A rare haemoglobin variant (Hb Phnom Penh) manifesting as a falsely high haemoglobin A1c value on ion-exchange chromatography.

Most haemoglobin (Hb) variants are clinically silent. However, some Hb variants may interfere with the measurement of haemoglobin A1c (HbA1c), resulting in spurious values depending on the assays used. We herein report the case of a 53-year-old Taiwanese man with type 2 diabetes mellitus, who presented with an abnormal HbA1c peak on ion-exchange chromatography. Additional investigations, including intensified self-monitored blood glucose tests, an alternative HbA1c assay, and a glycaemic indicator based on a different method, revealed that the HbA1c values were falsely elevated. Subsequent DNA analysis confirmed that the patient was heterozygous for the insertion of an isoleucine residue at codons 117/118 of the a1-globin gene, Hb Phnom Penh. Clinical laboratorians should be aware of the interfering factors in their HbA1c analysis. Cautious inspection of the chromatogram may provide a valuable clue to the presence of an Hb variant.

Saxagliptin-induced recurrent acute pancreatitis.

Although dipeptidyl peptidase-4 (DPP-4) inhibitors have been implicated in the development of acute pancreatitis, the causality of this phenomenon is not well established. We herein report the case of an 85-year-old woman who presented with epigastric pain after taking saxagliptin for five months. A high serum lipase level with characteristic computed tomography findings confirmed the diagnosis of acute pancreatitis. The patient's symptoms rapidly resolved after admission, although they recurred when she resumed treatment with saxagliptin for 18 days after discharge. In the absence of any identifiable causes of pancreatitis and considering the temporal sequence of events, the saxagliptin therapy was highly suspected to be the triggering factor. Although drug-induced pancreatitis is rare, treatment with DPP-4 inhibitors should be included as a potential etiology of acute pancreatitis.

Relationship between peripheral artery disease and combined albuminuria and low estimated glomerular filtration rate among elderly patients with type 2 diabetes mellitus.

This study aimed at investigating the combined effects of albuminuria and reduced estimated glomerular filtration rate (eGFR) on peripheral artery disease (PAD) among elderly patients with diabetes. A total of 236 subjects were cross-classified into four groups according to the presence or absence of albuminuria (urinary albumin creatinine ratio (ACR) ≥ 30 mg/g) and low eGFR (<60 mL/min/1.73 m²). Cardiovascular risk factors and the ankle-brachial index (ABI) were also assessed. After multivariate adjustment using logistic regression analysis, the odds ratios (OR) for prevalent PAD related to albuminuria with preserved eGFR, normoalbuminuria with low eGFR and albuminuria with low eGFR compared to normoalbuminuria with preserved eGFR were 1.10 [95% confidence interval (CI) = 0.43-2.79], 3.14 (95% CI = 1.20-8.22) and 3.87 (95% CI = 1.72-8.72), respectively. In conclusion, in elderly patients with type 2 diabetes, both normoalbuminuria with low eGFR and albuminuria with low eGFR are associated independently with PAD.

A rare hemoglobin variant (Hb Iraq-Halabja) causing spuriously low hemoglobin A1c values.

Various laboratory and patient-related factors can affect the measurement of hemoglobin A1c (HbA1c). We herein present the case of a diabetic patient with spuriously low HbA1c values on ion-exchange high-performance liquid chromatography (HPLC). Further investigations revealed that the patient was heterozygous for a rare Hb variant, namely Hb Iraq-Halabja (ß10 Ala→Val). This is the second report of this variant published in the literature. Clinicians should be aware of the limitations of HbA1c assays because inaccurate values may lead to the inappropriate management of diabetes. Unusual or discrepant HbA1c test results should prompt further investigations for potentially interfering factors, including rare Hb variants.

Combination effect of ribavirin and erythropoietin treatment on hemoglobin A1c in a diabetic patient with chronic hepatitis C.

Any condition that shortens erythrocyte lifespan or decreases mean erythrocyte age may falsely lower hemoglobin A1c (A1C) test results. Ribavirin (RBV) used for chronic hepatitis C virus (HCV) infection can cause reversible hemolytic anemia; erythropoietin (EPO) used for treatment-related anemia can stimulate the production of red blood cells. We reported a 55-year-old woman with diabetes who received peginterferon alfa plus RBV for HCV infection. Four weeks following HCV therapy, her Hb level declined from 13.3 g/dL to 11.3 g/dL with elevated lactate dehydrogenase and reduced haptoglobin, which confirmed hemolysis. As her Hb fell to a nadir of 8.5 g/dL at the eighth week, darbepoetin alfa was administered to treat anemia consecutively for 10 weeks. Two months later, the patient's A1C declined from 7.5% to an extremely low value of 4.0%, accompanied by a fasting glucose level of 116 mg/dL. During the preceding 3 months, there was no self-reported hypoglycemia or documented low blood glucose. About 3 months after HCV therapy was terminated, the A1C returned to 6.1% without medication adjustment. The concurrent use of RBV and EPO treatments can synergistically cause falsely low A1C values and may lead to inappropriate relaxation of glycemic control. During HCV treatment with RBV, A1C should not be used alone to guide diabetes therapy.

Efficacy of five-element gymnastics in glucose and lipid control in Taiwanese patients with type 2 diabetes.

The purpose of this quasi-experimental study was to determine the efficacy of Five-Element Gymnastics (FEG) in controlling glycosylated hemoglobin (HbA1C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) at the 8th and the 16th weeks of intervention for patients with type 2 diabetes in Taiwan. FEG consolidates several traditional Chinese exercises including Qigong, Xiang Gong, and martial arts with gymnastics. The experimental group (n = 31) practiced FEG at home for 16 weeks. The control group (n = 35) maintained usual activities. FEG was associated with decrease of HbA1C, TG, and LDL-C levels at the 8th week and continuous decrease of HbA1C through the 16th week. FEG could be an exercise choice for patients with type 2 diabetes.

[Relationships between emotional distress, empowerment perception and self-care behavior and quality of life in patients with type 2 diabetes].

BACKGROUND: Diabetes mellitus is a chronic disorder prevalent worldwide that, in addition to being costly to manage, severely impacts patient quality life. Therefore, it is extremely important to understand the factors associated with quality of life in diabetic patients. PURPOSE: The purposes of this study were to investigate relationships between variables including demographics, disease characteristics, emotional distress, empowerment perception, and self-care behavior and quality of life, as well as to identify the important explanatory factors of quality of life in patients with type 2 diabetes. METHODS: This study used a design that was cross-sectional, descriptive and correlated. A total of 220 patients diagnosed with type 2 diabetes in the previous ten year period were recruited as participants in this study. Data was collected using a structured questionnaire that incorporated scales to capture demographic, disease characteristic, emotional distress, empowerment perception, self-care behavior and quality of life data. The quality of life scale measured the three domains of satisfaction, impact, and worried about the diabetes. RESULTS: Results included: (1) the standardized score of quality of life was 79.6, considered in the moderate to high range; (2) Education level, age, "diabetes shared care" participation and insulin therapy were variables with significant impact upon quality of life; (3) The more severe the emotional distress, the worse quality of life scores were in every domain; (4) The better the perception of empowerment, the better the score in the satisfaction domain; (5) The better self care behavior was, the better the score in the satisfaction domain; and (6) emotional distress was the most important explanatory factor of quality of life, accounting for 28.7%-53.8% of total variance. CONCLUSION/IMPLICATIONS FOR PRACTICE: The findings of this study suggested that health professionals should evaluate emotional distress of diabetic patients in the early stage, provide emotional support and consultation and apply empowerment strategy to promote their quality of life.

[Implementation and evaluation of a proper dietary behavior program in diabetes support groups].

BACKGROUND: Active promotion in recent years of the Diabetes Share Care Program by the national Department of Health and the medical profession has gradually established a diabetes support system as well as patient support groups in Taiwan. The program concept holds that, by participating in a patient support group, diabetes patients and people in high risk categories will learn to adopt a healthier lifestyle in order to delay / avoid diabetes onset and complications. PURPOSE: Within the diabetes support group framework, we implemented correct dietary behavior programs and evaluated their efficacy. METHOD: A study using a quasi-experimental, single-group pretest and posttest design was carried out from December 2007 to May 2008. Participants included 48 registered patient members of a diabetes patient group located at a regional teaching hospital in Kaohsiung. Researchers used the Donabedian framework to evaluate program efficacy. RESULTS: Results indicated that the program could effectively promote proper dietary behavior in patients. CONCLUSION: Providing instant data during program execution and evaluation can enhance program efficacy. We hope that this experience can serve as a reference for medical staff when executing such programs.

Evidence that high-dose L-arginine may be inappropriate for use by diabetic patients as a prophylactic blocker of methylglyoxal glycation.

Previous reports have suggested that high-dose L-arginine could be used in diabetic patients as a prophylactic blocker for the initial glycation reaction of proteins by methylglyoxal (MG), a reactive dicarbonyl compound of glucose metabolism. Here, we present several lines of evidence to substantiate that this prophylactic intervention may be inappropriate and should be used with care. First, we demonstrated that when various concentrations of L-arginine (2.0-8.0 mM) were added to a fixed concentration of MG (1.56 microM) in a buffered lucigenin solution, dose-dependent generation of superoxide anion (O(-)(2))-mediated ultraweak chemiluminescence (uwCL) occurs. The suppression of uwCL generation by exogenously added superoxide dismutase further substantiated that the interaction between MG and L-arginine generated O(-)(2). This phenomenon can also be demonstrated in a serum-based system. Furthermore, when a fixed concentration of L-arginine (8.0 mM) was added exogenously to a group of sera obtained from either diabetic patients (n = 10) or their matched nondiabetic controls (n = 10), a marked discrepancy in the generation of O(-)(2)-mediated uwCL could be demonstrated (12,534 +/- 3,147 vs. 950 +/- 350 counts; p < 0.001). Taken together, this evidence demonstrates that the appropriateness of using high-dose L-arginine for prophylactic measures in diabetic patients may be questioned, because the inhibition of the glycation reaction between MG and proteins by high-dose L-arginine unexpectedly produces plethoric O(-)(2) as a by-product, which may subsequently aggravate the preexisting oxidative stress status of diabetic patients.