BACKGROUND Glycated hemoglobin A1c(HbA1c)is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience.However,the effect of HbA1c on diabetic retinopathy(DR)in the Han and Korean...BACKGROUND Glycated hemoglobin A1c(HbA1c)is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience.However,the effect of HbA1c on diabetic retinopathy(DR)in the Han and Korean populations in Jilin,China,remains inconclusive.AIM To determine the best cut-off of HbA1c for diagnosing DR among the Chinese.METHODS This cross-sectional study included 1933 participants from the Yanbian area of Jilin Province,China.Trained investigators employed a questionnaire-based survey,physical examination,laboratory tests,and fundus photography for the investigation.The best cut-off value for HbA1c was established via the receiver operating characteristic curve.The factors associated with HbA1c-associated risk factors were determined via linear regression.RESULTS The analysis included 887 eligible Chinese Han and Korean participants,591 of whom were assigned randomly to the training set and 296 to the validation set.The prevalence of DR was 3.27% in the total population.HbA1c of 6.2% was the best cut-off value in the training set,while it was 5.9% in the validation set.In both Chinese Han and Korean populations,an HbA1c level of 6.2% was the best cut-off value.The optimal cut-off values of fasting blood glucose(FBG)≥7 mmol/L and<7 mmol/L were 8.1% and 6.2% respectively in Han populations,while those in Korean populations were 6.9%and 5.3%,respectively.Age,body mass index,and FBG were determined as the risk factors impacting HbA1c levels.CONCLUSION HbA1c may serve as a useful diagnostic indicator for DR.An HbA1c level of 6.2% may be an appropriate cut-off value for DR detection in the Chinese population.展开更多
Background: Type II diabetes mellitus is associated with multiple metabolic derangements which can cause secondary pathophysiological changes in multiple organ systems. This in turn can impose a heavy burden of morbid...Background: Type II diabetes mellitus is associated with multiple metabolic derangements which can cause secondary pathophysiological changes in multiple organ systems. This in turn can impose a heavy burden of morbidity and mortality from micro‑ and macro‑vascular complications. This study aimed to describe the metabolic and therapeutic profile of a subgroup of type 2 diabetic patients who have treatment failure with oral anti-hyperglycemic agents with persistent hyperglycemia despite insulin treatment. Methods: 60 type 2 diabetic patients in treatment failure with oral antidiabetics and under insulin treatment, aged 35 to 70 years, were recruited at the Diabetes Clinic of the University Teaching Hospital of Treichville in Abidjan, Côte d’Ivoire. Blood samples were collected in tubes containing Ethylenediaminetetraacetic Acid (EDTA) to determine glycated hemoglobin (HbA1c). Results: The average age of the population was 54 ± 9.38 years with a sex ratio (M/F) of 0.3, an average BMI of 30.25 ± 5 kg/m<sup>2</sup>, and an average HbA1c of 10.1% ± 1.6% for an average diabetes duration of 11.8 ± 5.8 years. The average insulin dose was 74.556 ± 16.21 UI/day, and the average duration of insulin treatment was 5.4 ± 3.1 years. The average HbA1c value was 10.1% ± 1.87% in men against 10.03% ± 1.53% in women with no significant difference (p = 0.1). The mean HbA1c values according to patient weight were 10.08% ± 2.05% for normal weight, 9.55% ± 2.26% for overweight, and 10.57% for obese, with no significant difference between the three groups of patients (p = 0.1). Conclusion: This study showed a persistence increase in glycated hemoglobin regardless of the treatment regimen, duration, and dose of insulin treatment in the subpopulation of type 2 diabetic patients.展开更多
AIM To investigate the clinical significance of routinely used glycemic parameters in a cohort of colorectal cancer(CRC) patients.METHODS Pre-treatment fasting blood glucose, insulin, Hb A1 c and homeostasis model of ...AIM To investigate the clinical significance of routinely used glycemic parameters in a cohort of colorectal cancer(CRC) patients.METHODS Pre-treatment fasting blood glucose, insulin, Hb A1 c and homeostasis model of risk assessment(HOMA-IR) were retrospectively evaluated in a case-control study of 224 CRC and 112 control subjects matched for sex, obesity and diabetes frequency and blood lipid profile.Furthermore, the prognostic value of routinely used glycemic parameters towards progression-free(PFS) and overall survival(OS) was prospectively evaluated.RESULTS Fasting blood glucose, insulin, HOMA-IR and HbA 1c(all P < 0.0001) levels were higher in non-diabetic CRC patients compared with obesity-matched controls. All parameters were associated with increased CRC risk at ROC analysis, but no relationship with clinical-pathological variables or survival outcomes was observed for glycemia, insulinemia or HOMA-IR. Conversely, advanced CRC stage(P = 0.018) was an independent predictor of increased Hb A1 c levels, which were also higher in patients who had disease progression compared with those who did not(P = 0.05). Elevated Hb A1 c levels showed a negative prognostic value both in terms of PFS(HR = 1.24) and OS(HR = 1.36) after adjustment for major confounders, which was further confirmed in a subgroup analysis performed after exclusion of diabetic patients.CONCLUSION HbA 1c might have a negative prognostic value in CRC, thus suggesting that glycemic metabolic markers should be carefully monitored in these patients, independently of overt diabetes.展开更多
<div style="text-align:justify;"> <strong><span style="font-family:Verdana;">Introduction:</span></strong> <span style="font-family:Verdana;">Good qual...<div style="text-align:justify;"> <strong><span style="font-family:Verdana;">Introduction:</span></strong> <span style="font-family:Verdana;">Good quality care in Type 2 diabetes mellitus (T2DM), whose prevalence is approximately 10% in Kenya, may prevent or delay diabetes complications. This study determined blood glycemic targets, defined by HbA1c levels (>6.5% [53</span><span "=""> </span><span style="font-family:Verdana;">mmol/mol]) and associated factors among patients receiving diabetes management at Kenyatta National Hospital in Kenya.</span><span "=""> </span><b><span style="font-family:Verdana;">Methods: </span></b><span "=""><span style="font-family:Verdana;">In this cross-sectional study conducted between May to September 2017, we obtained blood samples from 381 consenting T2DM patients attending KNH. The study collected data using a detailed questionnaire while taking glycemic measurements. Factors associated with poor glycemic control </span><span style="font-family:Verdana;">(HbA1c levels >6.5%) were determined using Ordinal logistic regression modeling,</span><span style="font-family:Verdana;"> STATA software version 13.</span></span><span "=""> </span><b><span style="font-family:Verdana;">Results: </span></b><span "=""><span style="font-family:Verdana;">103 (27.1%) T2DM patients with poor glycemic control were identified. In multivariate analysis, independent risk factors associated with poor glycemic control and their 95% confidence intervals included: concurrent hypertension (aOR 1.6, [1.1, 2.4]), receiving ≥3 oral anti-diabetes medication (aOR 2.4, [1.3, 4.6]) </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> good adherence to medication based on self-reporting (aOR 6.2, [1.9, 41.3). Independent protective factors included self-monitoring of blood glucose levels (aOR 0.35, [0.2, 0.4]), patients aged 51 to 60 years (aOR 0.5, [0.3, 0.9]), weight between 50 and 70</span></span><span "=""> </span><span "=""><span style="font-family:Verdana;">kgs (aOR 0.5, [0.3, 0.9]) and receiving 1 to 2 diabetes medication (aOR 0.4, [0.3, 0.7]). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Significantly high proportion of T2DM patients receiving treatment at KNH had poor glycemic control. Addressing comorbidities and promoting good glycemic control among long-standing T2DM patients receiving ≥3 oral anti-diabetes </span><span style="font-family:Verdana;">medication</span><span style="font-family:Verdana;"> is key to delaying or preventing chronic diabetes complications. Self-monitoring of blood glucose levels needs to be encouraged as suggested by its protective effect. While differences in risk between diverse weights and ages need further studies, innovative ways of authenticating self-reports, e.g., triangulation, are required to e</span><span style="font-family:Verdana;">nsure credibility. This work supports the Government of Kenya</span></span><span style="font-family:Verdana;">’</span><span "=""><span style="font-family:Verdana;">s </span><i></i><i><i><span style="font-family:Verdana;">Vision</span></i></i></span><i><span "=""> </span></i><span style="font-family:Verdana;">2030 in </span><span style="font-family:Verdana;">creating a healthy and productive population contributing to the country</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> economic growth.</span> </div>展开更多
<strong>Background: </strong>Type-2 diabetic patients (uncontrolled levels of glucose blood) usually have periodontal diseases and alveolar bone loss. <strong>Objectives: </strong>The present s...<strong>Background: </strong>Type-2 diabetic patients (uncontrolled levels of glucose blood) usually have periodontal diseases and alveolar bone loss. <strong>Objectives: </strong>The present study was designed to clarify the impact of severity of periodontal bone loss and the levels of glycated hemoglobin (HbA1c) on the periodontal clinical parameters of the 2017 World Workshop among type 2 diabetic patients in Saudi Arabia (Saudi and non-Saudi). <strong>Material and Methods: </strong>This study was done on 298 type 2 diabetic patients, selected from the internship clinics, College of Dentistry, King Khalid University, Abha, Saudi Arabia. The selection of patients was dependent on the levels of glycated hemoglobin (HbA1c), and they were categorized into controlled (<7% HbA1c) and uncontrolled type 2 diabetics (>7% HbA1c). All patients were divided according to the severity of periodontal bone loss into three groups, group I: mild periodontal bone loss, group II: moderate periodontal bone loss, and group III: severe periodontal bone loss. Clinical evaluation of periodontal diseases was carried out by clinical parameters according to the 2017 World Workshop. All data were collected and analyzed. A p-value of <0.05 was considered significant, and of <0.001 was considered highly significant. <strong>Results:</strong> The severity of periodontal bone loss were determined in controlled type 2 diabetics (<7% HbA1c) and compared to uncontrolled type 2 diabetics (>7% HbA1c). An increased percentage of patients with severe periodontal bone loss was observed in uncontrolled type 2 diabetics (>7% HbA1c) (42.9%), as compared to controlled type 2 diabetics (<7% HbA1c) (30.5%) without statistically significant (p = 0.251). An increased mean of age, clinical attachment loss (CAL), and percentage of radiographic bone loss (% RBL) were detected in controlled type 2 diabetics (<7% HbA1c), as compared to uncontrolled type 2 diabetics (>7% HbA1c). In contrast, we found an increased mean of plaque control record (PCR), gingival bleeding index (GBI), and periodontal pocket depth (PPD) in uncontrolled type 2 diabetics (>7% HbA1c) more than in controlled type 2 diabetics (<7% HbA1c) without statistically significant (p > 0.05). Moreover, the mean of age, PCR, CAL, % RBL, and PPD were more in the patients with severe periodontal bone loss, as compared to the patients with mild and moderate periodontal bone. Highly statistically significant differences were recorded (p < 0.001). <strong>Conclusion:</strong> This study demonstrates the role of uncontrolled diabetes as a risk factor for the increase in the severity of periodontal bone loss. Thus, we suggest including the glycated hemoglobin (HbA1c) levels with periodontal parameters in the evaluation of periodontal bone loss among type 2 diabetics.展开更多
BACKGROUND In patients with type 2 diabetes mellitus(T2DM),the risk of hypoglycemia also occurs in at a time-in-range(TIR)of>70%.The hemoglobin glycation index(HGI)is considered the best single factor for predictin...BACKGROUND In patients with type 2 diabetes mellitus(T2DM),the risk of hypoglycemia also occurs in at a time-in-range(TIR)of>70%.The hemoglobin glycation index(HGI)is considered the best single factor for predicting hypoglycemia,and offers new perspectives for the individualized treatment of patients with well-controlled blood glucose levels that are easily ignored in clinical settings.All participants underwent a 7-days continuous glucose monitoring(CGM)using a retrospective CGM system.We obtained glycemic variability indices using the CGM system.We defined HGI as laboratory hemoglobin A1c minus the glucose management indicator.Patients were categorized into low HGI(HGI<0.5)and high HGI groups(HGI≥0.5)according to HGI median(0.5).Logistic regression and receiver operating characteristic curve analyses were used to determine the risk factors for hypoglycemia.RESULTS We included 129 subjects with T2DM(54.84±12.56 years,46%male)in the study.Median TIR score was 90%.The high HGI group exhibited lower TIR and greater time below range with higher hemoglobin A1c than the low HGI group;this suggests more glycemic excursions and an increased incidence of hypoglycemia in the high HGI group.Multivariate analyses revealed that mean blood glucose,standard deviation of blood glucose and HGI were independent risk factors for hypoglycemia.Receiver operating characteristic curve analysis indicated that the HGI was the best predictor of hypoglycemia.In addition,the optimal cut-off points for HGI,mean blood glucose,and standard deviation of blood glucose in predicting hypoglycemia were 0.5%,7.2 mmol/L and 1.4 mmol/L respectively.CONCLUSION High HGI was significantly associated with greater glycemic excursions and increased hypoglycemia in patients with TIR>70%.Our findings indicate that HGI is a reliable predictor of hypoglycemia in this population.展开更多
Background It has been suggested that glycated hemoglobin （HbAlc） underestimate the actual glycemic control levels in maintenance hemodialysis （MHD） patients, because of anemia and the using of erythropoietin （EP...Background It has been suggested that glycated hemoglobin （HbAlc） underestimate the actual glycemic control levels in maintenance hemodialysis （MHD） patients, because of anemia and the using of erythropoietin （EPO）; it was recommended that glycated albumin （GA） should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbAlc in this research by referring to mean plasma glucose （MPG） in diabetes mellitus （DM） patients undergoing MHD or not. Methods MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbAlc, albumin （ALB）, GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbAlc was done among the groups of MHD patients with DM （n=88） and without DM （NDM; n=90）, and non-MHD ones with DM （n=102） using MPG for an actual glycemic control standard. Results In these 3 groups, only for DM patients＇ （whether undergoing MHD or not）, GA and HbAlc correlated with MPG significantly （P 〈0.01）. Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts （2.418 vs. 2.329） and slopes （0.053 vs. 0.057） were very close to each other. On the contrary, regression curves of HbAlc did not coincide in the two groups, because variance of the slopes （0.036 vs. 0.052） were relatively large. Through comparing receiver operating characteristic （ROC） areas under the curve （AUC）, it could be understood that the assessment performances of GA and HbAlc in MHD patients were lower than those in non-MHD ones, and assessment performance of HbAlc in MHD patients was better than GA （P 〈0.05）. In addition, the effects of Hb and EPO dose on HbAlc, or that of ALB on GA were unobvious in our study. Conclusions Actual glycemic control level in MHD patients with DM may be underestimated by HbAlc, and it could be avoided by GA; however, glycemic evaluating performance of HbAlc may be still better than that of GA. Therefore, HbAlc should not be replaced completely although GA can be used as a choice to monitor glycemic level.展开更多
Background:Current practice uses the latest measure of glycated hemoglobin(HbAlc)to facilitate clinical decision-making.Studies have demonstrated that HbAlc variability links the risk of death and complications of dia...Background:Current practice uses the latest measure of glycated hemoglobin(HbAlc)to facilitate clinical decision-making.Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes.However,the role of HbAlc variability is unclear in clinical practice.This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro-and macro-vascular complications and death in people with type 2 diabetes.Methods:We searched PubMed,EMBASE(via OVID),and Cochrane Central Register(CENTRAL,via OVID)for studies investigating the association between HbAlc variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation(SD),coefficient of variation(CV),and HbAlc variability score(HVS).Results:In people with type 2 diabetes,the highest quantile of all three HbAlc variability metrics(HbAlc-standard deviation[HbAlc-SD],HbAlc-coefficient of variance[HbAlc-CV],and HVS)is associated with increased risks of all-cause mortality,cardiovascular events,progression to chronic kidney disease,amputation,and peripheral neuropathy.For example,the hazard ratio of HbAlc-SD on all-cause mortality was 1.89 with 95%confidence interval(95%CI)1.46–2.45(HbAlc-CV 1.47,95%CI 1.26-1.72;HVS 1.67,95%CI 1.34–2.09).Conclusions:High HbAlc variability leads to micro-and macro-vascular complications of type 2 diabetes and related death.People with type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.展开更多
Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mo...Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mortality in non-ST segment elevation acute coronary syndrome(NSTEACS)patients undergoing percutaneous coronary intervention(PCI). Methods In a single-center study,1075 patients undergoing PCI were included. HbA1 c was measured at admission,along with other standard laboratory values. The outcome was all-cause mortality during a 1.48-year median follow-up period. Results Kaplan-Meier curve showed that HbA1c≥6.5% was associated with all-cause mortality. According to multivariate analysis(after adjusting for potential confounding factors),HbA1c≥6.5% predicted mid-term mortality(hazard ratio:2.02;95% CI:1.03-3.98;P=0.041). The other risk factors for mortality were hemoglobin,low-density lipoprotein cholesterol,and triglyceride. Conclusions InNSTEACS patients undergoing PCI,HbA1c≥6.5% is associated with mid-term mortality.展开更多
Background Increased level of glycated hemoglobin （HbAlc） is associated with higher incidence of coronary artery disease （CAD） in the diabetics. However, the relationship between HbAlc and the risk of coronary art...Background Increased level of glycated hemoglobin （HbAlc） is associated with higher incidence of coronary artery disease （CAD） in the diabetics. However, the relationship between HbAlc and the risk of coronary artery stenosis in the non-diabetics is controversial. Methods A retrospective research was conducted on 338 enrolled participants who have undergone 2 times of coronary angiographic examination within the past year. Clinical and laboratory variables at the initial and the second time of admission were collected. According to the initial median HbAlc level, all participants were divided into two groups named lower and higher groups. The relationship between HbAlc level and the risk of coronary artery stenosis over time was evaluated. Results The initial values of HbAlc in lower and upper groups were 5.78 ± 0.35% and 6.21 ± 0.32% （P 〈 0.05）. As compared to the lower group, the percentages of male and smoking participants, and the serum level of CRP were significantly higher in the higher group （P 〈 0.05）. Other traditional risk factors were comparable between the two groups. There were 54.2% and 55.2% participants with single vessel stenosis, and 45.8% and 44.8% with multiple vessel stenoses, respectively in the two groups without significant difference. The second time of admission, were 308.5 ± 25.4 days （lower group） and 300.7 ± 30.1 days （higher group） from the initial admission. Although no significant changes of HbAlc level were observed when compared to initial, HbAlc level in the higher group was still significantly higher in comparison to the lower group （6.24 ±0.39% vs. 5.80 ± 0.36%, P = 0.008）. The percentage of new coronary artery stenosis （≥ 50% stenosis） was higher in the higher group than that in the lower group （41.7% vs. 32.3%, P 〈 0.001）. Multivariate regression analyses suggested that HbAlc remained independent factor associated with coronary artery stenoses after extensive adjustment for risk factors. Conclusion In the nondiabetics, increased baseline HbAlc level portends the risk of coronary atherosclerotic plaque progression over time.展开更多
AIM:To observe the changes in corneal subepithelial nerve fibers(CNFs)and Langerhans cells(LCs)in patients with type 2 diabetes using corneal laser confocal microscopy(CLCM).METHODS:A total of 60 patients(64 eyes),inc...AIM:To observe the changes in corneal subepithelial nerve fibers(CNFs)and Langerhans cells(LCs)in patients with type 2 diabetes using corneal laser confocal microscopy(CLCM).METHODS:A total of 60 patients(64 eyes),including 40 patients with type 2 diabetes(DM group)and 20 subjects without diabetes(control group)were included with CLCM.Neuron J plugin of Image J software were used for quantitative analysis of CNF length(CNFL),CNF density(CNFD),corneal nerve branch fiber density(CNBD),main branch length density,branch length density,corneal nerve fiber tortuosity(NT)score,and LCs density.An independent samples t-test to analyze the variability between the two groups was performed,and Pearson correlation analysis was used to analyze the relationships between CNF and multiple biochemical indicators in the DM group.The predictive power of CNF for type 2 diabetes was assessed using the receiver operating characteristic(ROC)curve.RESULTS:There were significant differences in the CNFL,CNFD,and main branch length density between two groups.The results of Pearson correlation analysis showed a significant negative correlation between CNFD and the duration of diabetes as well as triglyceride levels and total cholesterol,and a significant positive correlation between CNFD and serum albumin.In addition,the NT score showed a positive correlation and urea nitrogen,similar to the positive correlation observed between LC density and glycosylated hemoglobin(HbA1c)levels.CNFD showed the highest area under the curve(AUC of ROC)value,followed by main branch length density and CNFL.The AUC of the ROC curve under the logistic regression model also demonstrated good predictive values.The cut-off values of CNFD,CNFL,and main branch length density for diabetes showed 31.25,18.85,and 12.56,respectively.CONCLUSION:In patients with type 2 diabetes,there is a notable reduction in both CNFL and CNFD.These measurements can be influenced by various blood biochemical factors.However,the compromised nerve fibers can serve as valuable indicators for predicting the onset of type 2 diabetes and also as biomarkers for detecting diabetic neuropathy and its related complications.展开更多
In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoi...In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation.Conventional markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction.This comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD patients.CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c.Key studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant recipients.Despite challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are prone.The review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical practice.Altogether,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.展开更多
Purpose:The aim of the present study was to determine the association between adherence to the 24-h movement guidelines during middle adolescence and glucose outcomes(glycated hemoglobin and fasting glucose)and type 2...Purpose:The aim of the present study was to determine the association between adherence to the 24-h movement guidelines during middle adolescence and glucose outcomes(glycated hemoglobin and fasting glucose)and type 2 diabetes mellitus(T2DM)in adulthood,14 and 22 years later.Methods:We analyzed data from apparently healthy adolescents aged 12-18 years who participated in WavesⅠandⅡ(1994-1996,n=14,738),WaveⅣ(2008-2009,n=8913),and Wave V(2016-2018,n=3457)of the National Longitudinal Study of Adolescent to Adult Health(Add Health)in the United States.Physical activity,screen time,and sleep duration were measured using questionnaires,and the 24-h guidelines were defined as:5 or more times moderate-to-vigorous physical activity per week,≤2 h per day of screen time,and 9-11 h of sleep for 12-13 years and 8-10 h for 14-17 years.Capillary and venous whole blood was collected and analyzed to determine glycated hemoglobin and fasting glucose for WavesⅣandⅤ,respectively.Results:Only 2.1%of the adolescents met all the 3 guidelines,and 37.8%met none of them.In both wavesⅣandⅤ,adolescents who met physical activity and screen time guidelines had lower odds of T2DM in adulthood than those who did not meet any of these guidelines(WaveⅣ;prevalence ratio(PR)=0.57,95%confidence interval(95%CI):0.21-0.89;Wave V:PR=0.43,95%CI:0.32-0.74).Only for Wave V did adolescents who met all 3 guidelines have lower odds of T2DM at follow-up compared with those who did not meet any of these guidelines(PR=0.47,95%CI:0.24-0.91).Also,for each increase in meeting one of the 24-h recommendations,the odds of T2DM decreased by 18%(PR=0.82,95%CI:0.61-0.99)and 15%(PR=0.85,95%CI:0.65-0.98)in adulthood for WavesⅣandⅤ,respectively.Conclusion:Promoting all 24-h movement guidelines in adolescence,especially physical activity and screen time,is important for lowering the potential risk of T2DM in adulthood.展开更多
This review describes the prevalence,incidence,and demographics of children and young people(CYP)with type 1 diabetes in England and Wales using data from the United Kingdom National Paediatric Diabetes Audit(NPDA)and...This review describes the prevalence,incidence,and demographics of children and young people(CYP)with type 1 diabetes in England and Wales using data from the United Kingdom National Paediatric Diabetes Audit(NPDA)and has almost 100%submission from all paediatric diabetes centres annually.It is a powerful benchmarking tool and is an essential part of a long-term quality improvement programme for CYP with diabetes.Clinical characteristics of this population by age,insulin regimen,complication rates,health inequalities,access to diabetes technology,socioeconomic deprivation and glycaemic outcomes over the past decade is described in the review.The NPDA for England and Wales is commissioned by the United Kingdom Healthcare Quality Improvement Partnership as part of the National Clinical Audit for the United Kingdom National Service Framework for Diabetes.The rising incidence of Type 1 diabetes is evidenced in the past decade.Reduction in national median glycated hemoglobin for CYP with diabetes is observed over the last 10 years and the improvement sustained by various initiatives and quality improvement programmes implemented with universal health coverage.展开更多
Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease...Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the “sixth” major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A “two way” relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.展开更多
Objective To examine target attainment of lipid-lowering, antihypenensive and antidiabetic treatment in the elderly in a specialist set- ting of a University Hospital in Greece. Methods This was a retrospective study ...Objective To examine target attainment of lipid-lowering, antihypenensive and antidiabetic treatment in the elderly in a specialist set- ting of a University Hospital in Greece. Methods This was a retrospective study including consecutive subjects 〉 65 years old （n = 465） with a follow-up 〉 3 years. Low-density lipoprotein cholesterol （LDL-C）, blood pressure （BP） and glycated hemoglobin （HbAlc） goal achievement were recorded according to European Society of Cardiology/European Atherosclerosis Society （ESC/EAS）, European Society of Hypertension （ESH）/ESC and European Association for the Study of Diabetes （EASD） guidelines. Results The LDL-C targets were attained by 27~,4, 48% and 62% of very high, high and moderate risk patients, respectively. Those receiving statin ＋ ezetimibe achieved higher rates of LDL-C goal achievement compared with those receiving statin monotherapy （48% vs. 33%, P 〈 0.05）. Of the diabetic sub- jects, 71% had BP 〈 140/85 mmHg, while 78% of those without diabetes had BP 〈 140/90 mmHg. A higher proportion of the non-diabetic individuals （86%） had BP 〈 150/90 mmHg. Also, a higher proportion of those with diabetes had HbAlc 〈 8% rather than 〈 7% （88% and 47%, respectively）. Of note, almost one out of three non-diabetic individuals and one out of ten diabetic individuals had achieved all three treatment targets. Conclusions Even in a specialist setting of a University Hospital, a high proportion of the elderly remain at suboptimal LDL-C, BP and HbAlc levels. The use of drug combinations could improve multifactorial treatment target attainment, while less strict tar- gets could be more easily achieved in this population.展开更多
Helicobacter pylori(H.pylori)infection occurs in almost half of the world's population,most of whom are merely carriers of this microorganism.H.pylori is shown to be detected more frequently in patients with diabe...Helicobacter pylori(H.pylori)infection occurs in almost half of the world's population,most of whom are merely carriers of this microorganism.H.pylori is shown to be detected more frequently in patients with diabetes mellitus(DM)than in the general population,which is accompanied by a significantly increased risk of developing H.pylori-associated diseases.In addition,eradication therapy shows a low efficiency for H.pylori infection in patients with DM.There is a relationship between the level of chronic hyperglycemia and a higher detection rate of H.pylori as well as a lower efficiency of eradication therapy in patients with DM.The exact mechanisms of these phenomena are unknown.The authors make a hypothesis that explains the relationship between chronic hyperglycemia and the increased detection rate of H.pylori,as well as the mechanisms contributing to the improved survival of this bacterium in patients with DM during eradication therapy.展开更多
BACKGROUND Diabetes is a progressive disease that increases glucose levels in the blood.While studies have shown that patients with pulmonary disease(both obstructive and restrictive pulmonary disease)have a higher pr...BACKGROUND Diabetes is a progressive disease that increases glucose levels in the blood.While studies have shown that patients with pulmonary disease(both obstructive and restrictive pulmonary disease)have a higher prevalence of type 2 diabetes mellitus(T2DM),there have been more studies on restrictive patterns than chronic obstructive pulmonary disease.AIM To assess whether restrictive and obstructive pulmonary diseases are associated with T2DM in Koreans.METHODS For our analysis,we used data from the Korea National Health and Nutrition Examination Survey.A total of 2830 subjects were included in this study.Spirometry results were categorized into three patterns:Normal,restrictive pulmonary disease(RPD),and obstructive pulmonary disease(OPD).RESULTS The factors used as diabetic indicators(i.e.homeostatic model assessment of insulin resistance,homeostatic model assessment of beta-cell function,glycated hemoglobin,and fasting insulin)were among the highest in RPD but not in OPD.Based on multivariate logistic regression analysis,subjects with RPD were found with an increased odds ratio[OR:1.907,95%confidence interval(CI):1.110-3.277]for T2DM compared with subjects with normal pulmonary function,whereas in patients with OPD,the OR had not increased.Model 4,which adjusted for the variables that could affect diabetes and pulmonary disease,showed a significant increase in the T2DM OR to RPD(OR:2.025,95%CI:1.264-3.244).On the other hand,no statistically significant difference was shown in OPD(OR:0.982,95%CI:0.634-1.519).CONCLUSION RPD,not OPD,is highly associated with T2DM regardless of the risk factors of various T2DMs that can be confounds.展开更多
基金Supported by National Key R&D Program of China,No.2016YFC1305700.
文摘BACKGROUND Glycated hemoglobin A1c(HbA1c)is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience.However,the effect of HbA1c on diabetic retinopathy(DR)in the Han and Korean populations in Jilin,China,remains inconclusive.AIM To determine the best cut-off of HbA1c for diagnosing DR among the Chinese.METHODS This cross-sectional study included 1933 participants from the Yanbian area of Jilin Province,China.Trained investigators employed a questionnaire-based survey,physical examination,laboratory tests,and fundus photography for the investigation.The best cut-off value for HbA1c was established via the receiver operating characteristic curve.The factors associated with HbA1c-associated risk factors were determined via linear regression.RESULTS The analysis included 887 eligible Chinese Han and Korean participants,591 of whom were assigned randomly to the training set and 296 to the validation set.The prevalence of DR was 3.27% in the total population.HbA1c of 6.2% was the best cut-off value in the training set,while it was 5.9% in the validation set.In both Chinese Han and Korean populations,an HbA1c level of 6.2% was the best cut-off value.The optimal cut-off values of fasting blood glucose(FBG)≥7 mmol/L and<7 mmol/L were 8.1% and 6.2% respectively in Han populations,while those in Korean populations were 6.9%and 5.3%,respectively.Age,body mass index,and FBG were determined as the risk factors impacting HbA1c levels.CONCLUSION HbA1c may serve as a useful diagnostic indicator for DR.An HbA1c level of 6.2% may be an appropriate cut-off value for DR detection in the Chinese population.
文摘Background: Type II diabetes mellitus is associated with multiple metabolic derangements which can cause secondary pathophysiological changes in multiple organ systems. This in turn can impose a heavy burden of morbidity and mortality from micro‑ and macro‑vascular complications. This study aimed to describe the metabolic and therapeutic profile of a subgroup of type 2 diabetic patients who have treatment failure with oral anti-hyperglycemic agents with persistent hyperglycemia despite insulin treatment. Methods: 60 type 2 diabetic patients in treatment failure with oral antidiabetics and under insulin treatment, aged 35 to 70 years, were recruited at the Diabetes Clinic of the University Teaching Hospital of Treichville in Abidjan, Côte d’Ivoire. Blood samples were collected in tubes containing Ethylenediaminetetraacetic Acid (EDTA) to determine glycated hemoglobin (HbA1c). Results: The average age of the population was 54 ± 9.38 years with a sex ratio (M/F) of 0.3, an average BMI of 30.25 ± 5 kg/m<sup>2</sup>, and an average HbA1c of 10.1% ± 1.6% for an average diabetes duration of 11.8 ± 5.8 years. The average insulin dose was 74.556 ± 16.21 UI/day, and the average duration of insulin treatment was 5.4 ± 3.1 years. The average HbA1c value was 10.1% ± 1.87% in men against 10.03% ± 1.53% in women with no significant difference (p = 0.1). The mean HbA1c values according to patient weight were 10.08% ± 2.05% for normal weight, 9.55% ± 2.26% for overweight, and 10.57% for obese, with no significant difference between the three groups of patients (p = 0.1). Conclusion: This study showed a persistence increase in glycated hemoglobin regardless of the treatment regimen, duration, and dose of insulin treatment in the subpopulation of type 2 diabetic patients.
基金Supported by European Social Fund,under the Italian Ministry of Education,University and Research,PON03PE_00146_1/10 BIBIOFAR(CUP B88F12000730005 to Guadagni F,partially)
文摘AIM To investigate the clinical significance of routinely used glycemic parameters in a cohort of colorectal cancer(CRC) patients.METHODS Pre-treatment fasting blood glucose, insulin, Hb A1 c and homeostasis model of risk assessment(HOMA-IR) were retrospectively evaluated in a case-control study of 224 CRC and 112 control subjects matched for sex, obesity and diabetes frequency and blood lipid profile.Furthermore, the prognostic value of routinely used glycemic parameters towards progression-free(PFS) and overall survival(OS) was prospectively evaluated.RESULTS Fasting blood glucose, insulin, HOMA-IR and HbA 1c(all P < 0.0001) levels were higher in non-diabetic CRC patients compared with obesity-matched controls. All parameters were associated with increased CRC risk at ROC analysis, but no relationship with clinical-pathological variables or survival outcomes was observed for glycemia, insulinemia or HOMA-IR. Conversely, advanced CRC stage(P = 0.018) was an independent predictor of increased Hb A1 c levels, which were also higher in patients who had disease progression compared with those who did not(P = 0.05). Elevated Hb A1 c levels showed a negative prognostic value both in terms of PFS(HR = 1.24) and OS(HR = 1.36) after adjustment for major confounders, which was further confirmed in a subgroup analysis performed after exclusion of diabetic patients.CONCLUSION HbA 1c might have a negative prognostic value in CRC, thus suggesting that glycemic metabolic markers should be carefully monitored in these patients, independently of overt diabetes.
文摘<div style="text-align:justify;"> <strong><span style="font-family:Verdana;">Introduction:</span></strong> <span style="font-family:Verdana;">Good quality care in Type 2 diabetes mellitus (T2DM), whose prevalence is approximately 10% in Kenya, may prevent or delay diabetes complications. This study determined blood glycemic targets, defined by HbA1c levels (>6.5% [53</span><span "=""> </span><span style="font-family:Verdana;">mmol/mol]) and associated factors among patients receiving diabetes management at Kenyatta National Hospital in Kenya.</span><span "=""> </span><b><span style="font-family:Verdana;">Methods: </span></b><span "=""><span style="font-family:Verdana;">In this cross-sectional study conducted between May to September 2017, we obtained blood samples from 381 consenting T2DM patients attending KNH. The study collected data using a detailed questionnaire while taking glycemic measurements. Factors associated with poor glycemic control </span><span style="font-family:Verdana;">(HbA1c levels >6.5%) were determined using Ordinal logistic regression modeling,</span><span style="font-family:Verdana;"> STATA software version 13.</span></span><span "=""> </span><b><span style="font-family:Verdana;">Results: </span></b><span "=""><span style="font-family:Verdana;">103 (27.1%) T2DM patients with poor glycemic control were identified. In multivariate analysis, independent risk factors associated with poor glycemic control and their 95% confidence intervals included: concurrent hypertension (aOR 1.6, [1.1, 2.4]), receiving ≥3 oral anti-diabetes medication (aOR 2.4, [1.3, 4.6]) </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> good adherence to medication based on self-reporting (aOR 6.2, [1.9, 41.3). Independent protective factors included self-monitoring of blood glucose levels (aOR 0.35, [0.2, 0.4]), patients aged 51 to 60 years (aOR 0.5, [0.3, 0.9]), weight between 50 and 70</span></span><span "=""> </span><span "=""><span style="font-family:Verdana;">kgs (aOR 0.5, [0.3, 0.9]) and receiving 1 to 2 diabetes medication (aOR 0.4, [0.3, 0.7]). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Significantly high proportion of T2DM patients receiving treatment at KNH had poor glycemic control. Addressing comorbidities and promoting good glycemic control among long-standing T2DM patients receiving ≥3 oral anti-diabetes </span><span style="font-family:Verdana;">medication</span><span style="font-family:Verdana;"> is key to delaying or preventing chronic diabetes complications. Self-monitoring of blood glucose levels needs to be encouraged as suggested by its protective effect. While differences in risk between diverse weights and ages need further studies, innovative ways of authenticating self-reports, e.g., triangulation, are required to e</span><span style="font-family:Verdana;">nsure credibility. This work supports the Government of Kenya</span></span><span style="font-family:Verdana;">’</span><span "=""><span style="font-family:Verdana;">s </span><i></i><i><i><span style="font-family:Verdana;">Vision</span></i></i></span><i><span "=""> </span></i><span style="font-family:Verdana;">2030 in </span><span style="font-family:Verdana;">creating a healthy and productive population contributing to the country</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> economic growth.</span> </div>
文摘<strong>Background: </strong>Type-2 diabetic patients (uncontrolled levels of glucose blood) usually have periodontal diseases and alveolar bone loss. <strong>Objectives: </strong>The present study was designed to clarify the impact of severity of periodontal bone loss and the levels of glycated hemoglobin (HbA1c) on the periodontal clinical parameters of the 2017 World Workshop among type 2 diabetic patients in Saudi Arabia (Saudi and non-Saudi). <strong>Material and Methods: </strong>This study was done on 298 type 2 diabetic patients, selected from the internship clinics, College of Dentistry, King Khalid University, Abha, Saudi Arabia. The selection of patients was dependent on the levels of glycated hemoglobin (HbA1c), and they were categorized into controlled (<7% HbA1c) and uncontrolled type 2 diabetics (>7% HbA1c). All patients were divided according to the severity of periodontal bone loss into three groups, group I: mild periodontal bone loss, group II: moderate periodontal bone loss, and group III: severe periodontal bone loss. Clinical evaluation of periodontal diseases was carried out by clinical parameters according to the 2017 World Workshop. All data were collected and analyzed. A p-value of <0.05 was considered significant, and of <0.001 was considered highly significant. <strong>Results:</strong> The severity of periodontal bone loss were determined in controlled type 2 diabetics (<7% HbA1c) and compared to uncontrolled type 2 diabetics (>7% HbA1c). An increased percentage of patients with severe periodontal bone loss was observed in uncontrolled type 2 diabetics (>7% HbA1c) (42.9%), as compared to controlled type 2 diabetics (<7% HbA1c) (30.5%) without statistically significant (p = 0.251). An increased mean of age, clinical attachment loss (CAL), and percentage of radiographic bone loss (% RBL) were detected in controlled type 2 diabetics (<7% HbA1c), as compared to uncontrolled type 2 diabetics (>7% HbA1c). In contrast, we found an increased mean of plaque control record (PCR), gingival bleeding index (GBI), and periodontal pocket depth (PPD) in uncontrolled type 2 diabetics (>7% HbA1c) more than in controlled type 2 diabetics (<7% HbA1c) without statistically significant (p > 0.05). Moreover, the mean of age, PCR, CAL, % RBL, and PPD were more in the patients with severe periodontal bone loss, as compared to the patients with mild and moderate periodontal bone. Highly statistically significant differences were recorded (p < 0.001). <strong>Conclusion:</strong> This study demonstrates the role of uncontrolled diabetes as a risk factor for the increase in the severity of periodontal bone loss. Thus, we suggest including the glycated hemoglobin (HbA1c) levels with periodontal parameters in the evaluation of periodontal bone loss among type 2 diabetics.
基金Supported by Investigator-initiated Trial Research Funds from Eli Lilly and Co.and Amylin Pharmaceuticals,Inc.,No.A1570Natural Science Foundation of Guangdong Province,No.2018A030313915。
文摘BACKGROUND In patients with type 2 diabetes mellitus(T2DM),the risk of hypoglycemia also occurs in at a time-in-range(TIR)of>70%.The hemoglobin glycation index(HGI)is considered the best single factor for predicting hypoglycemia,and offers new perspectives for the individualized treatment of patients with well-controlled blood glucose levels that are easily ignored in clinical settings.All participants underwent a 7-days continuous glucose monitoring(CGM)using a retrospective CGM system.We obtained glycemic variability indices using the CGM system.We defined HGI as laboratory hemoglobin A1c minus the glucose management indicator.Patients were categorized into low HGI(HGI<0.5)and high HGI groups(HGI≥0.5)according to HGI median(0.5).Logistic regression and receiver operating characteristic curve analyses were used to determine the risk factors for hypoglycemia.RESULTS We included 129 subjects with T2DM(54.84±12.56 years,46%male)in the study.Median TIR score was 90%.The high HGI group exhibited lower TIR and greater time below range with higher hemoglobin A1c than the low HGI group;this suggests more glycemic excursions and an increased incidence of hypoglycemia in the high HGI group.Multivariate analyses revealed that mean blood glucose,standard deviation of blood glucose and HGI were independent risk factors for hypoglycemia.Receiver operating characteristic curve analysis indicated that the HGI was the best predictor of hypoglycemia.In addition,the optimal cut-off points for HGI,mean blood glucose,and standard deviation of blood glucose in predicting hypoglycemia were 0.5%,7.2 mmol/L and 1.4 mmol/L respectively.CONCLUSION High HGI was significantly associated with greater glycemic excursions and increased hypoglycemia in patients with TIR>70%.Our findings indicate that HGI is a reliable predictor of hypoglycemia in this population.
基金The work was supported by the grants from the Major State Basic Research Development Program of China （2013CB530800）, National Natural Science Foundation of China （81270819）, National Key Technology R＆D Program （2011BAI10B00）.
文摘Background It has been suggested that glycated hemoglobin （HbAlc） underestimate the actual glycemic control levels in maintenance hemodialysis （MHD） patients, because of anemia and the using of erythropoietin （EPO）; it was recommended that glycated albumin （GA） should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbAlc in this research by referring to mean plasma glucose （MPG） in diabetes mellitus （DM） patients undergoing MHD or not. Methods MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbAlc, albumin （ALB）, GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbAlc was done among the groups of MHD patients with DM （n=88） and without DM （NDM; n=90）, and non-MHD ones with DM （n=102） using MPG for an actual glycemic control standard. Results In these 3 groups, only for DM patients＇ （whether undergoing MHD or not）, GA and HbAlc correlated with MPG significantly （P 〈0.01）. Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts （2.418 vs. 2.329） and slopes （0.053 vs. 0.057） were very close to each other. On the contrary, regression curves of HbAlc did not coincide in the two groups, because variance of the slopes （0.036 vs. 0.052） were relatively large. Through comparing receiver operating characteristic （ROC） areas under the curve （AUC）, it could be understood that the assessment performances of GA and HbAlc in MHD patients were lower than those in non-MHD ones, and assessment performance of HbAlc in MHD patients was better than GA （P 〈0.05）. In addition, the effects of Hb and EPO dose on HbAlc, or that of ALB on GA were unobvious in our study. Conclusions Actual glycemic control level in MHD patients with DM may be underestimated by HbAlc, and it could be avoided by GA; however, glycemic evaluating performance of HbAlc may be still better than that of GA. Therefore, HbAlc should not be replaced completely although GA can be used as a choice to monitor glycemic level.
基金National Key R&D Program of China(No.2018YFC2SSlSSX)the 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(Nos.ZYGD18022 and 20HXFH011)。
文摘Background:Current practice uses the latest measure of glycated hemoglobin(HbAlc)to facilitate clinical decision-making.Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes.However,the role of HbAlc variability is unclear in clinical practice.This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro-and macro-vascular complications and death in people with type 2 diabetes.Methods:We searched PubMed,EMBASE(via OVID),and Cochrane Central Register(CENTRAL,via OVID)for studies investigating the association between HbAlc variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation(SD),coefficient of variation(CV),and HbAlc variability score(HVS).Results:In people with type 2 diabetes,the highest quantile of all three HbAlc variability metrics(HbAlc-standard deviation[HbAlc-SD],HbAlc-coefficient of variance[HbAlc-CV],and HVS)is associated with increased risks of all-cause mortality,cardiovascular events,progression to chronic kidney disease,amputation,and peripheral neuropathy.For example,the hazard ratio of HbAlc-SD on all-cause mortality was 1.89 with 95%confidence interval(95%CI)1.46–2.45(HbAlc-CV 1.47,95%CI 1.26-1.72;HVS 1.67,95%CI 1.34–2.09).Conclusions:High HbAlc variability leads to micro-and macro-vascular complications of type 2 diabetes and related death.People with type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.
基金supported by Medical Research Fund Project of Guangdong Province(No.C2017054)
文摘Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mortality in non-ST segment elevation acute coronary syndrome(NSTEACS)patients undergoing percutaneous coronary intervention(PCI). Methods In a single-center study,1075 patients undergoing PCI were included. HbA1 c was measured at admission,along with other standard laboratory values. The outcome was all-cause mortality during a 1.48-year median follow-up period. Results Kaplan-Meier curve showed that HbA1c≥6.5% was associated with all-cause mortality. According to multivariate analysis(after adjusting for potential confounding factors),HbA1c≥6.5% predicted mid-term mortality(hazard ratio:2.02;95% CI:1.03-3.98;P=0.041). The other risk factors for mortality were hemoglobin,low-density lipoprotein cholesterol,and triglyceride. Conclusions InNSTEACS patients undergoing PCI,HbA1c≥6.5% is associated with mid-term mortality.
文摘Background Increased level of glycated hemoglobin （HbAlc） is associated with higher incidence of coronary artery disease （CAD） in the diabetics. However, the relationship between HbAlc and the risk of coronary artery stenosis in the non-diabetics is controversial. Methods A retrospective research was conducted on 338 enrolled participants who have undergone 2 times of coronary angiographic examination within the past year. Clinical and laboratory variables at the initial and the second time of admission were collected. According to the initial median HbAlc level, all participants were divided into two groups named lower and higher groups. The relationship between HbAlc level and the risk of coronary artery stenosis over time was evaluated. Results The initial values of HbAlc in lower and upper groups were 5.78 ± 0.35% and 6.21 ± 0.32% （P 〈 0.05）. As compared to the lower group, the percentages of male and smoking participants, and the serum level of CRP were significantly higher in the higher group （P 〈 0.05）. Other traditional risk factors were comparable between the two groups. There were 54.2% and 55.2% participants with single vessel stenosis, and 45.8% and 44.8% with multiple vessel stenoses, respectively in the two groups without significant difference. The second time of admission, were 308.5 ± 25.4 days （lower group） and 300.7 ± 30.1 days （higher group） from the initial admission. Although no significant changes of HbAlc level were observed when compared to initial, HbAlc level in the higher group was still significantly higher in comparison to the lower group （6.24 ±0.39% vs. 5.80 ± 0.36%, P = 0.008）. The percentage of new coronary artery stenosis （≥ 50% stenosis） was higher in the higher group than that in the lower group （41.7% vs. 32.3%, P 〈 0.001）. Multivariate regression analyses suggested that HbAlc remained independent factor associated with coronary artery stenoses after extensive adjustment for risk factors. Conclusion In the nondiabetics, increased baseline HbAlc level portends the risk of coronary atherosclerotic plaque progression over time.
文摘AIM:To observe the changes in corneal subepithelial nerve fibers(CNFs)and Langerhans cells(LCs)in patients with type 2 diabetes using corneal laser confocal microscopy(CLCM).METHODS:A total of 60 patients(64 eyes),including 40 patients with type 2 diabetes(DM group)and 20 subjects without diabetes(control group)were included with CLCM.Neuron J plugin of Image J software were used for quantitative analysis of CNF length(CNFL),CNF density(CNFD),corneal nerve branch fiber density(CNBD),main branch length density,branch length density,corneal nerve fiber tortuosity(NT)score,and LCs density.An independent samples t-test to analyze the variability between the two groups was performed,and Pearson correlation analysis was used to analyze the relationships between CNF and multiple biochemical indicators in the DM group.The predictive power of CNF for type 2 diabetes was assessed using the receiver operating characteristic(ROC)curve.RESULTS:There were significant differences in the CNFL,CNFD,and main branch length density between two groups.The results of Pearson correlation analysis showed a significant negative correlation between CNFD and the duration of diabetes as well as triglyceride levels and total cholesterol,and a significant positive correlation between CNFD and serum albumin.In addition,the NT score showed a positive correlation and urea nitrogen,similar to the positive correlation observed between LC density and glycosylated hemoglobin(HbA1c)levels.CNFD showed the highest area under the curve(AUC of ROC)value,followed by main branch length density and CNFL.The AUC of the ROC curve under the logistic regression model also demonstrated good predictive values.The cut-off values of CNFD,CNFL,and main branch length density for diabetes showed 31.25,18.85,and 12.56,respectively.CONCLUSION:In patients with type 2 diabetes,there is a notable reduction in both CNFL and CNFD.These measurements can be influenced by various blood biochemical factors.However,the compromised nerve fibers can serve as valuable indicators for predicting the onset of type 2 diabetes and also as biomarkers for detecting diabetic neuropathy and its related complications.
文摘In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation.Conventional markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction.This comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD patients.CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c.Key studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant recipients.Despite challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are prone.The review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical practice.Altogether,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.
文摘Purpose:The aim of the present study was to determine the association between adherence to the 24-h movement guidelines during middle adolescence and glucose outcomes(glycated hemoglobin and fasting glucose)and type 2 diabetes mellitus(T2DM)in adulthood,14 and 22 years later.Methods:We analyzed data from apparently healthy adolescents aged 12-18 years who participated in WavesⅠandⅡ(1994-1996,n=14,738),WaveⅣ(2008-2009,n=8913),and Wave V(2016-2018,n=3457)of the National Longitudinal Study of Adolescent to Adult Health(Add Health)in the United States.Physical activity,screen time,and sleep duration were measured using questionnaires,and the 24-h guidelines were defined as:5 or more times moderate-to-vigorous physical activity per week,≤2 h per day of screen time,and 9-11 h of sleep for 12-13 years and 8-10 h for 14-17 years.Capillary and venous whole blood was collected and analyzed to determine glycated hemoglobin and fasting glucose for WavesⅣandⅤ,respectively.Results:Only 2.1%of the adolescents met all the 3 guidelines,and 37.8%met none of them.In both wavesⅣandⅤ,adolescents who met physical activity and screen time guidelines had lower odds of T2DM in adulthood than those who did not meet any of these guidelines(WaveⅣ;prevalence ratio(PR)=0.57,95%confidence interval(95%CI):0.21-0.89;Wave V:PR=0.43,95%CI:0.32-0.74).Only for Wave V did adolescents who met all 3 guidelines have lower odds of T2DM at follow-up compared with those who did not meet any of these guidelines(PR=0.47,95%CI:0.24-0.91).Also,for each increase in meeting one of the 24-h recommendations,the odds of T2DM decreased by 18%(PR=0.82,95%CI:0.61-0.99)and 15%(PR=0.85,95%CI:0.65-0.98)in adulthood for WavesⅣandⅤ,respectively.Conclusion:Promoting all 24-h movement guidelines in adolescence,especially physical activity and screen time,is important for lowering the potential risk of T2DM in adulthood.
文摘This review describes the prevalence,incidence,and demographics of children and young people(CYP)with type 1 diabetes in England and Wales using data from the United Kingdom National Paediatric Diabetes Audit(NPDA)and has almost 100%submission from all paediatric diabetes centres annually.It is a powerful benchmarking tool and is an essential part of a long-term quality improvement programme for CYP with diabetes.Clinical characteristics of this population by age,insulin regimen,complication rates,health inequalities,access to diabetes technology,socioeconomic deprivation and glycaemic outcomes over the past decade is described in the review.The NPDA for England and Wales is commissioned by the United Kingdom Healthcare Quality Improvement Partnership as part of the National Clinical Audit for the United Kingdom National Service Framework for Diabetes.The rising incidence of Type 1 diabetes is evidenced in the past decade.Reduction in national median glycated hemoglobin for CYP with diabetes is observed over the last 10 years and the improvement sustained by various initiatives and quality improvement programmes implemented with universal health coverage.
文摘Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the “sixth” major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A “two way” relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.
文摘Objective To examine target attainment of lipid-lowering, antihypenensive and antidiabetic treatment in the elderly in a specialist set- ting of a University Hospital in Greece. Methods This was a retrospective study including consecutive subjects 〉 65 years old （n = 465） with a follow-up 〉 3 years. Low-density lipoprotein cholesterol （LDL-C）, blood pressure （BP） and glycated hemoglobin （HbAlc） goal achievement were recorded according to European Society of Cardiology/European Atherosclerosis Society （ESC/EAS）, European Society of Hypertension （ESH）/ESC and European Association for the Study of Diabetes （EASD） guidelines. Results The LDL-C targets were attained by 27~,4, 48% and 62% of very high, high and moderate risk patients, respectively. Those receiving statin ＋ ezetimibe achieved higher rates of LDL-C goal achievement compared with those receiving statin monotherapy （48% vs. 33%, P 〈 0.05）. Of the diabetic sub- jects, 71% had BP 〈 140/85 mmHg, while 78% of those without diabetes had BP 〈 140/90 mmHg. A higher proportion of the non-diabetic individuals （86%） had BP 〈 150/90 mmHg. Also, a higher proportion of those with diabetes had HbAlc 〈 8% rather than 〈 7% （88% and 47%, respectively）. Of note, almost one out of three non-diabetic individuals and one out of ten diabetic individuals had achieved all three treatment targets. Conclusions Even in a specialist setting of a University Hospital, a high proportion of the elderly remain at suboptimal LDL-C, BP and HbAlc levels. The use of drug combinations could improve multifactorial treatment target attainment, while less strict tar- gets could be more easily achieved in this population.
文摘Helicobacter pylori(H.pylori)infection occurs in almost half of the world's population,most of whom are merely carriers of this microorganism.H.pylori is shown to be detected more frequently in patients with diabetes mellitus(DM)than in the general population,which is accompanied by a significantly increased risk of developing H.pylori-associated diseases.In addition,eradication therapy shows a low efficiency for H.pylori infection in patients with DM.There is a relationship between the level of chronic hyperglycemia and a higher detection rate of H.pylori as well as a lower efficiency of eradication therapy in patients with DM.The exact mechanisms of these phenomena are unknown.The authors make a hypothesis that explains the relationship between chronic hyperglycemia and the increased detection rate of H.pylori,as well as the mechanisms contributing to the improved survival of this bacterium in patients with DM during eradication therapy.
文摘BACKGROUND Diabetes is a progressive disease that increases glucose levels in the blood.While studies have shown that patients with pulmonary disease(both obstructive and restrictive pulmonary disease)have a higher prevalence of type 2 diabetes mellitus(T2DM),there have been more studies on restrictive patterns than chronic obstructive pulmonary disease.AIM To assess whether restrictive and obstructive pulmonary diseases are associated with T2DM in Koreans.METHODS For our analysis,we used data from the Korea National Health and Nutrition Examination Survey.A total of 2830 subjects were included in this study.Spirometry results were categorized into three patterns:Normal,restrictive pulmonary disease(RPD),and obstructive pulmonary disease(OPD).RESULTS The factors used as diabetic indicators(i.e.homeostatic model assessment of insulin resistance,homeostatic model assessment of beta-cell function,glycated hemoglobin,and fasting insulin)were among the highest in RPD but not in OPD.Based on multivariate logistic regression analysis,subjects with RPD were found with an increased odds ratio[OR:1.907,95%confidence interval(CI):1.110-3.277]for T2DM compared with subjects with normal pulmonary function,whereas in patients with OPD,the OR had not increased.Model 4,which adjusted for the variables that could affect diabetes and pulmonary disease,showed a significant increase in the T2DM OR to RPD(OR:2.025,95%CI:1.264-3.244).On the other hand,no statistically significant difference was shown in OPD(OR:0.982,95%CI:0.634-1.519).CONCLUSION RPD,not OPD,is highly associated with T2DM regardless of the risk factors of various T2DMs that can be confounds.
