients with double heterozygotes Hb Q-H and Hb J-Bangkok combined with β-thalassemia on the results of different HbA1c detection systems. @*Methods@#Blood samples from 20 healthy adults and 20 patients with type 2 diabetes mellitus (T2DM) were collected to assess the results of five glycosylated hemoglobin detection systems. Blood samples from one Hb Q-H patient and one Hb J-Bangkok patient with β-thalassemia were also collected, and they were performed hemoglobin capillary electrophoresis with Capillarys2 and globin gene analysis by gap-PCR, PCR-RDB and DNA sequencing. The levels of HbA1c in all samples were detected by BioRad VARIANT Ⅱ (VⅡ), BioRad VARIANT ⅡTurbo2.0 (V Ⅱ-T2.0), Capillarys 2 Flex Piercing (C2FP), Primus Ultra2 (Ultra2) and Roche PPI 800 (PPI 800) glycosy lated hemoglobin detection instruments, respectively. For the samples with double heterozygotes, the levels of HbA1c were detected for 3 times each sample, and the results were preserved and analyzed. @*Results@#The genotype of the Hb Q-H sample was --α QT /--SEA;β N /β N , and HbA1 CD74 G＞C mutation occurred in globin α1 chain, forming Hb Q-Thailand hemoglobin variant without normal α-globin peptide chain. The genotype of Hb J-Bangkok combined with β-thalassemia was αα/αα;βCD56/βCD41-42, and the point mutation of GGC＞GAC occurred at codon 56 of globin β-chain, forming Hb J-Bangkok hemoglobin variant without normal β-globin peptide chain. For the Hb Q-H sample, HbA1c results were reported by 3 of 5 HbA1c detection systems. The chromatograms of VⅡ and VⅡ-T2.0 detection systems were obviously different from normal chromatograms, and HbA1c results were not reported. However, the chromatograms of the C2FP system were similar to normal chromatograms, and the result of HbA1c was 3.7%. The Ultra2 system and PPI system reported the HbA1c results, 5.3% and 5.7%, respectively, without abnormal alarm. For the Hb J-Bangkok with β-thalassemia sample, HbA1c results were also reported by 3 of 5 HbA1c detection systems. The chromatograms of VⅡ and Sebia detection systems were obviously different from normal chromatograms, and HbA1c results were not reported. However, the chromatograms of VⅡ-T2.0 system were different from normal chromatograms, and a P4 peak (84.9%) was found. The HbA1c result was reported as 4.7%. The Ultra2 system and PPI system reported the HbA1c results, 4.7% and 3.8%, respectively, without abnormal alarm. @*Conclusion@#The samples from the Hb Q-H patient and the Hb J-Bangkok patient with β-thalassemia do not contain normal HbA, and there should be no HbA1c results. The chromatograms of VⅡ and VⅡ-T systems are obviously abnormal, indicating that the results can not be reported. The C2FP system is interfered obviously by Hb Q-H, but reports the HbA1c results, while it does not report the HbA1c results of Hb J-Bangkok combined with β-thalassemia. Both of Hb Q-H and Hb J-Bangkok have obvious interference to PPI and Ultra2 detection systems.

Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Mellitus Patients with Complications

OBJECTIVES: Inadequate glycemic control amongst patients with Type 2 diabetes mellitus (T2DM) indicates a major public health problem and a significant risk factor for the progression and complications caused by diabetes. Glycemic control is the main therapeutic objective for the prevention of organ damage and other complications arising from diabetes. METHODS: This was a retrospective observational study of T2DM patients with complications, who were aged 40 years and older. The study was conducted retrospectively on medical records (in-patient and out-patient) obtained from a South Indian teaching hospital, Manipal, India. The patients included in the study had fasting blood sugar, postprandial blood sugar and HbA1c measured at least twice during follow-ups the previous year. Patients’ HbA1c levels were categorized into good control ≤7% (≤53mmol/mol), and poor control >7% (>53mmol/mol), and patients’ characteristics were analyzed. RESULTS: A total of 657 patients were included in the study. The mean age was 59.67 (SD = 9.617) years, with 152 (23.1%) females and 505 (76.9%) males, and 514 (78.2%) patients had poor glycemic control. Most of the patients were on insulin mono-therapy [n = 271 (42.1%)], about a third of the patients were on combination therapy that included an oral hypoglycemic agent and insulin [n = 236 (36.6%)]. Patients with a history of more than 10 years of diabetes [n = 293 (44.6%)], had a family history of diabetes [n = 256 (39%)] and obesity [n = 95 (14.5%)], all had poor glycemic control. CONCLUSION: This present study indicated a significant association of gender (female), age, high-density lipoprotein level, duration of diabetes and type of medication, with poor glycemic control in T2DM patients that had secondary medical complications.

Effect of Health Education Based on Integrative Therapy of Chinese and Western Medicine for Adult Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Study / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the effects of health education based on integrative therapy of Chinese and Western medicine for type 2 diabetes mellitus (T2DM) from the aspects of knowledge, attitude and practice (KAP), health-related quality of life (HRQoL), body mass index (BMI) and glucose control.</p><p><b>METHODS</b>Patients were individually randomized into intervention group (receiving integrative education, n=120) and control group (receiving usual education, n=120). The primary outcome was the changes in glycosylated hemoglobin A1c (HbA1c) levels after 3, 6, 9 and 12 months from baseline. Hierarchical linear models (HLMs) were used to assess within-group changes in outcomes over time and between-group differences in patterns of change. Secondary outcomes were KAP scores, HRQoL scores and BMI after 6 and 12 months, paired-sample t test was used to assess within-group changes in outcomes in 6 and 12 months, independent-sample t test was used to assess between-group differences in patterns of change.</p><p><b>RESULTS</b>HbA1c decreased statistically from baseline to 3 months, from 3 to 6 months, from 6 to 9 months and from 9 to 12 months in the intervention group (all P<0.01); and decreased significantly from baseline to 3 months, and from 3 to 6 months in the control group P<0.01). There was a significant between-group difference from baseline to 3 months (P=0.044), from 6 to 9 months (P<0.01) and from 9 to 12 months (P<0.01). Significant improvements in the intervention group along with significant between-group differences were found in KAP and HRQoL scores respectively (all P<0.05). The number in the intervention group of normal weight increased from 56 at baseline to 81 (6 months), 94 (12 months), the number in the control group were 63 (baseline), 69 (6 months), 70 (12 months), the χof hierarchical analysis of BMI were 6.93 (P=0.075), 10.31 (P=0.016), 15.53 (P<0.01), respectively.</p><p><b>CONCLUSION</b>Health education based on integrative therapy of Chinese and Western medicine is beneficial to the control of T2DM and should be recommended for T2DM.</p>

Goal Attainment Rate for Parameters of Metabolic Adjustment in Elderly Patients with Type 2 Diabetes Taking a Hypoglycemic Agent / 임상당뇨병

BACKGROUND: This study aimed to investigate the goal attainment rates for hemoglobin A1c (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in elderly patients with type 2 diabetes. METHODS: The subjects were 762 over 65 years old patients with type 2 diabetes taking a hypoglycemic agent. Data were collected by reviewing medical records and included general characteristics, biochemical tests, prescribed pharmacologic agents, and complications. RESULTS: The goal attainment rates (mean value) for HbA1c, BP, and LDL-C were 50.4% (7.3% ± 1.2%), 78.9% (126.0 ± 15.1/72.1 ± 10.0 mm Hg), and 60.6% (88.6 ± 29.9 mg/dL). Diabetes-related complications for retinopathy, nephropathy, neuropathy, and cardio-cerebral vascular disease were 36.3%, 37.2%, 23.6%, and 31.9%, respectively. Life habit-related variables positively associated with goal attainment were not drinking alcohol and exercise for HbA1c, not smoking for BP and not drinking alcohol for LDL-C. Metabolic adjustment indicator-related significant variables for complications were HbA1c in retinopathy, BP in nephropathy, and LDL-C in cardio-cerebral disease. CONCLUSION: We found that goal attainment rates for parameters of metabolic adjustment were not high in elderly patients with type 2 diabetes. Thus, diabetes educators should be concerned about metabolic adjustment indicators. Also, case management guidelines according to elderly patient health and functional status should be developed to help manage metabolic adjustment.

Presencia de bacilos negro pigmentantés en bolsas periodontales de pacientes diabéticos tipo 2 y su relación con el control glicémico / Presence of bacilli black pigments in periodontal pockets of patients with type 2 diabetes and its relationship with the glycemic level

Objetivos: El estudio tuvo como objetivo identificar la presencia de bacilos negro pigmentantés (BNP) en bolsas periodontales de pacientes diabéticos tipo 2 y determinar una relación con su control glicémico. Material y métodos: Se evaluó un número total de 46 pacientes que cumplían con los criterio de inclusión en el estudio, de los cuales quedaron 20 por haber concluido con todas las pruebas realizadas en el estudio, como el estudio microbiológico de sus muestras de placa subgingival y las pruebas de hemoglobina glicosilada que se realizó en forma periódica en los 3 meses que se evaluó a los pacientes. Resultados: De los 20 pacientes evaluados que completaron todas sus pruebas, 14 eran mujeres y 6 varones, con un rango de edad de 40 a 68 años, pudiéndose identificar estos bacilos negro pigmentantés (BNP) en el 20 % de casos con diagnóstico de periodontitis moderada a severa (periodontitis moderada: bolsa periodontal de 6 a 7 mm y Periodontitis severa: bolsa periodontal mayor de 7 mm), presentando estos pacientes un control glicémico de condición bueno a moderado (control bueno: = 6.9 % HbAc1y control moderado: 7 a 7.9 % HbAc1). La prueba estadística realizada para valorar la relación presencia BNP y el control glicémico fue de Chi cuadrado el cual no determino significancia de la relación (P > 5 %). Conclusiones: Se identificó la presencia de BNP en pacientes diabéticos tipo 2 pero más relacionado a pacientes con cuadros de periodontitis moderada a severa y con un control glicémico de bueno a moderado, no presentando significancia estadística.

Objectives: The study aimed to identify the presence of bacilli black pigments in periodontal pockets of type 2 diabetic patients and determine a relationship with glycemic control. Material and methods: A total of 46 patients who met the criteria for inclusion in the study, of which were 20 for having completed all tests in the study, such as microbiological analysis of samples of subgingival plaque and evaluated glycosylated hemoglobin tests held periodically in the 3 months patients were assessed. Results: Of the 20 patients evaluated, 14 were women and 6 men, with an age range of 40 to 68 years, being able to identify these black bacilli pigments (BNP) in 20% of cases diagnosed with moderate to severe periodontitis (periodontitis. moderate: periodontal pocket of 6 to 7 mm and severe periodontitis: greater periodontal pocket of 7 mm), presenting these patients glycemic control in good condition to moderate (good control: = 6,9 % HbAc1 and moderate control: 7 to 7,9 % HbAc1) . The statistical test performed to assess the presence relationship BNP and glycemic control was Chi square which does not determine significance of the relationship (P> 5%). Conclusions: It was possible to identify the presence of BNP in patients with type 2 diabetes but more related to patients with moderate to severe pictures periodontitis and with good glycemic control to moderate, showing no statistical significance.

Clinical implications of circulating miRNA-101 expression level in patients with newly diagnosed type 2 diabetes mellitus / 中国临床药理学与治疗学

AIM:To investigate the serum miRNA-101 expression level in patients with newly diagnosed type 2 diabetes mellitus (T2DM),and to evaluate the clinical implications of miRNA-101 expression level variation.METHODS:qRT-PCR was used to determine the serum miRNA-101 expression level.Pearson correlation analysis was performed to observe the relationship between two variables.Multiple stepwise linear regression analysis was used to assess the association of serum miRNA-101 level and other parameters.RESULTS:Serum miRNA-101 level in patients with newly diagnosed T2DM was significantly higher than that in control subjects (P ＜ 0.05).The serum level of miRNA-101 was positively correlated with the glycosylated hemoglobin A1c (HbA1c,P ＜0.05).Multiple linear regression analysis revealed that the circulating miRNA-101 was in significant positive correlation with HbA1c (P ＜ 0.05) after adjustment for age,sex and body weight.CONCLUSION:Enhanced circulating miRNA-101 level in newly diagnosed T2DM patients may be associated with elevation of HbA1 c.

Correlação das dosagens de frutosamina e de hemoglobina glicosilada com o perfil glicêmico em gestantes com diabetes mellitus / Correlation of the Levels of Fructosamine and Glycated Hemoglobin with the Blood Glucose Profile in Pregnant Women with Diabetes Mellitus

Objetivo Avaliar se há correlação das dosagens de frutosamina e de hemoglobina glicosilada (HbA1c) com as frequências de desvios de glicemia capilar em gestantes com diabetes mellitus. Métodos estudo observacional, retrospectivo, de corte transversal, incluindo todas as gestantes comdiabetes que iniciaram o pré-natal emhospital terciário de ensino durante o ano de 2014 e que apresentavam pelo menos 20 dias de auto monitoramento glicêmico previamente às dosagens séricas de frutosamina e de HbA1c. Os desvios de glicemia capilar foram considerados "hipoglicemias" quando menores que 70mg/dL ou "hiperglicemias" quando acima do alvo glicêmico terapêutico para o horário. Foram testadas as correlações lineares par a par das dosagens de frutosamina e de HbA1c com as frequências de hipoglicemias e de hiperglicemias capilares pelo teste Tau-b de Kendall. Na sequência, foi avaliada a regressão linear entre as dosagens de HbA1c e de frutosamina e as frequências de hipoglicemias e de hiperglicemias. Resultados Foram incluídas 158 gestantes que contribuíram com 266 amostras para dosagem sérica de frutosamina e HbA1c. As dosagens de frutosamina e de HbA1c apresentaram, respectivamente, coeficientes τ de Kendall de 0,29 (p < 0,001) e 0,5 (p < 0,001) com a frequência de hiperglicemias, e de 0,09 (p = 0,04) e 0,25 (p < 0,001) com a frequência de hipoglicemias capilares. No modelo de regressão linear, as dosagens de frutosamina e de HbA1c apresentaram, respectivamente, coeficientes de determinação R2 = 0,26 (p < 0,001) e R2 = 0,51 (p < 0,001) para a predição de hiperglicemias, e R2 = 0,03 (p = 0,003) e R2 = 0,059 (p < 0,001) para a predição de hipoglicemias. Conclusão As dosagens de frutosamina e de HbA1c apresentam correlação fraca a moderada com as frequências de hiperglicemias e hipoglicemias capilares no auto monitoramento glicêmico e não são capazes de traduzir com precisão os desvios da meta glicêmica no tratamento de gestantes com diabetes.

Objective To evaluate the correlation of the levels of fructosamine and of glycated hemoglobin (HbA1c) with the frequency of blood glucose self-monitoring values out of the treatment target range in pregnant women with diabetes mellitus. Methods We performed an observational, retrospective, cross-sectional study, including all pregnant women with diabetes who attended prenatal care visits at a tertiary teaching hospital during the year of 2014 and who presented at least 20 days of blood glucose self-monitoring prior to assessment of serum levels of fructosamine and HbA1c. Capillary blood glucose values out of the treatment target range were considered "hypoglycemia" when lower than 70 mg/dL and "hyperglycemia" when above the glycemic therapeutic target. We evaluated the correlation of the levels of fructosamine and of HbA1c with the frequencies of hyperglycemia and hypoglycemia recorded in the glucometer device by performing Tau-b of Kendall correlation tests. Next, linear regression tests were performed between the levels of HbA1c and of fructosamine and the frequencies of hypoglycemia and hyperglycemia. Results We included 158 pregnant women, from whom 266 blood samples were obtained for assessing fructosamine and HbA1c levels. Measurements of fructosamine and of HbA1c presented, respectively, Kendall's τ coefficient of 0.29 (p < 0.001) and 0.50 (p < 0.001) regarding the frequency of hyperglycemia, and of 0.09 (p = 0.046) and 0.25 (p < 0.001) regarding the frequency of hypoglycemia. In the linear regression model, levels of fructosamine and of HbA1c respectively presented determination coefficients R2 = 0.265 (p < 0.001) and R2 = 0.513 (p < 0.001) for the prediction of hyperglycemia, and R2 = 0.033 (p = 0.003) and R2 = 0.059 (p < 0.001) for the prediction of hypoglycemia. Conclusion Levels of fructosamine and of HbA1c presented a weak to moderate correlation with the frequencies of hyperglycemia and hypoglycemia at blood glucose self-monitoring and were not able to accurately translate the deviations from the glycemic goals in pregnant women with diabetes.

Correlation Between the Severity of Diabetic Peripheral Polyneuropathy and Glycosylated Hemoglobin Levels: A Quantitative Study

OBJECTIVE: To investigate risk factors for diabetic peripheral polyneuropathy and their correlation with the quantified severity of nerve dysfunction in patients with diabetes mellitus (DM). METHODS: A total of 187 diabetic patients with clinically suspected polyneuropathy (PN) were subclassified into 2 groups according to electrodiagnostic testing: a DM-PN group of 153 diabetic patients without electrophysiological abnormality and a DM+PN group of 34 diabetic patients with polyneuropathy. For all patients, age, sex, height, weight, duration of DM, and plasma glycosylated hemoglobin (HbA1c) level were comparatively investigated. A composite score was introduced to quantitatively analyze the results of the nerve conduction studies. Logistic regression analysis and multiple regression analysis were used to evaluate correlations between significant risk factors and severity of diabetic polyneuropathy. RESULTS: The DM+PN group showed a significantly higher HbA1c level and composite score, as compared with the DM-PN group. Increased HbA1c level and old age were significant predictive factors for polyneuropathy in diabetic patients (odds ratio=5.233 and 4.745, respectively). In the multiple linear regression model, HbA1c and age showed a significant positive association with composite score, in order (β=1.560 and 0.253, respectively). CONCLUSION: Increased HbA1c level indicative of a state of chronic hyperglycemia was a risk factor for polyneuropathy in diabetic patients and a quantitative measure of its severity.

Relationship Between HbA1c and Complex Regional Pain Syndrome in Stroke Patients With Type 2 Diabetes Mellitus

OBJECTIVE: To investigate the relationship between glycosylated hemoglobin A (HbA1c) and complex regional pain syndrome (CRPS) in stroke patients with type 2 diabetes mellitus (T2DM). METHODS: A retrospective chart review was performed of stroke patients from January 2012 to December 2013. We reviewed 331 patients and included 200 in the analysis. We divided them into CRPS and non-CRPS groups and compared them by age, gender, stroke lesion, cause of stroke, duration of T2DM, HbA1c (%), National Institutes of Health Stroke Scale score, affected shoulder flexor muscle strength, Fugl-Meyer Assessment score, motricity index, Functional Independence Measure, Korean version of Modified Barthel Index, blood glucose level on admission day, duration from stroke onset to HbA1c check, and duration from stroke onset to three-phase bone scan for CRPS diagnosis. Thereafter, we classified the patients into five groups by HbA1c level (group 1, 5.0%–5.9%; group 2, 6.0%–6.9%; group 3, 7.0%–7.9%; group 4, 8.0%–8.9%; and group 5, 9.0%–9.9%) and we investigated the difference in CRPS prevalence between the two groups. RESULTS: Of the 200 patients, 108 were in the CRPS group and 92 were in the non-CRPS group. There were significant differences in HbA1c (p<0.05) between the two groups but no significant differences in any other factors. Across the five HbA1c groups, there were significant differences in CRPS prevalence (p<0.01); specifically, it increased as HbA1c increased. CONCLUSION: This study suggests that higher HbA1c relates to higher CRPS prevalence and thus that uncontrolled blood glucose can affect CRPS occurrence in stroke patients with diabetes.

Prevalence and Risk Factors of Clopidogrel Resistance in Patients of Acute Myocardial Infarction Underwent Emergency Percutaneous Coronary Intervention / 中国医科大学学报

Objective To assess the prevalence and risk factors associated with clopidogrel resistance in patients with acute myocardial infarction after primary PCI(percutaneous coronary intervention). Methods Using a retrospective case?control study,210 patients with acute myocardial in?farction who underwent primary PCI in the first hospital affiliated to China Medical University between October 2013 and September 2014 were re?viewed. Patients were divided into the normal group and the resistance group according to the platelet aggregation rate(PAR),and the incidence of clopidogrel resistance was calculated and the correlation between age,gender,smoking,alcohol drinking,blood pressure,blood lipid,glycosylated hemoglobin,and the clopidogrel resistance were analyzed. Results The incidence of clopidogrel resistance in patients underwent primary PCI was 36.67%. Platelet aggregation rates were 62.62 ± 9.23%and 32.71 ± 11.77%respectively in two groups(P<0.001). Multivariate logistic regression analysis found that clopidogrel resistance was positively correlated to high level of glycosylated hemoglobin(P=0.037,OR 1.241,95%CI 1.013?1.519). Conclusion High level of glycosylated hemoglobin was the independent risk factor of clopidogrel resistance. The risk of clopidogrel resis?tance will significantly increase in these diabetic patients who cannot control blood sugar well.

Analysis of glycosylated hemoglobin (HbA1c) level on maxillofacial fascial space infection in diabetic patients

OBJECTIVES: This study was performed to evaluate the impact of glycosylated hemoglobin (HbA1c) level on characteristics and prognosis of maxillofacial fascial infection in diabetic patients. MATERIALS AND METHODS: We reviewed the medical records of 72 patients (35 patients with HbA1c lower than 7.0% and 37 patients with HbA1c higher than 7.0%) diagnosed with maxillofacial fascial space infection and hospitalized for treatment at the Department of Oral and Maxillofacial Surgery in Dankook University Hospital (Cheonan, Korea) from January 2005 to February 2014. We compared demographics, parameters of glucoregulation (HbA1c), laboratory parameters of inflammation (white blood cell [WBC], C-reactive protein [CRP] count), type and number of involved spaces, type and number of antibiotics, period of hospitalization, number of surgical operations, need for tracheostomy, complications, computed tomography (CT), and microorganisms between the two groups. RESULTS: Compared with the well-controlled diabetes mellitus (DM) group (HbA1c or =7.0%) DM group had the following characteristics: longer hospitalization periods, higher values of laboratory parameters of inflammation (WBC, CRP count) at the time of admission, higher number of antibiotics prescribed, more frequent complications, frequent deep neck space involvement, and distinctive main causative microorganisms. As the HbA1c level increases, hospitalization periods and incidence of complications increase gradually. CONCLUSION: This retrospective study suggests that regulation of DM significantly impacts maxillofacial fascial infection. Poorly controlled DM with high HbA1c level negatively influences the prognosis of infection.

Clinical usefulness of the measurement of serum fructosamine in childhood diabetes mellitus

PURPOSE: Glycosylated hemoglobin (HbA1c) is often used as an indicator of glucose control. It usually reflects the average glucose levels over two to three months, and is correlated with the development of long-term diabetic complications. However, it can vary in cases of hemoglobinopathy or an altered red blood cell lifespan. The serum fructosamine levels reflect the mean glucose levels over two to three weeks. This study was designed to determine the clinical usefulness of the combined measurement of serum fructosamine and HbA1c in the management of childhood diabetes mellitus and the correlation between them. METHODS: Clinical data on 74 Korean children and adolescents with diabetes mellitus who were under management at the Department of Pediatrics of Dankook University Hospital were evaluated. Their fructosamine and HbA1c levels were reviewed based on clinical information, and analyzed using IBM SPSS Statistics ver. 21. RESULTS: Their HbA1c levels showed a strong correlation with their fructosamine levels (r=0.868, P<0.001). The fructosamine level was useful for the prompt evaluation of the recent therapeutic efficacy after the change in therapeutic modality. It was also profitable in determining the initial therapeutics and for the estimation of the onset of the disease, such as fulminant diabetes. CONCLUSION: The measurement of both fructosamine and HbA1c was useful in managing childhood diabetes mellitus, especially when there was discrepancy between the clinical information and the HbA1c level.

A Predictive Model of Health Outcomes for Young People with Type 2 Diabetes

PURPOSE: This study was conducted to develop and test a hypothetical model to predict health outcomes in young people with type 2 diabetes. METHODS: Data were collected from 190 adults aged 23-45 with type 2 diabetes mellitus who visited the endocrinology outpatient department of the two university hospitals in South Korea from November 2, 2012 to March 7, 2013. Data collection used the structured questionnaires and patient medical records. The descriptive and correlation statistics were analyzed using PASW 18.0 and structural equation modeling procedure was performed using the AMOS 18.0 program. RESULTS: The fit of the hypothetical model was appropriate with the ratio of the chi-square statistic to degrees of freedom at 17.00, goodness-of-fit index at .975, adjusted goodness-of-fit index at .930, root mean square error of approximation at .061, normed fit index at .926, Turker-Lewis index at .929, comparative fit index at .966. Behavioral skills were a critical factor that directly affects self-management behaviors. Through behavioral skills, motivation had a statistically significant indirect effect on self-management behavior. Self-management behavior had a statistically significant direct effect on health outcome. Through self-management behavior, behavioral skills had a statistically significant indirect effect on health outcome. These variables explained 17.9% of the total variance for the health outcome in young people with type 2 diabetes. CONCLUSIONS: The results suggest that self-management behavior could be improved through nursing interventions promoting personal motivation (positive attitude), social motivation (social support), and behavioral skills (self efficacy), which can result in better health outcomes for young people with type 2 diabetes.

The clinical application of glycosylated hemoglobin A1c and glycated albumin values in cirrhosis patients with hyperglycemia / 中华内科杂志

Objective To evaluate the diagnostic value of glycosylated hemoglobin A1c (HbA1c)and glycated albumin(GA) in hyperglycemia patients with liver cirrhosis (LCH).Methods One hundred LCH patients were divided into anemia and no-anemia group by Hb 110 g/L The no-anemia group was further divided into low albumin (serum albumin ＜ 30 g/L),and high albumin group (serum albumin 30-＜40 g/L).One hundred type 2 diabetes without liver cirrhosis were included as control group (T2DM).HbA1c,GA,fasting plasma glucose (FPG),postprandial 2h plasma glucose (2hPG) were collected for statistical analysis.Results (1) The HbA1c level in LCH with anemia tended lower than that in T2DM subjects [(6.76 ±2.20)％ vs (7.34 ± 1.23)％,P =0.06];though the level of GA [(19.10 ±7.47)％vs (16.68 ±2.90)％,P＜0.01] and 2hPG [(12.09 ±3.39) mmol/L vs (10.84 ±2.95) mmol/L,P＜0.05] were significantly higher than that in T2DM group.(2) No-anemia subjects in LCH group with albumin ＜ 30 g/L had obviously higher GA levels than those with albumin 30-＜ 40 g/L and T2DM (albumin≥40 g/L) [(18.79 ±2.28)％ vs (16.71 ±2.42)％ and (16.73 ±2.96)％,P＜0.01];though the level of HbA1c of three groups above has no significant difference.(3) The level of HbA1c between LCH without anemia group and T2DM group had no significant difference (P ＞ 0.05);and the level of GA between LCH without anemia group with albumin 30-＜ 40 g/L and T2DM group had no significant difference(P ＞0.05).(4) The HbA1c has a positive correlation with FPG and 2hPG in LCH (FPG∶r =0.45,P＜0.001;2hPG∶r =0.33,P=0.001) and T2DM subjects (FPG∶ r =0.76,P＜0.001;2hPG∶r =0.81,P ＜ 0.001).GA also has a positive correlation with FPG and 2hPG in LCH (FPG∶ r =0.48,P ＜0.001;2hPG:r=0.39,P ＜0.001) and T2DM subjects (FPG∶ r =0.74,P ＜0.001;2hPG∶ r =0.76,P ＜0.001).Conclusion It is unfavorable to use HbA1c to evaluate the blood glucose level in liver cirrhosis patients with Hb ＜ 110 g/L and to use GA in patients with serum albumin ＜ 30 g/L.

Diagnostic and therapeutical value of FPG,GA,HbA1c and GA/HbA1c ratio in T1 DM/T2 DM / 中国免疫学杂志

Objective:To investigate the diagnostic and terapeutical value of FPG,GA,HbA1c and GA/HbA1c ratio in T1DM/T2DM.Methods:The study was made by case-control method.In our study,30 healthy subjects were selected from health physical ex-amination as control group while 160 diabetics were selected as case group,in which there are 76 TIDM and 84 T2DM.Analyzing the difference of relevance of FPG,GA and HbA1c,the difference of GA/HbA1c and threshold of the case and the control,and this analysis was also used between the T1DM and the T2DM.The data was managed by independent-sample t test,ROCK and Pearson correlation test of SPSS.Results:The results of FPG,GA ,HbA1c and GA/HbA1c ratio of T1DM and T2DM were significantly higher than those in the control group(P0.05),and weakly negative correlative with HbA1c(P>0.05);in T2DM group,there were positive correlation among FPG,GA and HbA1c(PFPG/GA>FPG/HbA1c;analyzing the ROC of measures in T1DM group,the sensitivity and specificity were re-spectively 86.8% and 100% for diagnosing DM when FPG threshold was set on 5.86 mmol/L ( AUC=0.922 ) ( P0.05).Conclusion:FPG,GA, HbA1c and GA/HbA1c ratio are of high value in monitoring of blood glucose, diagnosis and typing in T1DM and T2DM.There are missed diagnosis when we diagnose T1DM and T2DM by the upper limit of reagent instruestion of FPG,GA,HbA1c.It is more important for a person with T1DM to monitor FPG than others.