A1c Values Research Articles

Abstract P395: High Risk Diabetics Risk of Recurrent Stroke and Cardiovascular Disease Persists Even With Patient Personalized Subspecialty Care

Introduction: Diabetes management is an important aspect of stroke prevention. To our knowledge, studies that focus specifically on the role of multidisciplinary teams for adjusting diabetes medications and diabetes education for stroke and cardiovascular disease prevention to compliment standard stroke prevention and nursing education are lacking. Here we sought to evaluate whether high risk diabetics, hemoglobin A1c (HA1c) > 8%, admitted secondary to stroke would benefit from a multidisciplinary team model that also incorporates endocrinology consultation and diabetes education to personalized nursing education and education and management of the admitting service. Methods: Data was obtained from our Institutional Review Board approved stroke admission database from 2017 to November 2019. Regression analysis was used to identify significant associations between diabetes education (DE) and endocrine consultation (EC) with readmission rates with 30 days, re-admission within 30 days secondary to stroke, cardiovascular event or stroke within a year of the stroke admission, and medication change after controlling for age, sex, NIHSS, HbA1c, low density lipoprotein (LDL), reperfusion therapy for acute stroke. Follow-up HbA1c post hospitalization was available for only 17% of the population, and was not included in the regression models. Results: A total of 202 patients were included, median age 66 (interquartile range 56-75), 43% women, NIHSS median 5 (interquartile range (IQR, 2-9), LDL median 105 (IQR, 69-155), A1c median 9.5 (IQR, 8.5 -11.1), and 24% received reperfusion therapy. EC was associated with higher likelihood of a medication change (odds ratio (OR) 9.43, 95% confidence interval (CI) (3.22-30.69). DE was associated with younger age (OR 0.96, 95% CI 0.92-0.99); higher A1c value (OR 1.47, 95% CI 1.18 - 1.87) and higher likelihood of cardiovascular event within a year of the stroke (OR 3.38, 95% CI 1.23 - 9.70). Conclusion: While the endocrine consultation does lead to medications changes with the intent of improving post discharge glycemic control, cardiovascular events were still more likely, possibly from DM disease severity. Further continuation of follow up of these patients with EC and DE after hospital discharge may be needed.

Evaluation of the Use of a Diabetes Risk Test to Identify Prediabetes in an Employee Wellness Screening

Background: The American Diabetes Association (ADA) Diabetes Risk Test (DRT) is a screening tool to identify people at risk for developing diabetes. Individuals with a DRT score of 5 or higher may have prediabetes or diabetes and should see a healthcare provider. Objective: To determine how many additional employees are identified as being at risk for developing diabetes during an employee wellness screening by using a more stringent DRT cutoff score of 4 instead of 5. Methods: During an annual employee wellness screening event, a hemoglobin A1C (A1c) was drawn for participants with a DRT score of > 4 or by request regardless of risk score. A1C values were classified as normal (<5.7%), prediabetes (>5.7 and <6.5%) or diabetes (>6.5%). Risk scores and A1C values were analyzed using descriptive statistics. Cost of additional laboratory testing was also reviewed. Results: An A1C was collected for 158 participants. Fourteen of 50 (28%) participants with a DRT of 4 had A1c values in the prediabetes range and no history of diabetes or prediabetes. Using the lower DRT score of 4 resulted in an additional expenditure of $305 with $85.40 resulting in the identification of an otherwise unaware person at risk for developing diabetes. Conclusion: Using a DRT cutoff score of 4 as part of an employee wellness screening program resulted in additional laboratory costs to identify persons at risk for developing diabetes but also allowed for earlier education to slow or stop the progression to diabetes which may reduce healthcare costs over time.

Impact and Sustainability of a 10-year Community Pharmacy Disease Management Service.

Community pharmacy practice needs to demonstrate services beyond traditional dispensing roles to continue to function in a changing marketplace. Pharmacists have established themselves as being capable of improving patient outcomes and saving healthcare dollars by providing disease management services to patients. This paper describes a sustained community pharmacy-run disease management program that continued after a grassroots grant-funding effort in 2007. The city of Colorado Springs recognized the successes shown by the pharmacy during the Ten City Challenge funded project, and decided to financially support pharmacy diabetes care services. Partnering with the local School of Pharmacy, the pharmacist obtained advanced training and continued to deliver individualized counseling and management to approximately 100 patients per year for the past 14 years. Objective lab measurements (systolic and diastolic blood pressures, A1C values, total lipid profiles) were obtained or performed, and clinical goals were set based on national guidelines. Patients received a series of appointments to learn how to control their diabetes, and later their cardiovascular disease. Financial estimates were calculated using 2008 baseline numbers and adding estimated inflation based on published Segal rates. The pharmacy services successfully maintained participation of approximately 100 patients annually each year since its inception. Average lab value markers for disease control were at or close to clinical guideline recommendations for the population. Services were associated with estimated cost savings for the health system. Positive results led to expansion in services to include cardiovascular disease in 2017. A community pharmacy has successfully sustained a disease management program for patients for over 14 years, demonstrating high patient enrollment, health outcomes at or near clinical guidelines for control, and positive financial outcomes associated with the program.

Visceral fat accumulation is associated with risk of diabetes in community‐dwelling Japanese older adults

The prevalence of diabetes generally increases with age, and older adults with diabetes are at a higher risk of adverse outcomes. Visceral fat accumulation is a well-known risk factor for diabetes in middle-aged adults, and its association with diabetes increases with age. The present study investigated the association between visceral fat and risk of diabetes in older adults that is yet to be completely elucidated. This cross-sectional study enrolled 2850 community-dwelling older adults. Participants underwent abdominal bioelectrical impedance analysis to estimate the visceral fat area (VFA). The risk of diabetes was assessed using the value of hemoglobin A1c according to the diagnostic criteria of diabetes. We examined the relationship of VFA and risk of diabetes, and explored the optimal cut-off value stratified by sex. In total, 47 of 1640 (2.9%) women and 41 of 1210 (3.4%) men had a high risk of diabetes. Higher values of VFA in units of 10 cm2 were significantly associated with a higher risk of diabetes for both women (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [95% CI]: 1.02-1.34) and men (aOR: 1.18; 95% CI: 1.06-1.31) in multivariate logistic regression analysis. The cut-off value to classify 30% of subjects into high VFA (72 cm2 ) had a relatively higher sensitivity of 0.660 and was significantly associated with a higher risk of diabetes for women (aOR: 3.49; 95% CI: 1.54-8.12), whereas all cut-off values we examined had no relation in men. Increases in VFA is associated with a high risk of diabetes in older adults but the optimal cut-off value is inconclusive in men. Geriatr Gerontol Int 2021; ••: ••-••.

Efficacy of Hyperbaric Oxygen Therapy on Central Corneal Thickness, Intraocular Pressure, and Nerve Fiber Layer in Patients with Type 2 Diabetes: A Prospective Cohort Study.

PurposeTo evaluate the effect of hyperbaric oxygen therapy (HBOT) on central corneal thickness (CCT), intraocular pressure (IOP), and the retinal nerve fiber layer (RNFL) thickness in patients with type 2 diabetes mellitus.MethodsThis prospective non-randomized cohort study consisted of type 2 diabetes mellitus patients who received 30 sessions of HBOT for diabetic foot ulcer. The CCT, IOP, and RNFL measured at baseline, after the 10th session of HBOT, after the 20th session of HBOT, after the 30th session of HBOT, and after the 3 months of the last session of HBOT. We gained the superior-nasal, superior-temporal, inferior-nasal, inferior-temporal, nasal and temporal quadrant RNFL values with a spectral-domain optical coharence tomography.ResultsForty-six eyes of 46 patients included in the study. During the study period, a statistically significant increase in mean IOP values compared to baseline was observed (p < 0.001). We found no significant changes at CCT and all quadrants of RNFL values during HBOT and after 3 months of the treatment (p > 0.05). During the study period, the IOP levels increased over 21 mmHg (between 22 and 28 mmHg) in seven eyes (15.2%). The mean hemoglobin A1c values of these patients with IOP >21 mmHg were 8.2 ± 0.9 mg/dL, and there was significant differences compared with those of patients with IOP values ≤21 mmHg (7.4 ± 2.8 mg/dL) (p = 0.001).ConclusionsHBOT increase IOP in type 2 diabetic patients especially in ones with impaired blood glucose regulation. However, it does not cause any changes in CCT and RNFL. As diabetic retinopathy and diabetic foot ulcer are in common pathologies, thus this brief report concludes a need for further studies with longer follow-up periods to explore the potential interaction of HBOT on CCT, IOP, and RNFL.

Profiles of Depressive Symptoms and Diabetes Distress in Preadolescents With Type 1 Diabetes

ObjectivesDiabetes distress and depressive symptoms are common psychosocial concerns for people with diabetes. These are related, yet distinct, mood states, which have each been related to diabetes management and glycated hemoglobin (A1C) among adolescents and adults with diabetes. However, they have not been examined concurrently in preadolescents with type 1 diabetes. Understanding the overlaps and distinctions between diabetes distress and depressive symptoms in youth would help guide decisions about psychosocial screening in diabetes clinical practice. In this study, we aimed to categorize preadolescents based on clinical cutoffs of concurrently administered measures of depressive symptoms and diabetes distress, and identify clinical and demographic characteristics of each group. MethodsOne hundred eighty youth (age range, 9 to 13 years; age [mean ± standard deviation], 11.3±1.3 years; 55% female; 56% Caucasian; mean A1C, 8.4±1.6% [68 mmol/mol]) completed measures of diabetes distress, depressive symptoms and quality of life. Daily blood glucose monitoring frequency was calculated from meter download. A1C values were obtained from electronic medical records. ResultsDepressive symptoms and diabetes distress each significantly correlated with A1C and quality of life. Although most (69%) participants had no clinically significant elevations in either diabetes distress or depressive symptoms, 14% had elevated depressive symptoms only and 17% had elevated distress without concurrent elevated depressive symptoms. Groups differed based on A1C, quality of life and insurance status. ConclusionsRoutine assessment of both depressive symptoms and diabetes distress may help to identify preadolescents with type 1 diabetes who require psychosocial support.

The Relationship Between Glucose Control and Cognitive Function in People With Diabetes After a Lacunar Stroke.

Lacunar strokes and diabetes are risk factors for cognitive dysfunction. Elucidating modifiable risk factors for cognitive dysfunction has great public health implications. One factor may be glycemic status, as measured by glycated hemoglobin (A1c). The aim of this study was to assess the relationship between A1c and cognitive function in lacunar stroke patients with diabetes. The effect of baseline and follow-up A1c on the baseline and the change in Cognitive Assessment Screening Instrument (CASI) score over time among participants with a median of 2 cognitive assessments (range, 1-5) was examined in 942 individuals with diabetes and a lacunar stroke who participated in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (ClinicalTrials.gov No. NCT00059306). Every 1% higher baseline A1c was associated with a 0.06 lower standardized CASI z score (95% CI, -0.101 to -0.018). Higher baseline A1c values were associated with lower CASI z scores over time (P for interaction = .037). A 1% increase in A1c over time corresponded with a CASI score decrease of 0.021 (95% CI, -0.0043 to -0.038) during follow-up. All these remained statistically significant after adjustment for age, sex, education, race, depression, hypertension, hyperlipidemia, body mass index, cardiovascular disease, obstructive sleep apnea, diabetic retinopathy, nephropathy insulin use, and white-matter abnormalities. This analysis of lacunar stroke patients with diabetes demonstrates a relationship between A1c and change in cognitive scores over time. Intervention studies are needed to delineate whether better glucose control could slow the rate of cognitive decline in this high-risk population.

Effect of CFTR modulator therapy on cystic fibrosis-related diabetes

Half of adults with cystic fibrosis (CF) develop CF-related diabetes (CFRD). CFRD contributes to worsened pulmonary function and malnutrition. We undertook this study to determine the effect of cystic fibrosis transmembrane regulator (CFTR) modulators on CRFD. We reviewed the medical records of adults with CF who followed in the CF clinic at Oklahoma University Medical Center. We collected data for age at diagnosis of CF and CFRD, CF mutations present, first date of ivacaftor therapy either alone or in combination, insulin use, pulmonary function, body mass index data, and home glucose monitoring results. Clinical resolution of CFRD was taken as discontinuation of routine insulin and resolution of high interstitial home glucose values. We identified 69 adult CF patients, of whom 31 had CFRD. Among these 14 CFRD patients taking ivacaftor alone or in combination, four patients completely stopped using insulin. Another patient went from three times a day pre-prandial insulin to using insulin once a week. Home blood glucose and hemoglobin A1c values supported resolution of CFRD. Three patients continued to have hypoglycemia despite stopping insulin. No CFRD patient not taking CFTR modulators markedly changed the insulin regimen. Pulmonary function was preserved in those patients with resolved CFRD (FEV1 +6.75% ±7.6), whereas it worsened in CFRD patients who either were not taking CFTR modulators (FEV1 -2.09% ±3.9) or who had no response of CFRD status (FEV1 -4.9% ±7.6). About one-third of patients on CFTR modulator therapy had resolution or near resolution of CFRD.

Little Earth Strong: A Community-Level, Culturally Appropriate Diabetes Prevention Pilot Targeting Urban American Indians

The purpose of this study was to develop a culturally appropriate, community-based diabetes prevention program, named Little Earth Strong, through partnership with an urban, Indigenous, American Indian community and determine its feasibility in lowering diabetes risks. Using a community-based participatory research, community-level intervention approach, and after conducting a focus groups with key stakeholders (n = 20), a culturally appropriate health intervention was designed across six stages. This included providing nutrition and physical activity individual, family, and group counseling and conducting individual level biometric tests at a monthly Progress Powwow. Community participants (n = 69) included Indigenous individuals ages 18 to 64 years and their families residing in an urban American Indian housing organization. Findings included the project's feasibility, sustainability, and future needs. Lessons learned included the need the need to situate health interventions within Indigenous culture, engage multiple stakeholders, remain flexible and inclusive of all community members, address cultural concerns regarding biometric testing, and focus on specific ages and groups. The outcome variables included qualitative focus group data regarding feasibility and design and quantitative biometric data including hemoglobin A1C levels and weight in which a significant decrease in A1C values were found among womenConclusions: Little Earth Strong was both feasible and successful in decreasing A1C levels using a community-level approach, especially in high participators who attended most events. These results demonstrate the promise of diabetes prevention fitness and nutrition interventions that are collaboratively designed with the community.

Effect of Pharmacist-Led Intervention on Progression of Diabetic Complications at Two Tertiary Care Hospitals of Malaysia.

Background and Objective:Diabetes mellitus is a chronic disease which can lead to different complications in patients if not treated properly. An appropriate intervention from health care providers is needed to stop and decrease the progression of diabetic complication in diabetic patients. This study aimed to measure the effect of pharmacist intervention on improvement in sign and symptoms and progression of diabetic complications in diabetic patients.Methodology:Diabetic patients were randomly selected and divided into two groups from two tertiary care hospitals. Control group contained those 200 patients who were receiving usual treatment from hospitals. In contrast, the intervention group included those 200 patients who were receiving conventional treatment from hospitals together with separate counselling sessions with pharmacists from Diabetes Medication Therapy Adherence Clinic departments. The study continued for 1 year and two follow-up visits for both groups. A prevalidated data collection form was used to measure the improvement in sign and symptoms and progression of diabetic complication in diabetic patients. Statistical Package for the Social Sciences (SPSS) version 24 was used to analyze the data.Results:The average hemoglobin A1c (HbA1c) values decreased up to 1.43% in the control group and 2.82% in the intervention group. The intervention group showed significant improvement in HbA1c between groups (P < 0.05). The results of univariate and multivariate regression analysis showed that a statistically significant (P < 0.001) improvement was observed in all the predictors of diabetic complications among in the intervention group when compared with the control group.Conclusion:Statistically significant reduction in the sign and symptoms of diabetic complications was observed in the intervention group at the end of 1 year. The progression of diabetic neuropathy was significantly reduced in the pharmacist intervention group.

Outcome of Patients with ST-T Changes in Non STSegment Elevation Myocardial Infarction

This article discusses the fundamental characteristics of measured glucose levels and predicted glycated hemoglobin A1c (HbA1c) values among three sets of collected data, measured finger-piercing and continuous glucose monitoring (CGM) sensor device collected glucose levels at 15-minute (15-min) and 5-minute (5-min) intervals. The average glucose (in milligram per deciliter-mg/dL) is listed below: Finger glucose: 109 mg/dL (100%) Sensor at 15-min: 120 mg/dL (109%) Sensor at 5-min: 117 mg/dL (107%) Using candlestick chart, the comparison of average glucoses during this period between two sensor glucose (mg/dL) data (15-min/5-min) are as follows: Open glucose: 108/111 Close glucose: 115/115 Maximum (max) glucose: 170 /175 Minimum (min) glucose: 85/83 Average glucose: 120/117 Additional analysis of time above range (TAR)≥140 mg/dL for hyperglycemia, time within the range (TIR) from 70-140 mg/dL for normal, time below range (TBR)≤70 mg/dL for hypoglycemia based on two sensor candlesticks revealing the following information in a specific format of TAR%/ TIR%/TBR%. 15-min:18.3%, 80.5%, 1.2% 5-min: 17.0%, 81.9%, 1.1% By evaluating the results of the TIR analysis, the 5-min glucose levels appear to be marginally healthier (1.4%) than the 15-min ones. During the coronavirus pandemic (COVID 19) quarantine period, the author lived a rather unique lifestyle which is extremely calm with regular routines, such as eating home-cooked meals and exercising on a regular basis. As a result, his HbA1c has decreased from 6.6% to 6.3% with an average A1c of 6.4% without taking any diabetes medications. However, these three different measurement methods still provide three different sets of glucoses levels which are within a 10% margin of differences, while the HbA1c values are particularly close to each other between the finger-piercing and CGM 15-min.

ESC 2019 guidelines for the management of type 2 diabetes mellitus: Evaluation of the application for patients admitted in a cardiology unit

Cardiovascular (CV) diseases remain a leading cause of morbidity and mortality in people with Type 2 Diabetes Melitus (T2DM). Good glycemic management is not sufficient to decrease markedly CV risk and new evidences show that the choice of the glucose-lowering medications (GLM) is a key component to decrease this risk. New ESC guidelines recommend the use of GLM with proven CV benefits for patients at high or very high CV risk. To evaluate the compliance of T2DM treatment at patient admission with the ESC Guidelines for patients hospitalized in cardiology units. We retrospectively reviewed the usual treatments of patients with T2DM hospitalized in cardiology units between January and March 2020. Usual GLM were extracted from medication reconciliations which are carried out routinely by the pharmaceutical team present in the 3 cardiology units. CV history and haemoglobin A1c (HbA1c) value were collected from medical records. Data from 179 patients were collected. The mean age was 72 years and the sex ratio was 3.5. 88% of the patients had a very high CV risk and 12% a high risk. The most prescribed drugs were metformin (115), long-acting insulins (65), rapid-acting insulins (65), DPP-4i (48), sulfonylureas (41) and GLP1-RA (21). 35% of patients had a recommended treatment. The 3 most frequently non-recommended combination therapies are insulin dual therapy (12%), sulfonylureas monotherapy (9%), and metformin with insulin dual therapy (8%). Among patients with recommended treatment, 95% had a controlled HbA1c (< 8%), compared with only 58% for patients with unrecommended treatment. Most of patients were at very high risk of CV complications. Moreover, only 12% of patients had one of the first-line treatment for this category of patients (GLP1-RA). The recommended combinations of treatment were prescribed only in approximatively one third of patients. This work demonstrates that improvements are necessary in the management of patients with D2TM at high CV risk.

Comparison of Glucose and HBA1C Values Between Finger-Piercing and Continuous Glucose Monitoring Sensor Using Gh-Method: Math-Physical Medicine (no. 293)

This article discusses the fundamental characteristics of measured glucose levels and predicted glycated hemoglobin A1c (HbA1c) values among three sets of collected data, measured finger-piercing and continuous glucose monitoring (CGM) sensor device collected glucose levels at 15-minute (15-min) and 5-minute (5-min) intervals. The average glucose (in milligram per deciliter-mg/dL) is listed below: Finger glucose: 109 mg/dL (100%) Sensor at 15-min: 120 mg/dL (109%) Sensor at 5-min: 117 mg/dL (107%) Using candlestick chart, the comparison of average glucoses during this period between two sensor glucose (mg/dL) data (15-min/5-min) are as follows: Open glucose: 108/111 Close glucose: 115/115 Maximum (max) glucose: 170 /175 Minimum (min) glucose: 85/83 Average glucose: 120/117 Additional analysis of time above range (TAR)≥140 mg/dL for hyperglycemia, time within the range (TIR) from 70-140 mg/dL for normal, time below range (TBR)≤70 mg/dL for hypoglycemia based on two sensor candlesticks revealing the following information in a specific format of TAR%/ TIR%/TBR%. 15-min:18.3%, 80.5%, 1.2% 5-min: 17.0%, 81.9%, 1.1% By evaluating the results of the TIR analysis, the 5-min glucose levels appear to be marginally healthier (1.4%) than the 15-min ones. During the coronavirus pandemic (COVID 19) quarantine period, the author lived a rather unique lifestyle which is extremely calm with regular routines, such as eating home-cooked meals and exercising on a regular basis. As a result, his HbA1c has decreased from 6.6% to 6.3% with an average A1c of 6.4% without taking any diabetes medications. However, these three different measurement methods still provide three different sets of glucoses levels which are within a 10% margin of differences, while the HbA1c values are particularly close to each other between the finger-piercing and CGM 15-min.

Isolated abducens nerve palsy: Comparison of microvascular and other causes.

OBJECTIVEAbducens nerve paralysis is the most common ocular motor neuropathy. In this article, we aimed to compare the causes of isolated abducens nerve palsy in terms of demographic, clinical features, and prognosis.METHODSThirty-six isolated abducens nerve palsy patients were prospectively enrolled in the study. The demographic, clinical features, and prognosis compared in two etiological groups as microvascular and other causes.RESULTSThe most common etiology was microvascular, which was seen in 16/36 (44.4%) patients. Mean clinical recovery time was 2.5±1.3 months (range, 10 days–6 months). When etiological groups were compared as microvascular and other causes, the mean age of the microvascular group was significantly higher (62.8±13.3 vs. 44.5±16.4, p=0.001). Diabetes mellitus was seen significantly higher in the microvascular group than other causes group (p=0.001), but no significant difference was observed in terms of other atherosclerotic risk factors (p>0.05). The fasting blood glucose and hemoglobin A1c value were significantly higher in the microvascular group (p=0.02 and p=0.02, respectively). There was no significant difference in terms of clinical improvement and clinical recovery times between groups (p>0.05).CONCLUSIONThere is no difference between microvascular group and other causes in terms of clinical outcome, while the mean age and presence of diabetes were higher in the microvascular group. The presence of diabetes should be questioned in cases with isolated abducens nerve palsy.

Extended Comparison Study a mong lab-Tested HbA1C, ADA’s eGA HbA1C Conversion Model, and eclaireMD HbA1C Prediction Model based on lower Bound and Higher Bound of Measured Glucoses Using GH-Method: Math-Physical Medicine (No. 341)

This paper describes the author’s extended study regarding American Diabetes Association (ADA) recently recommended estimated average glucose (eAG) equation. He conducts a rational range analysis with lower bound and higher bound of different HbA1C values for type 2 diabetes (T2D) conditions by using glucoses collected via finger-piercing test strip method (Finger) and continuous glucose monitoring sensor (CGM Sensor). This study also includes his developed eclaireMD mathematical model of predicted HbA1C and A1C value calculated using the ADA’s eAG A1C conversion equation

1168. Higher Glycosylated Hemoglobin (A1c) Levels are Associated with Increased Mortality from Cryptococcus Infection

BackgroundDiabetes mellitus is a well-established risk factor for the development of bacterial infections. However, the role of diabetes mellitus as a risk factor in the occurrence of Cryptococcosis is unknown. The aim of the study was to determine whether diabetes and A1c levels were independent risk factors for infection and mortality in Cryptococcus infection.MethodsA retrospective hospital-based case-control study matched by age and gender (96 cases and 125 controls) was performed in patients tested for Cryptococcus infection at University of Colorado Hospital from 2001-2019 (n=221). Data was extracted through RedCap. A multivariable logistic regression model was used to identify predictors of infection and mortality.ResultsDiabetes mellitus was present in 24 cases (25.0%) and 24 controls (19.2%). In cases, the mean age was 54 years, 79% were men, and diabetes was the only known risk factor in 6 cases (6.3%) and accompanied additional risk factor in 18 cases (18.8%). Other common risk factors included: HIV (39.9%), steroid use (24.7%), malignancy (23.2%), solid organ transplant recipients (18.1%), and cirrhosis (5.2%). Cryptococcal meningitis (49.0%) followed by pulmonary infection (36.5%) were the most common sites of infection. The mean A1c value for cases vs. controls was 6.5 ± 1.5 vs. 6.2 ± 1.8 mmol/L, p=0.43. Overall mortality was 27.3% vs. 26.9% among cases and controls, respectively. Among cases, the risk of death was higher for patients with diabetes, although not significantly (39.1% vs 23.1%, p= 0.137). Adjusted for gender, age and case/control; for every 1-point increase in A1c levels, the odds of mortality increased by 40% (OR = 1.4, CI: 1.0-1.9, p= 0.045).ConclusionDiabetes mellitus alone is an uncommon risk factor for acquiring Cryptococcus infection. However, uncontrolled diabetes in Cryptococcosis may worsen outcomes from infection, including increased mortality. Glucose control interventions may improve clinical outcomes in patients with cryptococcal infection.Disclosures All Authors: No reported disclosures

Effect of alpha-lipoic acid supplementation on the lipid profile and lipid ratios in women with gestational diabetes mellitus: A clinical trial study.

Background Evidence suggests that Oxidative stress has been shown to plays an important role in gestational diabetes mellitus (GDM) etiology. On the other hand, women with GDM are at an increased risk for complications such as endothelial dysfunction and cardiovascular diseases.ObjectiveTo investigate the effects of alpha-lipoic acid (ALA) on the maternal circulating values of lipid profile and lipid ratios in women with GDM.Materials and MethodsSixty women with GDM were participated in the present study. The ALA group (n = 30) received ALA (100 mg/day) and the placebo group (n = 30) received cellulose acetate (100 mg/day) for eight wk. The maternal circulating values of hemoglobin A1C, triglyceride (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, triglyceride-glucose (TyG) index, atherogenic index of plasma (AIP), non-HDL-C, and lipid ratios were assessed before and after the intervention. P-value 0.05 was considered as statistically significant.ResultsThe values of TyG index (p 0.001), TG (p = 0.006), TG/HDL-C (p = 0.003), and AIP (p = 0.005) decreased significantly in the ALA group after the intervention.Conclusion Maternal circulating values of TyG index, TG, TG/HDL, AIP decreased after eight wk of ALA supplementation in women with GDM.

Do Youth Want Psychosocial Screenings in Diabetes Clinic? Profiles of Acceptability.

Psychosocial screenings are recommended and increasingly common in pediatric subspecialty clinics, though little is known about their acceptability. This study seeks to uncover profiles of acceptability and assess demographic and clinical correlates among adolescents with diabetes. A sample of 124 adolescents (57.7% female) ages 12-21 years (M = 16.2 ± 2.3) completed screenings during routine diabetes appointments. K-means clustering of responses to acceptability items derived profiles; Analysis of Variance (ANOVA) and Chi-square tests assessed correlates. Adolescents with the most common profile (72.6%) placed high importance on medical providers' awareness of their emotions and reported no difficulties/discomfort with the screener. These youth had moderate depressive symptoms, low diabetes distress, and low A1c. Those who fit a less common profile (18.5%) were uncomfortable with the screener and had the highest depressive symptoms and lowest A1c. Youth who fit a smaller profile (6.5%) endorsed technical difficulties and had high depressive symptoms and lowest diabetes distress. The smallest profile (2.4%, N = 3) had difficulty understanding and experienced discomfort with the screening and had the lowest depressive symptoms and the highest diabetes distress and A1c. These differences in depressive symptoms (F = 3.54, p = .017), A1c values (F = 4.03, p = .009), and diabetes distress (F = 3.27, p = .036) were significant though differences in age, gender, and diabetes duration were not. Most youth responded favorably to in-clinic psychosocial screenings. Youth who were less satisfied were at increased risk for psychosocial and medical complications. Findings highlight areas of need, such as enhanced support with and an emphasized rationale for screenings, which may improve patient experience in subspecialty care.

Reduced erythrocyte lifespan measured by chromium-51 in patients with type 2 diabetes undergoing long-term hemodialysis.

A reduced erythrocyte lifespan potentially explains the low hemoglobin A1c values found in hemodialysis patients. However, data supporting this notion in patients with type 2 diabetes is unclear. We evaluated the erythrocyte lifespan in patients with type 2 diabetes undergoing long-term hemodialysis and investigated potential predictors of erythrocyte lifespan. Long-term hemodialysis patients with type 2 diabetes and type 2 diabetes patients without nephropathy (estimated glomerular filtration rate > 60 mL/min/1.73 m2 ) were included. The erythrocyte lifespan was measured using chromium-51 (51 Cr)-labeled erythrocytes. Blood radiotracer activity was measured six to nine times over a period of 3-5 weeks to determine the erythrocyte lifespan of each patient. Biochemical markers were obtained five times over 16 weeks and associated with the erythrocyte lifespan. Type 2 diabetes patients undergoing hemodialysis (N = 13) had a significantly shorter median erythrocyte lifespan of 49.7 (interquartile range [IQR] = 44.1-58.6) days compared with 64.2 (IQR = 62.6-83.5) days in the control group (N = 10) (P ˂ 0.001) with a difference between medians of 14.5 (95% confidence interval = 8.1-38.8) days. In the hemodialysis group, no association could be detected between the erythrocyte lifespan and markers of hemolysis, level of inflammation, or urea. A reduced erythrocyte lifespan was detected in type 2 diabetes patients undergoing long-term hemodialysis. This may contribute to the reduced hemoglobin A1c values observed in the type 2 diabetic hemodialysis population. An association could not be detected between the erythrocyte lifespan and biochemical markers of hemolysis or inflammation.

Bone Fractures in Children and Young Adults With Type 1 Diabetes: Age Distribution, Fracture Location, and the Role of Glycemic Control.

Type 1 diabetes (T1D) is a known risk factor for fractures, but the underlying pathophysiology is still not fully understood. This study aims to define age peaks and frequent fracture sites of children and young adults with T1D. Additionally, associations of fractures with metabolic and lifestyle factors as well as with additional complications in individuals with T1D were analyzed. A total of 750 individuals with T1D aged ≤25 years with fractures were matched to 3750 patients with T1D without fractures by demographics and insulin regimen. Hemoglobin A1c (HbA1c) values were compared using linear regression, and logistic regression was used to calculate odds ratios (OR) for fractures in individuals with acute complications and diseases. Median (Q1-Q3) age was 12.7 (9.9 to 14.9) years in individuals with fractures and 16.3 (12.6 to 17.8) years in the entire control group with 65% versus 53% males. Peak age for fractures was 7 to <15 years in males and 9 to <11 years in females, which is earlier than reported for the general population. HbA1c (%) was significantly higher in individuals with fractures than in controls (difference of estimated means: 0.26%; 95% confidence interval [CI] 0.07-0.46), especially in postpubertal females (0.68; 0.10-1.26). Significantly higher odds for fractures were observed in individuals with severe hypoglycemia (OR=1.90; 95% CI 1.47-2.47), especially in prepubertal females (OR=2.81; 1.21-6.52]) and postpubertal males (2.44; 1.11-5.38), celiac disease (2.02; 1.67-2.45), and with a history of smoking (1.38; 1.02-1.88). The age peak of fractures seems to be earlier in T1D than in the general population. Poor glycemic control is related to fractures, even before puberty. Associations of HbA1c and severe hypoglycemia with fractures highly depend on age and sex. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).