Opiniones y recomendaciones de la Sociedad Argentina de Diabetes. Hemoglobina A1c / Opinions and recommendations of the Argentine Diabetes Society. Hemoglobin A1c

La estandarización de la hemoglobina A1c (HbA1c) permitió en algunos países su uso para el diagnóstico de la diabetes mellitus (DM) y la prediabetes, además de su empleo en el seguimiento del paciente con DM. Es importante recordar que se trata de una medida indirecta del promedio glucémico durante el tiempo de vida media del eritrocito, pudiendo verse afectada por variables no glucémicas, como también por interferencias analíticas según la metodología empleada para su determinación. A continuación, se describen las recomendaciones y consideraciones a tener en cuenta para la determinación de la HbA1c cuando se emplea como criterio diagnóstico de la DM, teniendo en cuenta que al utilizarla para tal fin es necesario que la medida se realice con métodos certificados y estandarizados al ensayo utilizado en el Diabetes Control and Complications Trial (DCCT).

The standardization of hemoglobin A1c (HbA1c) allowed in some countries its use for the diagnosis of diabetes mellitus (DM) and prediabetes, in addition to its use in the follow-up of patients with DM. It is important to highlight that it is an indirect measurement of the glycemic average during the halflife of the erythrocyte, and may be affected by non-glycemic variables, as well as by analytical interferences depending on the methodology used for its determination. The recommendations and considerations to take into account for the determination of HbA1c when it is used as a diagnostic criterion for diabetes are described below. In addition, it is important to emphasize that it is essential that the HbA1c measurement be performed with certified and standardized methods to the Diabetes Control and Complications Trial (DCCT)results.

Risk analysis of blood glucose variation in type 2 diabetic STEMI patients with different HbA 1c levels undergoing emergency PCI / 中国医师杂志

Objective:To investigate the impact of short-term variability in fasting blood glucose (FPG) on the recent major cardiovascular adverse events (MACE) in patients with ST segment elevation myocardial infarction (STEMI) with different levels of glycated hemoglobin (HbA 1c) . Methods:Retrospective analysis was made on the patients with type 2 diabetes mellitus who underwent emergency percutaneous coronary intervention (PCI) due to STEMI from January 2016 to March 2020 in Shenzhen Hospital, Fuwai Hospital, Chinese Academy of Medical Sciences. The patients were divided into HbA 1c compliant group (<6.5%) and non-compliant group (≥6.5%). The blood glucose variability indexes defined included FPG variability score (FPG-VS), variability index independent of FPG mean (VIM) and mean fast plasma glucose (FPG-M). The logistic regression model was used to evaluate the relationship between different HbA 1c levels, blood glucose variability risk indicators, and MACE. Results:A total of 612 patients were ultimately included in the analysis. The blood glucose variability indicators (FPG-VS, VIM) of the HbA 1c non-compliant group (302 cases) were higher than those of the compliant group (310 cases): [FPG-VS: (0.7±0.3) vs (0.4±0.4), P<0.001, VIM: (0.4±0.2) vs (0.3±0.2), P<0.001], while there was no statistically significant difference in FPG-M between the two groups [(7.9±3.2) vs (8.0±3.9), P=0.221]. In the HbA 1c non-compliant group, the correlation between FPG-VS, VIM, and FPG-M and the risk of MACE within 30 days was 0.89(95% CI: 0.69-1.15), 1.21(95% CI: 0.65-2.25), and 1.06(95% CI: 0.97-1.16), respectively (all P>0.05). In the HbA 1c compliant group, FPG-VS was associated with an increase in MACE risk within 30 days ( P=0.04): for each increase in FPG variation ≥1 mmol/L, after multiple factor adjustment, the risk of MACE increased by 8% within 30 days ( OR=1.08, 95% CI: 0.71-1.65); Compared with FPG-VS<20%, FPG-VS≥80% increased the risk of MACE within 30 days by 33% ( OR=1.33, 95% CI: 0.21-8.25, P<0.01), while the correlation between VIM and FPG-M and the risk of MACE within 30 days was 1.65(95% CI: 0.96-2.83) and 1.15(95% CI: 0.98-1.35), respectively (all P>0.05). Conclusions:High FPG-VS is associated with the recent MACE risk in STEMI patients who do not meet HbA 1c standards. After reaching HbA 1c standards, FPG-VS remains an independent MACE risk factor.

Comparison of high-resolution manometry parameters among type II diabetes patients and normal volunteers

Background: Gastrointestinal (GI) autonomic neuropathy and reflux esophagitis are common in chronic diabetics. To gauge the adequacy of peristalsis, high-resolution esophageal manometry is considered as a reliable test. Aim and Objective: To compare the GI symptoms and high-resolution manometry parameters between type II diabetes patients and normal volunteers. Materials and Methods: This comparative study was conducted on 35 known type II diabetes mellitus patients (hemoglobin A1c [HbA1c] levels ?6.5%) and 35 normal volunteers between the age group of 35 and 70 years. Sociodemographic details, drug history, disease duration, and GI symptoms were elicited among the study participants. HbA1c and High-resolution manometry were measured for all the participants. Results: The frequency of epigastric pain (31.48%), heartburn (34.28%), pharyngeal irritation (31.43%), and loose stools (37.14%) were significantly higher in the diabetics. Significant difference (P < 0.05) was observed in mean basal expiratory pressure (MBEP) and mean basal inspiratory pressure (MBIP) values between diabetics and controls. There was a positive significant correlation between esophagogastric junction contractile integral and MBIP (r = 0.557), MBEP (r = 0.583), Median Integrated Relaxation pressure (r = 0.410). Conclusion: Hyperglycaemia seems to be an independent risk factor for gastroesophageal reflux disease (GERD). Obesity significantly increments the occurrence of GERD in diabetics. Strict adherence to preventive measures such as weight reduction, diet management, glycaemic control will have a great impact on the occurrence of GERD in diabetics.

Relationship between pancreatic fibrotic markers and glycated hemoglobin levels in patients with type 3c diabetes mellitus secondary to chronic pancreatitis / 中华胰腺病杂志

Objective:To investigate the relationship between pancreatic fibrotic marker transforming growth factor-β(TGF-β) and platelet derived growth factor-BB(PDGF-BB) and serum glycated hemoglobin (HbA1c) levels in patients with type 3c diabetes mellitus secondary to chronic pancreatitis(CP-T3cDM).Methods:The clinical data of 39 patients with CP-T3cDM admitted to the Department of Gastroenterology of the First Affiliated Hospital of Naval Medical University between February 2018 and August 2020 were collected, and the patients' age, gender, body mass index, duration of chronic pancreatitis and diabetes mellitus, smoking history, alcohol consumption history, serum HbA1c level at admission, degree of pancreatic atrophy, morphology of the main pancreatic duct, and treatment of diabetes mellitus were recorded. Serum TGF-β and PDGF-BB were detected by ELISA. Patients were divided into high and low level group according to the median TGF-β and PDGF-BB levels, respectively. Clinical characteristics of patients were compared between the TGF-β and PDGF-BB high and low level group. The correlation between TGF-β, PDGF-BB and HbA1c was analyzed by Spearman's correlation analysis.Results:A total of 39 CP-T3cDM patients were included; 35 were male and 4 were female. The age of first onset of chronic pancreatitis was (42±14) years old, and the duration of diabetes mellitus was 24(4, 36) months. The serum HbA1c level was (7.8±1.6)%, and the serum TGF-β and PDGF-BB levels were 20.5(10.5, 43.1) and 647.5(276.9, 1349.2)pg/ml, respectively. The serum HbA1c levels of patients in the high-level group of serum TGF-β and PDGF-BB were significantly higher than those in the corresponding low-level group [8.6%(7.4%, 9.9%) vs 6.7%(6.2%, 7.8%) and 8.6%(7.4%, 9.6%) vs 6.7%(6.1%, 7.8%), respectively] , and the difference was statistically different (both P value <0.01), while none of other indicators showed statistically significant differences between both groups. The correlation analysis showed that the levels of TGF-β and PDGF-BB were significantly positively correlated with HbA1c level ( r=0.45, 0.53, both P value <0.01). Conclusions:Increased pancreatic fibrosis in patients with CP-T3cDM was an important factor contributing to elevated blood glucose level. Patients with higher serum pancreatic fibrotic factors exhibited a significant increase in HbA1c level.

Type 1 diabetes care in mexico: an analysis of the renaced-dt1 national registry

Background: Information regarding diagnosis, treatment, and follow-up of patients with type 1 diabetes (PWT1D) in Mexico is limited. We developed an on-line platform Registro Nacional de Pacientes con Diabetes Tipo 1 (RENACED-DT1). Objective: The objective of the study was to describe the characteristics and healthcare of PWT1D registered in RENACED-DT1. Methods: Analyses of 965 PWT1D from July 2014 to January 2018 in different endocrinology clinics around Mexico. Results: Sixty-one percent were female with median age of 21 years, age at diagnosis 11 years, and disease duration at inclusion 8.2 years. Treatment regimen was basal-bolus in 61% and insulin-pumps in 21% (mainly in the private sector); 33.3% with self-monitoring of blood-glucose (SMBG) ≥4 times/day. Mean HbA1c at last follow-up was 8.7 ± 2.1% (72±23 mmol/mol), 18% had HbA1c < 7% (53 mmol/mol), and 35% > 9% (75 mmol/mol). SMBG ≥ 4 times/day was associated with HbA1c < 7%. Time since diagnosis > 10 years, female sex, BMI ≥ 30 kg/m2, SMBG < 4 times/day, and any hypoglycemia were associated with microvascular complications (p < 0.05). Conclusions: Percentage of patients achieving HbA1c < 7% is low; increased blood glucose monitoring is associated with better glycemic control. The achievement of optimal glycemic control must be increased to reduce the incidence of chronic complications and improve quality of life in PWT1D.

Impacto en la calidad de vida de los adolescentes con diabetes mellitus tipo 1 / Impact on the quality of life of adolescents with diabetes mellitus type 1

INTRODUCCIÓN: La diabetes mellitus tipo 1 (DM1) es una enfermedad que se perfila para toda la vida. OBJETIVO: Identificar evidencia científica sobre el impacto de la DM1 en la calidad de vida de los adolescentes portadores de esta enfermedad. MÉTODO: Revisión sistemática en las bases bibliografías MEDLINE, LILACS, CINAHL y ScIELO, utilizando los descriptores "Adolescent*", "Teen*", "Diabe tes Mellitus, Type1", "Diabetes, type 1", "Type 1 diabetes", "Quality of life", "Health related quality of life", "Life quality", "Health impact assessment", "Health impact", "Impact assessment, health", "Diabetes Impact Measurement Scales", "PedsQL", "Glycated Hemoglobin A1c", "Glycosylated He moglobin A1c", y "HbA1c". De los 679 artículos localizados, 25 fueron incluidos en el análisis. Al gunos estudios fueron multicéntricos nacionales e internacionales. Los instrumentos más utilizados, relativos a las mediciones de la calidad de vida, fueron el Cuestionario de Calidad de Vida Pediátrica (PedsQL) en su versión genérica y módulo diabetes. RESULTADOS: La calidad de vida evaluada por el adolescente que padece DM1 mediante Escalas de calidad de vida, está significativamente e inversa mente asociada a los valores de HbA1c. Esta vinculación se extiende a una correlación significativa entre los puntajes genéricos totales de calidad de vida y HbA1c, pero no tiene la misma repercusión en los puntajes específicos. CONCLUSIONES: El control metabólico se establece como la piedra angular que incide en el impacto en la relación DM1 y calidad de vida; vinculación que se vislumbra como bidireccional, aunque no se evidencia un consenso absoluto sobre los tipos de factores y los grados que influirían en el control metabólico.

INTRODUCTION: Type 1 diabetes mellitus (DM1) is a chronic disease. OBJECTIVE: To identify scientific evidence on the impact of DM1 on the quality of life of adolescents with this disease. METHOD: Sys tematic review in the bibliographic databases MEDLINE, LILACS, CINAHL, and ScIELO, using the following descriptors: "Adolescent *", "Teen *", "Diabetes Mellitus, Type1", "Diabetes, type 1", "Type 1 diabetes", "Quality of life", "Health related quality of life", "Life quality", "Health impact assessment", "Health impact", "Impact assessment, health", "Diabetes Impact Measurement Scales", "PedsQL", "Glycated Hemoglobin A1c", "Glycosylated Hemoglobin A1c", and "HbA1c". Out of 679 articles identified, 25 were included in the analysis. Some studies were national and international multicenter. The most widely used instruments related to quality of life measurements were the Pediatric Quality of Life Questionnaire (PedsQL) in its generic version and the diabetes module. RESULTS: The quality of life assessed by the adolescent with DM1 using Quality of Life Scales is significantly and inversely associated with HbA1c values. This association includes a significant correlation between the total generic quality of life scores and HbA1c but does not have the same impact on specific sco res. CONCLUSIONS: Metabolic control appears to be the cornerstone that influences the impact on the bidirectional relationship between DM1 and quality of life, however, there is no absolute consensus on the types of factors and degrees that would influence metabolic control.

Evaluation of cognitive functions in diabetic patients

Background: Diabetes Mellitus is an independent risk factor for cognitive impairment and dementia. In this study, authors investigated cognitive functions in the diabetes and control group with Mini Mental State Examination (MMSE). Authors analyzed the association of cognitive status with age, sex, duration of diabetes, insulin use and HbA1c in diabetic patients.Methods: Fifty patients with diabetes diagnosed between the ages of 50 and 70 who applied to this Diabetes and General Internal Medicine Clinics between January 2017 and September 2017 were included. Fifty patients with nondiabetes diagnosed with similar age and demographic characteristics were included in the control group. MMSE was applied to both groups. In the diabetic group, cognitive functions were investigated in relation with age, gender, duration of diabetes, insulin usage and HbA1c.Results: The MMSE score in diabetic patients was lower than the control group (p<0.05). In addition, cognitive impairment in diabetic patients was associated with duration of diabetes and HbA1c level. There wasn't significant difference was found between cognitive impairment and age, sex, insulin use.Conclusions: Diabetes Mellitus is a risk factor for cognitive impairment and dementia with many possible mechanisms. In the routine, there is no screening for cognitive impairment and dementia in diabetic patients; but if authors detect early cognitive impairment, authors can prevent cognitive impairment progression to dementia with medical treatment and cognitive exercises.

Fulminant type 1 diabetes mellitus in pregnancy

Fulminant type 1 diabetes mellitus (FT1DM) has received clinical attention for its low incidence and poor prognosis. Currently, few cases of FT1DM are associated with pregnancy in clinical practice, but it poses a great threat to the life of mothers and infants. Here, we present two cases of FT1DM in pregnancy. In Case 1, the patient was a 26-year-old woman who was admitted to the hospital with reduced fetal movement. She was diagnosed with FT1DM and delivered a dead female fetus. Lispro and lantus were administered to control blood glucose, and lipoic acid for antioxidant therapy. In Case 2, the patient was a 28-year-old woman who developed nausea, vomiting, diarrhea, and polydipsia, which later proved to be FT1DM. An abortion was induced and blood glucose levels were controlled using an insulin pump. All physicians should be aware of this disease in order to provide prompt diagnosis and emergency treatment, thus improving maternal prognosis. We suggest that plasma glucose/hemoglobin A1C ratio be adopted as a new clinical parameter in predicting FT1DM.

Relationship between glycosylated hemoglobin and hemorrhagic transformation after cerebral infarction / 中国医师进修杂志

Objective To assess the relationship between hemoglobin A1c (HbA1c) and hemorrhagic cerebral infarction (HI) in patients with acute cerebral infarction.Methods From January 2014 to June 2016,in the Lianyungang Hospital Affiliated to Xuzhou Medical University,426 patients with acute anterior circulation infarction were included.The blood sugar status before stroke was expressed by HbA1c.HbA1c and fasting blood glucose (FBG) were measured on the second day after admission.The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological function at admission.The modified Rankin scale (mRS) was used to evaluate the prognosis at discharge.CT or MRI/SWI examination was performed to determine whether there was HT.Logistic regression was used to evaluate the risk factors for HT and short-term prognosis after cerebral infarction.Results Of the 426 patients enrolled,93 (21.8％) appeared HT,60 (14.1％) had hemorrhagic cerebral infarction (HI) and 33 (7.7％) had parenchymal hemorrhage (PH).Multivariate analysis showed that HbA1c and infarct volume were independent predictor of HT.When patients were grouped according to fasting blood glucose (FBG ＜ 7.8 mmol/L or ≥ 7.8 mmol/L),the predictive effect of HbA1c on HT was found in both groups.In multiple Logistic regression analysis,HbA1c was also a predictor of poor prognosis after stroke (OR =1.482,95％ CI 1.228-1.788).Conclusions In patients with ischemic stroke,elevated HbA1c is independently associated with post-infarction HT,and this result doesn't change even in patients with well-controlled blood glucose.HbA1c is also a predictor of poor prognosis after stroke.These findings are important for blood glucose management in patients with diabetes and acute anterior circulation infarction.

Effects of traditional Chinese exercises on blood glucose and hemoglobin A1c levels in patients with prediabetes: A systematic review and meta-analysis / 中西医结合学报

BACKGROUND@#Traditional Chinese exercises (TCEs) have a positive effect on glycemic control and hemoglobin A1c (HbA1c), but there is no consensus on the benefits of TCEs for patients with prediabetes.@*OBJECTIVE@#The objective of this study was to systematically investigate the effects of TCEs on blood glucose control in patients with prediabetes.@*SEARCH STRATEGY@#Comprehensive retrieval of randomized controlled trials (RCTs) was carried out using PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Wanfang Data Knowledge Service Platform, China Biology Medicine disc, Google Scholar and Baidu academic databases. The retrieval window ranged from the establishment of the database to December 2018, and references related to the included trials were searched without language restrictions.@*INCLUSION CRITERIA@#The study included RCTs with a clinical diagnosis of prediabetes that was also treated with TCEs.@*DATA EXTRACTION AND ANALYSIS@#Literature screening, data extraction and literature quality assessment were performed independently by two researchers. In the case of disagreement, a third party was invited to negotiate and make a decision. Standardized mean difference (SMD) was used to estimate the therapeutic effect. Meta-analysis was performed using Review Manager 5.3.5 and Stata 15.0. Heterogeneity was assessed using Q test and I, and the source of heterogeneity was determined using Galbraith diagram and sensitivity analysis. A Q test resulting in P  50% indicated significant difference and random effect model analysis was performed. Otherwise, a fixed effect model was applied. Begg's and Egger's tests were used to assess publication bias.@*RESULTS@#Nine RCTs involving 485 participants were included in this study. The results showed that TCEs could reduce fasting blood glucose (FBG), 2 h blood glucose (2hPBG) and HbA1c in patients with prediabetes. The treatment subgroup showed that an intervention of 6 months had better results, while the Gongfa subgroup showed that the TCE Baduanjin yielded better results. (1) FBG: SMD = -0.73, 95% confidence interval (CI) [-0.97, -0.50], P < 0.00001; Baduanjin: SMD = -0.83, 95% CI [-1.13, -0.53], P < 0.00001; 6 month treatment: SMD = -0.73, 95% CI [-1.20, -0.26], P = 0.002. (2) 2hPBG: SMD = -0.75, 95% CI [-0.94, -0.57], P < 0.00001; Baduanjin: SMD = -0.62, 95% CI [-0.91, -0.32], P < 0.00001; 6 month treatment: SMD = -0.91, 95% CI [-1.39, -0.44], P = 0.0002. (3) HbA1c: SMD = -0.56, 95% CI [-0.89, -0.23], P = 0.00008; Baduanjin: SMD = -0.46, 95% CI [-0.83, -0.08], P = 0.02; 6 month treatment: SMD = -0.77, 95% CI [-1.24, -0.29], P = 0.002.@*CONCLUSION@#TCEs had positive effects in improving blood glucose levels in patients with prediabetes. Hence, TCEs may be of potential therapeutic value for patients with prediabetes, as an adjuvant therapy along with other treatments. Although the evidence suggests that the intervention is effective for 6 months, the mechanism of TCEs on glycemic control, the minimum exercise dose and their safety remain to be further studied.

Effects of l-arginine supplementation on glycemic profile: Evidence from a systematic review and meta-analysis of clinical trials / 中西医结合学报

BACKGROUND@#The effects of l-arginine supplementation on indices of glycemic control and the role of many factors influencing this intervention have been controversial in clinical trials.@*OBJECTIVE@#This meta-analysis was performed to assess the effects of l-arginine supplementation on indices of glycemic control, including fasting blood glucose (FBG), hemoglobin A1c (HbA1c), serum insulin and homeostatic model assessment of insulin resistance (HOMA-IR) levels in randomized controlled trials (RCTs).@*SEARCH STRATEGY@#This study conducted a systematic review of RCTs published in PubMed, Scopus, Web of Science, Cochrane Library and Embase, up to 5 May, 2018.@*INCLUSION CRITERIA@#Studies were included in this meta-analysis if they were RCTs with parallel design and reported sufficient data on participants before and after intervention, and outcomes of glycemic profile parameters in both the arginine supplementation and control groups.@*DATA EXTRACTION AND ANALYSIS@#The screening of titles and abstracts was performed independently by two reviewers. Selected articles were considered if they met the study's inclusion criteria. The quality of included studies was assessed by using the Cochrane Collaboration modified tool. From 710 articles retrieved in the initial search, only 10 trials were suitable for pooling the effects of arginine supplementation on serum glucose, insulin, HOMA-IR and HbA1c levels, with effect sizes of nine, eight, five and five, respectively.@*RESULTS@#Pooled random-effect analysis revealed that l-arginine supplementation could significantly decrease FBG level (weighted mean difference [WMD]: 3.35 mg/dL; 95% confidence interval [CI] = [-6.55, -0.16]; P = 0.04) and serum insulin level (WMD: -2.19 μIU/mL; 95% CI = [-3.70, -0.67]; P = 0.005). However, the effects of l-arginine supplementation on HOMA-IR and HbA1c were not significant. Results of subgroup analysis showed that supplementation with l-arginine could significantly decrease serum insulin levels when the dosage of l-arginine is > 6.5 g/d (WMD: -3.49 μIU/mL; 95% CI = [-5.59, -1.38]; P = 0.001), when the duration of supplementation is ≤ 12.8 weeks (WMD: -3.76; 95% CI = [-6.50, -0.98]; P = 0.008), when the participants are not diabetic patients (WMD: -2.54 μIU/mL; 95% CI = [-4.50, -0.50]; P = 0.01) and when the baseline serum level of insulin was > 20 μIU/mL (WMD: -3.98; 95% CI = [-6.31, -1.65]; P = 0.001).@*CONCLUSION@#Although the results of this study confirmed that supplementation with l-arginine could have significant effects on some glycemic profile indices of participants in clinical trials, the clinical importance of this reduction may not be meaningful.

Relationship between glycosylated hemoglobin and hemorrhagic transformation after cerebral infarction / 中国医师进修杂志

Objective@#To assess the relationship between hemoglobin A1c (HbA1c) and hemorrhagic cerebral infarction (HI) in patients with acute cerebral infarction.@*Methods@#From January 2014 to June 2016, in the Lianyungang Hospital Affiliated to Xuzhou Medical University, 426 patients with acute anterior circulation infarction were included. The blood sugar status before stroke was expressed by HbA1c. HbA1c and fasting blood glucose (FBG) were measured on the second day after admission. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological function at admission. The modified Rankin scale (mRS) was used to evaluate the prognosis at discharge. CT or MRI/SWI examination was performed to determine whether there was HT. Logistic regression was used to evaluate the risk factors for HT and short-term prognosis after cerebral infarction.@*Results@#Of the 426 patients enrolled, 93 (21.8%) appeared HT, 60 (14.1%) had hemorrhagic cerebral infarction (HI) and 33 (7.7%) had parenchymal hemorrhage (PH). Multivariate analysis showed that HbA1c and infarct volume were independent predictor of HT. When patients were grouped according to fasting blood glucose (FBG<7.8 mmol/L or ≥ 7.8 mmol/L), the predictive effect of HbA1c on HT was found in both groups. In multiple Logistic regression analysis, HbA1c was also a predictor of poor prognosis after stroke (OR=1.482, 95% CI 1.228 -1.788).@*Conclusions@#In patients with ischemic stroke, elevated HbA1c is independently associated with post-infarction HT, and this result doesn′t change even in patients with well-controlled blood glucose. HbA1c is also a predictor of poor prognosis after stroke. These findings are important for blood glucose management in patients with diabetes and acute anterior circulation infarction.

Risk factors influencing prognosis in surgical patients with proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical and imaging data of proliferative diabetic retinopathy(PDR)treated by pars plana vitrectomy(PPV), and to further explore the risk factors associated with poor prognosis. <p>METHODS: Data of 90 eyes of 90 patients at Guangxi Zhuang Autonomous Region People's Hospital from January 2016 to December 2018 were retrospectively reviewed. According to the postoperative visual acuity, the patients were divided into favorable prognosis group(group A)and unfavorable prognosis group(group B). To explore the clinical and image risk factors and prognosis of disease outcome. Univariate analysis uses Chi-square analysis,while multivariate analysis takes Logistic regression analysis. <p>RESULTS: Univariate analysis showed that there was much more difference between good prognosis and those with poor prognosis: the preoperational PRP treatment experience(<i>P</i>=0.042), HbA1c(<i>P</i>=0.008), OCT-TRD(<i>P</i>=0.004), OCT-HRF(<i>P</i>=0.005). Multivariate logistic regression analysis showed that HbA1c(<i>OR</i>=1.439, <i>P</i>=0.009)and OCT-TRD(<i>OR</i>=4.007, <i>P</i>=0.040)were independent risk factors for poor prognosis after proliferative diabetic retinopathy. <p>CONCLUSION: HbA1c and OCT-TRD are independent predictors of poor prognosis in PDR patient.

Evaluation of Analytical Performance of an Automated Glycated Hemoglobin Analyzer, HLC-723 G11

Depression and diabetes: A tendency or demon of darkness among diabetics? A cross-sectional study among type 2 diabetes mellitus patients attending an “integrated diabetes and gestational diabetes clinic” of Eastern India

Background: Depression is a common comorbid condition found in chronic medical illnesses in general and diabetes mellitus (DM) in particular. Worldwide, more than 365 million people are estimated to have Type 2 DM (T2DM), and almost 300 million people have major depression. Depression can be viewed as a Modifiable independent risk factor for the development of T2DM and for progression of complications from either type 1 or T2DM. Objectives: The aim of the study was to find out the distribution and determinants of depression among T2DM patients attending an integrated diabetes and gestational diabetes clinic (IDGDC) of a tertiary care hospital of West Bengal, East India. Materials and Methods: This cross-sectional, observational study was conducted among T2DM patients who attended IDGDC during May 2017–June 2017. Public Health Questionnaire-9 was used to assess depression and its severity. A total of 196 study subjects participated in the study. Results: The prevalence of depression was found to be 54.6%. About 28.1% of the study subjects had mild depression, 17.9%, 6.1%, and 2.6% subjects had moderate, moderately severe, and severe depression, respectively. Women gender, increasing age, rural residence, low literacy, longer duration of diabetes, and overweight/obesity were significantly associated with high frequency of depression. Addiction was significantly higher among depressed T2DM patients. Mean hemoglobin A1c level was significantly lower among non-depressed T2DM patients. Conclusion: More than half of the T2DM patients are suffering from depression of varying severity. There should be a dedicated counselor in diabetes clinics for routine screening of depression among all T2DM patients to identify the high-risk patients requiring urgent psychiatrist consultation.

Prevalence of thyroid dysfunction in patients with type 2 diabetes

 Background: Diabetes mellitus, a leading cause of death worldwide, is the most common endocrine disorder. Type 2 Diabetes (T2D) and Thyroid Dysfunction (TD) often present together and complicate each other at many levels. Recent studies find out the prevalence of TD in T2D in Malwa Region. Objective of the purpose of this study was to find out the prevalence of TD in patients with T2D.Methods: A match cross-sectional study design was conducted at Department of Medicine, Sri Aurobindo Medical College, from March 2018 to April 2019. Source populations were all patients who live in Malwa Region, Indore. A total of 150 cases were enrolled in this study, 75 cases (TD in T2D) and 75 controls were taken into study.Results: There was no significant difference in age and body mass index (BMI) between groups. The average duration of diabetes was 7.76±5.57 years and mean Hemoglobin A1c (HBA1c) was 8.17±1.66%. Only 29(38.6%) of patients had HbA1c below 7%. There was significant difference (p=0.001) in HbA1c. Prevalence of TD in T2D was significantly more in females. Out of TD in T2D patients, sub-clinical hypothyroid was present in 14.6% hypothyroidism was present in 8% patients and sub-clinical hyperthyroidism and hyperthyroidism was present in 1.3% patients.Conclusions: This study reveals about one in four people living with T2D are suffering from TD in Malwa Region. TD is common in T2D patients and can produce significant metabolic disturbances.

Evaluate the differences in serum magnesium levels and lipid profile with correlation of hemoglobin A1C levels in type 2 diabetes patients: a case control study

Background: Magnesium deficiency is a common problem in diabetic patients. Magnesium deficiency may increase the incidence of Type 2 Diabetic (T2D) and occurrence complications. Objective of this study aimed at determining the differences in serum magnesium levels and lipid profile among patients newly diagnosed with T2D and normoglycemic individuals.Methods: The cross sectional observation study design was conducted at Sri Aurobindo Medical College, from March 2018 to April 2019. Source populations were all patients who attending to the OPD, Department of General Medicine. A total of 75 patients were enrolled in this study. This study was divided in two group’s cases group (T2D) and second control group (Non-diabetic). First group not initiated on any oral-hypoglycaemic, anti-hypertensive or lipid lowering drugs, and healthy patients were included in control group.Results: Triglycerides (TG), Total Cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C) showed significantly (p<0.001) higher mean levels in T2D compared to the controls. The Magnesium and High-Density Lipoproteins-cholesterol (HDL-C) levels were significantly (p<0.001) lower among the T2D group compared to the control group. There was a significant inverse correlation (r2= 0.567, p<0.001) between Hemoglobin A1C (HbA1c) levels and serum magnesium.Conclusions: Serum magnesium levels and lipid profile were significantly different in T2D patients compared to control group.

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.

​Efficacy Of Teneligliptin As Add-On Therapy In Patients With Type 2 Diabetes Mellitus And Chronic Kidney Disease: A Real-World Experience

Introduction: Type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD) is dreadful combination necessitatingadequate glycemic control to prevent further complications. Teneligliptin is found to be renal friendly antidiabetic agent whichcan provide effective glycemic control.Objective: The objective of this study was to determine the efficacy of teneligliptin as add-on to existing therapy in patients ofT2DM with CKD.Materials and Methods: This was a retrospective study where patients with T2DM and CKD who received teneligliptin wereincluded in the study. Changes in glycemic parameters such as hemoglobin A1c (HbA1c) (%), fasting plasma glucose (FPG),and postprandial plasma glucose (PPG) and change in estimated glomerular filtration rate (eGFR) were analyzed.Results: In total, 66 patients were included in analysis. Mean age was 57.7 ± 14.0 years and 60.6% were males. BaselineHbA1c, FPG, and PPG levels were 7.8 ± 0.7%, 128.0 ± 25.5 mg/dl, and 214.0 ± 55.9 mg/dl, respectively. There was a significantreduction in HbA1c at 3 and 6 months (mean difference from baseline: −0.9 ± 0.5 and −1.2 ± 0.5 respectively, P < 0.001 forboth). Similarly, mean change in FPG (−28.4 ± 20.9 and −29.9 ± 24.3 mg/dl, respectively) and PPG (−70.5 ± 49.2 and −97.0 ±60.7 mg/dl, respectively) was also significant (P < 0.001 for all comparisons). The change in eGFR was significant at 3 months(P = 0.049) and 6 months (P = 0.014).Conclusion: Teneligliptin is effective in reducing glycemic burden in patients with T2DM and CKD and can be considered asbe considered among first choices for glycemic control in patients with renal impairment.

Analysis of key technical points of diagnostic reagents for diabetes / 中华检验医学杂志

Detecting the concentration of glucose and hemoglobin A1cin blood can be used in the diagnosis and treatment monitoring of diabetes. With the high incidence of diabetes worldwide, these diagnostic reagents for diabetes have gradually become the hot spot of registration. In view of the characteristics of these reagents, this review analyzes the main technical issues referring to internal and overseas related technical documentation, to providing ideas and help for product development and registration.