Audit of the use of HbA1c in children and young people without a prior diagnosis of diabetes mellitus

Aim: To analyze the relationship between diagnosis of DM, Hyperglycemia of hospital admission and evolution of patients hospitalized for COVID-19 in the Sanatorium “Las Lomas” Asunción, Paraguay. Materials and methods: Observational, analytical, case-control, retrospective design. Total population: 304 patients. Study period: September 2020 to March 2021. Definitions: Controls (Group 1) : Demographically similar patients without diagnosis of DM or Hyperglycemia at hospital admission. Non-probabilistic sampling, consecutive cases. Cases: adult patients ≥18 years, both sexes, hospitalized for COVID-19 with diagnosis of DM (Group 2) or Hyperglycemia at admission without prior diagnosis of DM (Group 3) Admission hyperglycemia was considered 140 mg/dl. Results: Of the 304 patients selected: 100 were from Group 1 (G1) , 102 from Group 2 (G2) and 102 from Group 3 (G3) . The length of hospital stay was 7, 10 and 10 days, for G1, G2 and G3 respectively. Mortality was 5%, 10.7% (OR: 2.3 p: 0.12) and 11.7% (OR: 2.5 P: 0.08) for G1, G2 and G3 respectively. It was observed in G1, G2 and G3: the need for O2: 56%, 57.8% (OR: 1.07 p: 0.79) and 71.5% (OR: 2 p: 0.02) ; the use of high-flow cannula was necessary in 7%, 10,7% (OR: 1.6 p: 0.34) and 17.6% (OR: 2.8 p: 0.02) ; ICU admission in 11%, 25.4% (OR: 2.8 p: 0.007) 27.4% (OR: 3 p: 0.003) ; need for mechanical ventilation: 8%, 22.5% (OR: 3.3 p: 0.004) , 21.5% (OR: 3.1 p: 0.006) ; need for dialysis: 2%, 3.9% (OR: 2 p: 0.42) , 6.8% (OR: 3.6% p: 0.09) . The occurrence of complications: 11%, 30.3% (OR: 3.5 p: 0.000) , 34.3% (OR: 4,2 p: 0,000) Conclusion: The need for admission to ICU, mechanical ventilation, and occurrence of complications were significantly more frequent in patients with DM than controls. Mortality was no different statistically. In patients with hyperglycemia without prior diagnosis of DM, mortality was more frequent, but without statistical significance. The rest of the variables of bad evolution except the need for dialysis were all more frequent. Disclosure M. G. Canata: None. S. A. Logwin: None. E. D. Bueno colman: None. A. Benitez: None. A. J. Fretes: None. G. Brunstein diez perez: None. C. Bordon: None. J. T. Jimenez: None. M. Palacios: None.

Risk Factor Control in Stroke Survivors with Diagnosed and Undiagnosed Diabetes: A Ghanaian Registry Analysis

BackgroundPrior studies suggest soluble fibers may favorably affect glucose/insulin metabolism.MethodsThis prospective, randomized, placebo controlled, double blind, parallel group trial evaluated 50 generally healthy subjects without prior diagnosis of diabetes mellitus (44 completers), who were administered beverages containing placebo (control), lower dose (3 g/d), or higher dose (6 g/d) reduced viscosity barley β-glucan (BBG) extract. Subjects (68% women) mean age 56 years, Body Mass Index (BMI) 32 kg/m2 and baseline fasting plasma glucose 102 mg/dl were instructed to follow a weight-maintaining Therapeutic Lifestyle Changes (TLC) diet and consumed three 11 oz study beverages daily with meals for 12 weeks. The four primary study endpoint measures were plasma glucose and insulin [each fasting and post-Oral Glucose Tolerance Testing (OGTT)].ResultsCompared to placebo, administration of 3 g/d BBG over 12 weeks significantly reduced glucose incremental Area Under the Curve (iAUC) measures during OGTT and 6 g/d BBG over 12 weeks significantly reduced fasting insulin as well as the related homeostasis model assessment of insulin resistance (HOMA-IR). Beverages were generally well tolerated with no serious adverse experiences and no significant differences between groups for adverse experiences. Per protocol instruction, subjects maintained body weight.ConclusionsThese findings suggest 6 g/d BBG consumed in a beverage over 12 weeks may improve insulin sensitivity among hyperglycemic individuals with no prior diagnosis of diabetes mellitus, and who experience no change in body weight.Trial RegistrationClinicalTrials.gov Identifier: NCT01375803.

HbA1c and Diabetes Predict Perioperative Hyperglycemia and Glycemic Variability in On-Pump Coronary Artery Bypass Graft Patients

To examine whether the presence of a prior diagnosis of diabetes mellitus (DM) influences mortality risk in elderly patients experiencing a first episode of heart failure (HF) hospitalization. A total of 677 consecutive patients aged ≥75 years admitted for a first episode of acute decompensated heart failure were evaluated according to the presence or not of DM, and in-hospital and 1-year mortality rates were evaluated. A total of 240 patients (35.4%) had a diagnosis of DM. Overall, 42 patients (6.2%) died during admission; and 205 patients (30.3%) died after 1 year; however, no differences were observed in mortality rates between both groups. Cox univariate analysis did not identify prior DM diagnosis as a risk factor for 1-year mortality (HR 0.767, P < 0.082). Multivariate analysis identified older age (HR 1.101, P < 0.0001), lower preadmission Barthel Index (HR 0.987, P = 0.002), higher heart rate (HR 1.013, P = 0.02), higher admission serum potassium (HR 1.471, P = 0.016) and non-prescription of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists (HR 1.597, P = 0.018) as independent risk factors for 1-year mortality. More than one-third of elderly patients experiencing a first admission because of acute heart failure decompensation had a prior diagnosis of DM. However, DM did not seem to be associated to a significant 1-year mortality risk. Geriatr Gerontol Int 2018; 18: 554-560.

<h3>Background</h3> The presence of diabetes mellitus (DM) is associated with increased mortality in patients with acute ST segment elevation myocardial infarction (STEMI) treated with fibrinolysis. Primary percutaneous coronary intervention (PPCI) confers improved outcomes compared to fibrinolysis in unselected patients and is now the reperfusion strategy of choice. However, the impact of DM on survival in the era of PPCI for STEMI remains unclear. <h3>Methods</h3> We carried out a retrospective analysis of a database of all patients undergoing PPCI for STEMI at the Yorkshire Heart Centre, Leeds General Infirmary (covering a regional population of ∼3.2 million). 30-day and 1-year mortality, demographic factors and procedural characteristics were compared between patients with and without a diagnosis of DM on presentation. <h3>Results</h3> Between September 2002 and September 2008, 1629 patients underwent PPCI for STEMI at our centre. 209 (12.8%) patients had a prior diagnosis of DM. Mortality at 30 days (8.4% vs 3.9%; p=0.0023) and 1 year (15.8% vs 6.8%; p&lt;0.0001) was significantly higher in patients with DM (Abstract 128 Figure 1). Patients with DM were older (mean age 63.78 vs 61.16; p=0.006) and more often required circulatory support (8.6% vs 4.5%; p=0.014) than patients without DM. Triple vessel disease was more common in patients with DM (32.5% vs 19.6%; p=0.001). Drug eluting stents were deployed more frequently in patients with DM (32% vs 25%; p=0.03). Administration of heparin+abciximab (62.1% vs 61.2%) and bivalirudin (38.8% vs 37.9%) was similar in both groups. TIMI flow grade was similar in the two groups at baseline. However, final TIMI flow achieved was lower in patients with DM compared to patients without diabetes (mean 2.74 vs 2.85; p=0.001). ‘Symptom to balloon time’ (Median time (minutes) (IQR): 244 (168–447) vs 211 (153–350); p=0.006) and ‘door to balloon time’ (107 (62–165) vs 85 (52–129); p=0.0003) were significantly longer in patients with DM. <h3>Conclusions</h3> Survival remains substantially impaired in patients with DM undergoing contemporary reperfusion with PPCI for STEMI. Increased age, more advanced coronary disease and greater requirement for circulatory support may contribute to poorer outcomes, but the influence of DM on timing of presentation and reperfusion requires further investigation. Abstract 128 Figure 1. Kaplan Meier curves showing 1-year mortality post PPCI.

HbA1c has become the gold standard for monitoring glycemic control in patients with diabetes mellitus. The use of this test has been expanded to diagnose and screen for diabetes mellitus with the endorsement of influential diabetes societies and the World Health Organization. The literature on the use of HbA1c for the diagnosis and screening of diabetes mellitus was critically examined. There is substantial recent literature on this topic with strong advocates for the use of HbA1c to diagnose and screen for diabetes and equally strong detractors for its use. Advocates of the use of HbA1c cite challenges in respect of patient compliance and the analysis of glucose and inconsistency of diagnosis with glucose-based diabetes diagnosis with the elimination or reduction in these challenges in HbA1c-based diagnosis. Detractors of its use cite increased cost, concerns about the availability of HbA1c testing, and the influence of demographic and clinical factors on HbA1c results that make the use of a single-threshold values questionable for different ethnic and age groups. Despite the recommendation of many international diabetes societies that HbA1c be used for screening and diagnosis of diabetes mellitus, there is a wide divergence of opinion on this use.

SAT0092 A Risky “Metabolic Intersection”: the Risk of Incident Diabetes in Patients with Gout

To evaluate glycated hemoglobin (HbA1c) levels in patients who have not been diagnosed with diabetes mellitus (DM) but exhibit oral DM symptoms prior to dental implant surgery. This study was designed as a retrospective cohort. It was conducted on patients who previously presented to the Department of Oral and Maxillofacial Surgery for dental implant surgery and had not been diagnosed with DM. The inclusion criteria were as follows: patients with the need for dental implants and augmentation, presence of oral DM symptoms, and access to blood test results that included HbA1c. Patients with a prior diagnosis of DM were excluded from the study. A retrospective analysis was conducted on data from 253 patients who applied for dental implant surgery. Among them, 72 patients underwent HbA1c level assessments via blood tests. Patients with previously uncontrolled DM (n = 21) and those whose blood tests were performed at different institutions (n = 8) were excluded from the study. Consequently, the study encompassed a cohort of 43 patients. Among the participants, 55% of them were female and 45% of them were male. The HbA1c values of the patients ranged from 5.1 to 10.9, with an average value of 6.57 ± 1.44. Of the patients, 41.8% were diagnosed with DM, 30.2% were prediabetic (preDM), and 27.9% did not receive any diagnosis. There was no statistically significant relationship between the combinations of xerostomia, delayed wound healing, oral infection, burning sensation in the mouth, periodontitis, and dental caries with HbA1c levels (P > .05). In this study, patients presenting to the clinic for dental implant surgery were directed based on oral symptom findings, and the rates of diagnosed DM and preDM were determined to be 7.11% and 5.14%, respectively. Considering the negative effects and prevalence of uncontrolled DM, it may be recommended to assess the HbA1c levels in patients with oral symptoms before dental implant surgery.

BackgroundInpatient hyperglycaemia and diabetes mellitus (DM) are common and are associated with an increased risk of complications and mortality. The severity of hyperglycaemia determines the rate of complications in patients treated in the emergency department (ED). Our aim was to examine whether determination of the capillary haemoglobin A1c (HbA1c) is a reliable method for detecting unknown diabetes and poor glycaemic control in the ED.MethodsA prospective observational study was conducted in adult (>18 years) patients treated in a single-centre ED. We compared the results of HbA1c levels measured by Bio-Rad in2it point-of-care device on a capillary blood sample and by the hospital laboratory.ResultsA total of 187 ED patients with an average age of 57.1 ± 19.2 years were studied. The mean HbA1c value was 5.78 ± 1.26 % by capillary POC testing and 6.10 ± 1.12 % by the hospital laboratory (correlation = 0.712, P < 0.001). A total of 17.1 % of cases had a prior diagnosis of DM. The diagnosis of DM (plasma glucose > 126 mg/dL and/or HbA1c > 6.5 %) was made in ten (5.4 %) additional cases (prior undiagnosed DM) for a total prior DM prevalence of 22.5 % (95 % CI 16.4–28.5 %). Capillary HbA1c detected 11 additional cases of unknown DM (5.9 %). A capillary HbA1c value greater than 6 % has a sensitivity of 85.7 % and specificity of 85.3 % for the screening of DM.ConclusionsDetermination of the capillary HbA1c in the ED is a reliable, fast, and simple system for the screening of unknown or uncontrolled DM.

Functional dentition and chronic noncommunicable diseases among adults in Brazil.

Diabetic ketoacidosis (DKA) is the presence of metabolic acidosis with an elevated anion gap, ketonemia or ketonuria, with or without hyperglycemia, in the context of a prior diagnosis of diabetes mellitus (DM) or a new diagnosis of DM. In this case, it is caused by a relative or absolute insulin deficiency, leading to ketogenesis, lipolysis, lipotoxicity, and metabolic acidosis. There is a vast amount of literature—articles, reports, books, journals, and many other sources—focused on advances in the treatment and pathophysiology of DM and its decompensated states, primarily diabetic ketoacidosis. However, no ideal study has yet been established to fully explain the pathophysiology, triggers, and, of course, optimal treatment without generating controversy. Therefore, the objective of this review is to analyze, describe, and discuss updates on the pathophysiology and treatment of DKA in a precise and concise manner, in order to support healthcare personnel in managing patients with this complication. Decompensated DM can have a broad pathophysiology, so ideal treatments must be considered to avoid short- and long-term complications, including ketoacidosis, as well as certain variations in clinical presentation, such as in the case of euglycemic ketoacidosis

Cognitive impairment has been documented in adult diabetes but is unclear in pediatric diabetes. No study had been conducted to explore the relationship between attention-deficit/hyperactivity disorder (ADHD) and diabetes. Using a population-based data set, we aimed to examine the association between ADHD and a prior diagnosis of diabetes mellitus (DM) in Taiwan. A total of 4,302 patients with ADHD were selected as cases and 21,510 randomly selected subjects as controls. We used conditional logistic regression to calculate the odds ratio (OR) for having previously received a diagnosis of DM between subjects with and without ADHD. In this study, 116 of the 25,812 sampled subjects (0.5%) had received a diagnosis of DM prior to their index date. Subjects with ADHD had a higher proportion of prior DM diagnoses than controls (0.9% vs. 0.4%, P < 0.001). After adjusting for age, sex, index year, geographic location, and obesity, ADHD was significantly associated with a prior diagnosis of type 2 DM (OR = 2.75, 95% confidence interval (CI) = 1.82-4.16). However, no significant association was observed between ADHD and type 1 DM. The findings suggest that ADHD was associated with a previous diagnosis of type 2 DM.

Association between SLGT2 Inhibitor Use and the Progression of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma

Background and Objectives: We conducted a retrospective observational study to evaluate the impact of elevated blood glucose levels in patients with SARS-CoV-2 infection and a prior diagnosis of diabetes mellitus (DM) or newly diagnosed hyperglycemia. Materials and Methods: This study analyzed 6065 patients admitted to the COVID-19 departments of the "Marius Nasta" National Institute of Pulmonology in Bucharest, Romania, between 26 October 2020 and 5 January 2023. Of these, 813 patients (13.40%) were selected for analysis due to either a pre-existing diagnosis of DM or hyperglycemia at the time of hospital admission. Results: The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were elevated in patients with blood glucose levels exceeding 300 mg/dL. These elevations correlated with the presence of respiratory failure and increased mortality rates. Additionally, oxygen requirements were significantly higher at elevated blood glucose levels (p < 0.001), with a direct relationship between glycemia and oxygen demand. This was accompanied by lower oxygen saturation levels (p < 0.001). Maximum blood glucose levels were associated with the severity of respiratory failure (AUC 0.6, 95% CI: 0.56-0.63, p < 0.001). We identified cut-off values for blood glucose at admission (217.5 mg/dL) and maximum blood glucose during hospitalization (257.5 mg/dL), both of which were associated with disease severity and identified as risk factors for increased mortality. Conclusions: High blood glucose levels, both at admission and during hospitalization, were identified as risk factors for poor prognosis and increased mortality in patients with SARS-CoV-2 infection, regardless of whether the hyperglycemia was due to a prior diagnosis of DM or was newly developed during the hospital stay. These findings underscore the importance of glycemic control in the management of hospitalized COVID-19 patients.