A study on influence of iron deficiency anaemia over HbA1c levels

Background: Haemoglobin A1c (HbA1c) is a glycated form of haemoglobin reflects average plasma glucose over the previous 8 to 12 weeks. HbA1c can be affected by multiple non-glycaemic parameters. Iron deficiency anaemia (IDA) is one among them which is the most common type of anaemia in India. However, reports on the effects of iron deficiency anaemia on HbA1c levels are inconsistent. Hence we conducted a study to find out the influence of iron deficiency anaemia over HbA1c levels. Methods: 120 patients confirmed to have iron deficiency anaemia were enrolled in this study. HbA1c levels were measured at baseline and 3 months after treatment, and these values were compared with those in the control population.Results: The mean baseline HbA1c level in anaemic patients (4.62%) was significantly lower than that in the control group (5.45%, P<0.001). A significant increase was observed in the patients HbA1c levels at 3 months after treatment (5.82%, P<0.001). There was a significant correlation observed between haemoglobin and HbA1c level (Coefficient of correlation=0.26, P<0.01) in the study group before correction.Conclusions: In contrast to the observations of previous studies, ours showed that HbA1c levels increased with treatment of iron deficiency anaemia. This could be attributable to nutritional deficiency, racial-ethnic variations and/or certain unknown variables. Further studies are warranted.

Value of haemoglobin A1c as the cut-off point for diabetes diagnosis based on the population in the department of endocrinology / 中国医师进修杂志

investigate the value of haemogobin A1c(HbA1c) for diagnosing various hyperglycemias in the Second Affiliated Hospital of Harbin Medical University. Methods This study is based on the data randomly selected from patients without clinical intervention in the endocrinology department and admission office in the Second Affiliated Hospital of Harbin Medical University from January 1st of 2010 to December 31th of 2012. In this study, 2 853 patients aged 16-85 year were selected, who performed OGTT and HbA1c on the same day. Their data of HbA1c and OGTT were collected. Selection criteria: the OGTT and HbA1c were performed simultaneously unless the patients had acidosis, and patients with past history of diabetes and oral hypoglycemic drugs or insulin treatment, or other basic combined diseases were included in this study. People in pregnancy were ruled out. Area under the receiver operating characteristics curve (ROC), sensitivity, and specificity were adopted to evaluate the diagnosis effect of HbA1c using FPG and OGTT as golden standard for diabetes and pre-diabetes. Results The area under the ROC were 0.902 (95% confidence interval 0.890- 0.914) for HbA1c alone and 0.915 (0.906-0.925) for FPG alone. The HbA1c threshold of 6.5% showed the highest Youden index of 64.4% and significantly higher sensitivity 81.1% compared with FPG ≥ 7.0 mmol/L (69.8%, P<0.01) in detecting diabetes. The optimal HbA1c thresholds for diagnosing pre-diabetes was 5.6% (the area under the ROC: 0.725; sensitivity: 74.1% ; specificity: 60.3% ). Conclusions These findings suggest that HbA1c 6.5% and 5.6% can be used as the diagnosing criterions for diabetes and pre-diabetes among the population who visit department of endocrinology.

Value of haemoglobin A1c as the cut-off point for diabetes diagnosis based on the population in the department of endocrinology / 中国医师进修杂志

Objective@#To investigate the value of haemogobin A1c(HbA1c) for diagnosing various hyperglycemias in the Second Affiliated Hospital of Harbin Medical University.@*Methods@#This study is based on the data randomly selected from patients without clinical intervention in the endocrinology department and admission office in the Second Affiliated Hospital of Harbin Medical University from January 1st of 2010 to December 31th of 2012. In this study, 2 853 patients aged 16-85 year were selected, who performed OGTT and HbA1c on the same day. Their data of HbA1c and OGTT were collected. Selection criteria: the OGTT and HbA1c were performed simultaneously unless the patients had acidosis, and patients with past history of diabetes and oral hypoglycemic drugs or insulin treatment, or other basic combined diseases were included in this study. People in pregnancy were ruled out. Area under the receiver operating characteristics curve (ROC), sensitivity, and specificity were adopted to evaluate the diagnosis effect of HbA1c using FPG and OGTT as golden standard for diabetes and pre-diabetes.@*Results@#The area under the ROC were 0.902 (95% confidence interval 0.890-0.914) for HbA1c alone and 0.915 (0.906-0.925) for FPG alone. The HbA1c threshold of 6.5% showed the highest Youden index of 64.4% and significantly higher sensitivity 81.1% compared with FPG ≥ 7.0 mmol/L (69.8%, P < 0.01) in detecting diabetes. The optimal HbA1c thresholds for diagnosing pre-diabetes was 5.6% (the area under the ROC: 0.725; sensitivity: 74.1%; specificity: 60.3%).@*Conclusions@#These findings suggest that HbA1c 6.5% and 5.6% can be used as the diagnosing criterions for diabetes and pre-diabetes among the population who visit department of endocrinology.

Do statins adversely affect the HbA1c of diabetic patients?

This paper discusses the adverse effect of statins on the HbA1c levels of diabetic patients. Studies have shown that statins may slightly worsen the HbA1c level. The effects vary depending on the type of statins, the dosage and the duration of therapy. However, it has been confirmed that statin use has benefits that outweigh its harms. Therefore, a diabetic patient should be given advice on the need for appropriate lifestyle changes and the importance of continuing the statins.

Seasonal variation of haemoglobin A1c in a Portuguese adult population

Objective Haemoglobin A1c (Hb A1c) is routinely used for monitoring glycemic control in patients with diabetes. Hb A1c seasonal fluctuations can be directly related to different biological, geographical and cultural influences. Our purpose was to evaluate seasonal variation of Hb A1c in a hospital-based adult population over a period of 5 years.Materials and methods We analyzed retrospectively monthly Hb A1c mean values (DCCT, %) based on all the assays performed to adult patients at a tertiary care university Portuguese hospital between 2008-2012.Results We obtained 62,384 Hb A1c valid measurements, with a peak level found in January-February (7.1%), a trough in August-October (6.8%) and an average peak-to-trough amplitude value of 0.3%. This trend was observed in both genders and age subgroups evaluated.Conclusions There is a Hb A1c circannual seasonal pattern with peak levels occurring in winter months in this Portuguese population. This finding should be recognized in daily clinical practice to warrant better clinical and epidemiological interpretation of Hb A1c values. Arch Endocrinol Metab. 2015;59(3):231-5.

Practice and perception of self - management among diabetics in Taif, KSA: Impact of demographic factors.

Background: Diabetes is a chronic disease that can be treated but not cured. The medications can help to improve symptoms and to slow down the progression of this disease and it complications. Effective self-management of diabetes has long been acknowledged as essential in the maintenance of good glycemic control and prevention of diabetic complications. Aims & Objective: To assess practice of diabetic patients regarding self-Management in Taif region as well as to collaret specific demographic characteristics associated with practice that may affect patients’ perceptions regarding diabetes self-management. Material and Methods: A cross-sectional study was conducted including diabetic patients, who attended the Family Medicine and Endocrinology clinics during regular day working hours (from 8:00 am – 4:00 pm) throughout January, 2011. They were recruited from four hospitals, belonging to Ministry of Defence and Aviation and Ministry of Health by stratified random sampling. An interview was conducted to determine subject's practice, regarding self-management, and potential factors influencing this practice and these practices of self-management using the SDSCA questionnaire. Results: A total of 386 respondents were interviewed in the current study. Their age ranged between 20 and 70 years with a mean of 49.03±13.05. More than half of them were males (56.7%) with a male to female ratio of 1.3:1. The duration of diabetes mellitus was more than 8 years in 46.1% of the participants. More than one-third of participated diabetic patients were aware of their type of diabetes (38.9%) while less than one-third of them were aware of Haemoglobin A1c (29.3%). The highest level of practice was observed regarding compliance with medication (94.7%), while the lowest level of practice was detected regarding blood glucose testing (22.4%). Their practice regarding specific diabetic diet, practicing physical exercise and foot care were 41.7%, 41.2% and 53.4% respectively. Conclusion: This study reflects the poor practice about the management plan of diabetic care particularly the non-pharmacological component of the plan. As, it has been observed that compliance is better with medical aspects of the regimen (e.g. medications) than with life style aspects of the regimen (diet and physical exercise).

Level of glycaemic control in type 2 diabetes mellitus in Bareilly region (India).

Background: Diabetes mellitus has emerged as a major health care problem of India. The real burden of diabetes is due to its associated complications which lead to increased morbidity and mortality. An accurate diagnosis of diabetes and level of glycaemic control in known diabetics is recommended for the treatment and prevention of complication in the population. Aims & Objective: To identify the pattern of glycaemic control in type 2 diabetes mellitus using glycosylated haemoglobin (HbA1C) in Bareilly region, India. Material and Methods: The present cross sectional study was conducted in one of the tertiary care hospital of Bareilly district. The respondents were the 1000 type 2 diabetics of 35 to 60 years of age group. Glycosylated haemoglobin A1C (HbA1C) was done in all subjects by ion exchange chromatography and results were categorized as normal, good, average and poor diabetes control. The statistical analysis was Analysis of variance (ANOVA) using SPSS software. Results: Out of 1000 individuals, 120 had good, 469 had fair and 411 had poor glycaemic control on the basis of their HbA1C status. Age was similar for all 3 groups and was insignificantly related to glycaemic control (p-0.663). Out of 1000 individuals, 703(70.30%) had normal BMI while 297 (29.7%) were overweight. Conclusion: Measurement of glycosylated haemoglobin levels should be used in monitoring the treatment and long term glycaemic control of diabetes in a population and the assessment of body mass index should be done for the need of life style intervention in a population.

Prevalence and severity of periodontal diseases in type 2 diabetes mellitus of Bareilly region (India).

Background: Periodontal disease and diabetes share a two way relationship because of common pathways of disease progression. Aims & Objective: Extensive study on various population worldwide were carried out but there is a limited data for Indian population, Hence, the present study was done to evaluate the prevalence and severity of periodontitis in type 2 diabetes mellitus of Bareilly region of Uttar Pradesh (INDIA). Material and Methods: 1000 individuals of type 2 diabetes mellitus were categorized as good, average and poor glycaemic control on the basis of glycosylated hemoglobinA1C(HbA1C). Periodontal examination was done by recording oral hygiene index simplified, clinical attachment loss and gingival bleeding index. This periodontal result was correlated with glycaemic status and duration of diabetes since diagnosis. Results: Results showed a 91.7% prevalence of periodontitis, predominating with 41.3% cases of moderate periodontitis followed by 26.2% of severe and 24.2% of slight and 8.3% of gingivitis cases. In poor oral hygiene strata; the amount of severe periodontitis cases increased from 0% to 26.2% and up to 73.8%; as the glycaemic control deteriorated from good to average to poor. Similar results were reported for good and fair oral hygiene strata. Conclusion: Results of present study demonstrated that with worsening of glycaemic control, severity of periodontitis significantly increases even when examined for similar oral hygiene status.

Hemoglobina glucosilada A1C como parámetro de control metabólico en pacientes con diabetes mellitus / Glycated hemoglobin A1C as parameter metabolic control in patients with diabetes mellitus

Se realizó un estudio prospectivo , de carácter observacional ,para determinar los niveles de hemoglobina glicosilada A1c ( Hb A1c ) como parámetro de control metabólico en pacientes con diabetes mellitus del Hospital de Clínicas de La Paz,. Se seleccionó una muestra de 72 pacientes que contaban con controles periódicos de Hb A1C. De los mismos solo uno era diabético de tipo 1, el resto (71) son diabéticos tipo 2. El 69% (49) de los pacientes eran mujeres y un 31 % (23) varones. La mayor parte de los pacientes están por encima de los 45 años, dato en relación con el tipo de diabetes que se presenta (DMT2), el único caso de diabetes mellitus tipo 1 se da en un paciente menor de 25 años. Dos tercios de los pacientes (69% del total) no cuentan siquiera con una dosificación inicial de HbA1c. Se solicitó el examen al 75 % de los pacientes, solamente el 32,7% de los pacientes lo efectivizaron. El 43,3% de los pacientes que cuentan con el control presentaban un nivel de Hb A1c por debajo de 7,5%, sin embargo solo el 20 % logran la meta de Hb A1c por debajo de 6,5 %, que es la cifra que ha demostrado reducir las complicaciones crónicas de la diabetes. Se debe solicitar en la totalidad de los pacientes la dosificación de Hb A1c (como mínimo tres veces al año) para permitirnos conocer la efectividad del manejo realizado y lograr la prevención de complicaciones crónicas.

This is a prospective observational study in order to determine the levels of glycosylated hemoglobin A1c (HbA1c) as parameter of metabolic control in patients with diabetes mellitus in the Hospital de Clinicas, La Paz. A sample of 72 patients was selected who had periodic controls of HbA1c. Only one of these patients had diabetes type 1, the rest (71) had diabetes type 2. Of the patients, 49 (69%) were females and 23 (31%) were males. The majority of the patients were older than 45 years, which is to be expected in relation with the type of diabetes presented (DMT2), being the only case of diabetes type 1 a man under 25 years of age. Two thirds of the patients (69% of the total) did not even have an initial measurement of HbA1c. This measurement was requested in 75% of the patients, but only 32.7% had the test done. The 43.3% of the patients who had the control, showed a level of HbA1c below 7.5%, however, only 20% achieved the goal of a HbA1c below 6.5%, which is the level that has been shown to reduce the chronic complications of diabetes. In all patients a periodic control of HbA1c should be requested at least 3 times per year, in order to know the effectiveness of our work and to prevent chronic complications of diabetes.