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 glicosilada A1c vs. glucemia plasmática en ayunas de pacientes ambulatorios de un laboratorio médico / Glycosylated haemoglobin A1c compared to fasting plasma glucose in outpatients referred to a medical laboratory

Objetivo Comparar la prueba hemoglobina glicosilada (HbA1c) en diferentes puntos de corte, con la prueba de glucemia plasmática en ayunas (GPA); para medición de glucosa en sangre en pacientes ambulatorios de un laboratorio médico de la ciudad de Medellín, entre marzo y abril de 2010. Métodos Estudio en 1016 muestras de sangre de pacientes referidos a un laboratorio médico. Se obtuvo la concordancia entre las pruebas (Índice de Kappa), se calcularon sensibilidad y especificidad, además se evaluaron diferentes puntos de corte para la prueba HbA1c con la curva ROC. Se usó correlación de Spearman para establecer la asociación entre GPA y HbA1c. Resultados El valor promedio de HbA1c fue 5,7 % ±0,8 y de la GPA fue 96 mg/dL±26,1; y esta última fue mayor en hombres (99,04±32,7). El 75,4 % de las muestras fueron normales para diagnóstico de diabetes con la prueba GPA, y con la HbA1c el 51,4 % clasificaron en este rango. El punto de corte donde la combinación sensibilidad-especificidad presenta los mejores valores para HbA1c fue 6,2 %. Discusión La prueba HbA1c presentó valores altos de sensibilidad y especificidad, por lo que su uso rutinario en el diagnóstico de diabetes mellitus podría contribuir a la búsqueda activa y la detección precoz de casos, que aseguren un mejor control de los factores de riesgo.

Objective Comparing haemoglobin A glycosylate (HbA1c) at different cutoff points for blood glucose measurement to the fasting plasma glucose (FPG) test in outpatients visiting a medical laboratory in the city of Medellin between March and April 2010. Methods 1,016 blood samples were studied from patients who had been referred to a medical laboratory. Agreement was obtained between tests (Kappa index); sensitivity and specificity were calculated. Different cutoff points for the HbA1c test were also evaluated with the ROC curve. Spearman correlation was used to establish association between FPG and Hb A1c. Results Average HbA1c was 5.7 %±0.8 and average FPG was 96 mg/dL±26.1; this was higher in men (99.04±32.7). 75.4 % of the samples came within the normal range for diagnosing diabetes with the FPG test, compared to 51.4 % with the HbA1c test. The cutoff point where combined sensitivity and specificity presented the best HbA1c value in this study group was 6.2 %. Discussion The HbA1c test had high sensitivity and specificity values, so its routine use in diagnosing diabetes mellitus could contribute towards active and early detection of cases to ensure better control of risk factors.

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.