American Diabetes Association Diagnostic Criteria Research Articles

The evolution and future of diagnostic criteria for diabetes mellitus

Background: The diagnostic criteria for diabetes mellitus have evolved over time, taking into account new evidence. Here, the author would like to review the evolution of diagnostic criteria for diabetes mellitus, the current diagnostic criteria, and future perspectives.Current Concepts: For the first time, in 1965, the World Health Organization (WHO) recommended that a 2-hour plasma glucose concentration of 130 mg/dL or more after taking a 50-g or 100-g oral glucose bolus may be used to make the diagnosis in people younger than 45 years and that other clinical data might be used to make the diagnosis in people older than 45 years. The 2003 American Diabetes Association Diagnostic Criteria set the threshold for normal fasting glucose at 100 mg/dL. The International Expert Committee (IEC) in 2009, the American Diabetes Association in 2010, and the WHO in 2011 proposed new diagnostic criteria for diabetes: glycated hemoglobin (HbA1c) of 6.5% or higher. More recently, diabetes has been diagnosed via a fasting blood glucose of 126 mg/dL or higher after fasting for at least 8 hours, a 2-hour postprandial blood glucose of 200 mg/dL or higher, glycated hemoglobin of 6.5% or higher, or a random blood glucose of 200 mg/dL or higher with symptoms of hyperglycemia.Discussion and Conclusion: Further research is needed on the accuracy of other markers, such as HbA1c, fructosamine, and 1,5-anhydroglusitol, in the diagnosis of diabetes, and sufficient evidence is required to determine whether it is appropriate to use the same diagnostic criteria for diabetes in aged people and different ethnic groups.

Increased intestinal-fatty acid binding protein in obesity-associated type 2 diabetes mellitus.

Obesity is a traditional risk factor for type 2 diabetes mellitus (T2DM). However, recent studies reported that metabolically unhealthy obesity (MUO) exerts a higher risk of developing T2DM than metabolically healthy obesity (MHO) because of its higher state of insulin resistance. This may happen due to metabolic endotoxemia through gut dysbiosis and increased intestinal permeability. Our study aimed to know the association of intestinal permeability using intestinal fatty acid-binding protein (I-FABP) with obesity-related T2DM patients in Indonesia. This was a cross-sectional study that recruited 63 participants with obesity defined using body mass index (BMI) classification for the Asia-Pacific population (BMI ≥25 kg/m2). All participants were then grouped into T2DM and non-T2DM based on American Diabetes Association (ADA) diagnostic criteria. The I-FABP levels were measured using the enzyme-linked immunosorbent assay method. The I-FABP level of T2DM group was higher compared to non-T2DM group, namely 2.82 (1.23) ng/mL vs. 1.78 (0.81) ng/mL (p<0.001; mean difference 1.033 with 95% CI 0.51-1.55). This difference was not attenuated even after adjustment for age. The fitted regression model using linear regression was: i-FABP = 1.787+1.034*(DM) (R2 = 18.20%, standardized ß = 0.442, p<0.001). This study underscores the association of intestinal permeability with T2DM in people with obesity and supports the evidence of the potential role of intestinal permeability in the pathogenesis of obesity-related T2DM.

A Statistical Simulation to Evaluate the Robustness of Hb A1c Measurement in the Presence of Quantitative Error.

The performance requirements for hemoglobin (Hb) A1c analysis have been questioned as analytic methods have improved. We developed a statistical simulation that relates error to the clinical utility of an oft-used laboratory test, as a means of assessing test performance expectations. Finite mixture modeling of the Centers for Disease Control and Prevention-National Health and Nutrition Examination Survey (NHANES) 2017-2020 Hb A1c data in conjunction with Monte Carlo sampling were used to model and simulate a population prior to the introduction of error into the results. The impact of error on clinical utility was assessed by categorizing the results using the American Diabetes Association (ADA) diagnostic criteria and assessing the sensitivity and specificity of Hb A1c under various degrees of error (bias and imprecision). With the current allowable total error threshold of 6% for Hb A1c measurement, the simulation estimated a worst case between 50% and 60% for both test sensitivity and specificity for the non-diabetic category. Similarly, sensitivity and specificity estimates for the pre-diabetic category were 30% to 40% and 60% to 70%, respectively. Finally, estimates for the diabetic category yielded values of 80% to 90% for sensitivity and >90% for specificity. Bias and imprecision greatly affect the clinical utility of Hb A1c for all patient groups. The simulated error demonstrated in this modeling impacts 3 critical applications of the Hb A1c in diabetes management: the capacity to reliably screen, diagnostic accuracy, and utility in diabetes monitoring.

Diabetic Ketoacidosis and COVID-19: A Case Series From an Inner-City Community Teaching Hospital in New York.

Introduction: Throughout the coronavirus disease 2019 (COVID-19) pandemic, studies have repeatedly shown that COVID-19 outcomes are more severe in the elderly and those with comorbidities, with diabetes being a significant risk factor associated with more severe infection. Here, we present the clinical characteristics of 25 patients with pre-existing type 2 diabetes mellitus who presented with diabetic ketoacidosis (DKA) and COVID-19 in a community hospital in Brooklyn, New York, and identify possible predictors of mortality.Methods: This retrospective case series recruited patients from March 1st to April 9th, 2020, with lab-confirmed COVID-19 and met DKA criteria on admission (based on American Diabetes Association diagnostic criteria for DKA).Results: Of the 25 patients who met the inclusion criteria, 22 were African American and three were Hispanic. Common comorbidities in addition to diabetes were hypertension, obesity, coronary artery disease, and dyslipidemia. Fever, cough, myalgias, and shortness of breath were common presenting symptoms. Most patients had elevated inflammatory markers erythrocyte sedimentation rate, C-reactive protein, D-dimer, and ferritin, but higher values increased the odds of mortality. The overall survival was 64%, with those recovering having more extended hospital stays but requiring less time in the intensive care unit. At the same time, those who died were more likely to require mechanical ventilation, have an acute cardiac injury, and/or be obese. Despite numerous studies on COVID and diabetes, only a few studies described DKA.Conclusion: This observational retrospective study illustrated that patients with diabetes are at risk of developing DKA with COVID-19 and identified some predictors of mortality. However, further studies with larger sample sizes and a control group are necessary to understand better the effects of COVID-19 on DKA and their clinical outcomes.

Study of the Relationship between Serum Asprosin, Endothelial Dysfunction and Insulin Resistance

Background: Until now, the relationship between asprosin and soluble E-selectin (sE-selectin) as well as the role of asprosin in diabetes are still unclear. This work aimed to assess the relationship between fasting serum asprosin and markers of endothelial dysfunction and metabolic parameters, namely, sE-selectin, fasting insulin, fasting plasma glucose (FPG), HOmeostatic Model Assesment – Insulin Resistance (HOMA-IR), fasting lipid profile, and glycated hemoglobin (HbA1c) among people with different spectra of glycemia including normal subjects, impaired glucose tolerance (IGR), and subjects with type 2 diabetes mellitus (T2DM). Methods: Ninety subjects were recruited and divided according to the American Diabetes Association (ADA) diagnostic criteria into three groups; subjects with type 2 diabetes mellitus (n = 30), subjects with impaired glucose resistance (n = 30), and control subjects (n = 30). All groups were subjected to thorough history taking, physical examination, and laboratory investigation, involving fasting asprosin, sE-selectin, and HOMA-IR. Results: The univariate analysis showed a significant positive correlation between asprosin and glycemic parameters, insulin resistance, obesity parameters, and endothelial dysfunction in the three groups. However, multivariate analysis showed that triglycerides and sE-selectin are the most independent factors affecting asprosin. Univariate analysis for parameters affecting sE-selectin showed that asprosin is significantly correlated with sE-selectin, and multivariate analysis revealed that asprosin was the most independent factor affecting sE-selectin. Conclusions: Our study showed a significant positive correlation between asprosin, glucose dysregulation, insulin resistance, and endothelial dysfunction.

The correlation between blood glucose level and muscle mass, strength and function in an elderly population

Objective: To explore the correlation between blood glucose levels and the three factors of sarcopenia (muscle mass, strength and function) in older Chinese community dwellers. Methods: This is a retrospective study conducted by collecting the data of patients in Jiangsu Huaqiao Road Community Health Service Center from 2018 to 2019. Two hundred and fifty people aged 60 years or elder were selected. Among them, 101 were men and 149 were women. According to the American Diabetes Association diagnostic criteria for diabetes mellitus in 2018, they were divided into normal glucose tolerance (NGT) group, pre-diabetes group and diabetes group. The patients were assessed for sarcopenia as well. Results: Compared with those in the NGT group, muscle mass and upper limb muscle strength did not change in the diabetic group, but lower limb muscle strength and body function [walking speed, balance, short physical performance battery (SPPB)] decreased significantly in the diabetic group. Pearson correlation analyses showed that fasting plasma glucose(FPG) was negatively correlated with walking speed (r=-0.248, P=0.001), three-pose balance (r=-0.166, P=0.013) and SSPB (r=-0.213, P=0.001). Glycosylated hemoglobin A1c(HbA1c) was positively correlated with sitting and standing time (r=0.205, P=0.002), and negatively correlated with three-pose balance (r=-0.186, P=0.006) and SSPB (r=-0.154, P=0.024). Multiple regression analyses showed that FPG was negatively associated with walking speed (β=-0.125, P=0.005) and SPPB (β=-0.034, P=0.012), and that HbA1c was positively associated with sitting and standing time (β= 0.218, P =0.006) and negatively associated with three-pose balance (β=-0.143, P=0.012), and SPPB (β=-0.117, P =0.036). Conclusions: There is no significant correlation between blood glucose levels and muscle mass in the elderly; however, FPG is closely correlated with gait speed, and HbA1c is closely correlated with muscle strength of lower limbs and balance ability in the elderly.

Triglyceride glucose-body mass index in identifying high-risk groups of pre-diabetes

BackgroundTriglyceride glucose-body mass index (TyG-BMI) has been recommended as an alternative indicator of insulin resistance. However, the association between TyG-BMI and pre-diabetes remains to be elucidated.MethodsMore than 100,000 subjects with normal glucose at baseline received follow-up. The main outcome event of concern was pre-diabetes defined according to the diagnostic criteria recommended by the American Diabetes Association (ADA) in 2018 and the World Health Organization (WHO) in 1999. A Cox proportional hazard regression model was used to evaluate the role of TyG-BMI in identifying people at high risk of pre-diabetes.ResultsAt a mean observation period of 3.1 years, the incidence of pre-diabetes in the cohort was 3.70 and 12.31% according to the WHO and ADA diagnostic criteria for pre-diabetes, respectively. The multivariate Cox regression analysis demonstrated that TyG-BMI was independently positively correlated with pre-diabetes, and there was a special population dependence phenomenon. Among them, non-obese people, women and people under 50 years old had a significantly higher risk of TyG-BMI-related pre-diabetes (P-interaction< 0.05).ConclusionsThese findings suggest that a higher TyG-BMI significantly increases an individual’s risk of pre-diabetes, and this risk is significantly higher in women, non-obese individuals, and individuals younger than 50 years of age.

Dietary fibre intake and risk of prediabetes in China: results from the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study.

High dietary fibre intake has been associated with a lower risk of diabetes, but the association of dietary fibre with prediabetes is only speculative, especially in China, where the supportive data from prospective studies are lacking. This study aimed to examine the association between dietary fibre intake and risk of incident prediabetes among Chinese adults. We performed a prospective analysis in 18085 participants of the Tianjin Chronic Low-grade Systemic Inflammation and Health cohort study who were free of diabetes, prediabetes, cancer and CVD at baseline. Dietary data were collected using a validated 100-item FFQ. Prediabetes was defined based on the American Diabetes Association diagnostic criteria. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95 % CI. During 63175 person-years of follow-up, 4139 cases of incident prediabetes occurred. The multivariable HR of prediabetes for the highest v. lowest quartiles were 0·85 (95 % CI 0·75, 0·98) (P for trend = 0·02) for total dietary fibre, 0·84 (95 % CI 0·74, 0·95) (P for trend < 0·01) for soluble fibre and 1·05 (95 % CI 0·93, 1·19) (P for trend = 0·38) for insoluble fibre. Fibre from fruits but not from cereals, beans and vegetables was inversely associated with prediabetes. Our results indicate that intakes of total dietary fibre, soluble fibre and fibre derived from fruit sources were associated with a lower risk of prediabetes.

Assessment of TNF Alpha in Type 2 Diabetic Patients with Lactobacillus Acidophilus

Background: Lactobacillus acidophilus is a probiotic strain that is widely used in traditional foods such as dairy products and nutritional supplements. It has been shown that L. acidophilus interacts with immune system cells and increases intestinal integrity with a beneficial effect on glucose balance as it has been found to delay the onset of glucose intolerance, hyperglycemia, dyslipidemia and oxidative stress in diet-induced diabetic rats. Objectives: To assess the level of TNF alpha in type 2 diabetic patients with lactobacillus acidophilus. Patients and methods: This study is a case control study that was conducted on 100 type 2 diabetic patients diagnosed according to the American diabetes association diagnostic criteria. They were recruited from the Outpatient Clinic of Internal Medicine and Endocrinology Department Unit of Ain Shams University Hospitals during the period from February 2019 to November 2019. They were divided into 2 groups, group 1 that included 50 type 2 diabetic patients with atherosclerosis and group 2, which included 50 type 2 diabetic patients without atherosclerosis. Results: There was a statistically significant positive correlation between PCR cut-off threshold and HbA1c (p-value = 0.026), 2hr pp (p-value = 0.013) and intimal media thickness (p-value = 0.031) and there was a statistically significant positive correlation between TNF alpha level and HbA1c (p-value = 0.015), LDL cholesterol (p-value = 0.024) and intimal media thickness (IMT) (p-value = 0.033). In addition, there was highly statistically significant positive relation found between TNF alpha level and PCR cut-off threshold (p-value < 0.001). Conclusions: Lactobacillus acidophilus has been found to delay the onset of glucose intolerance, hyperglycemia, dyslipidemia and oxidative stress in patients with type 2 diabetes mellitus.

Gestational diabetes diagnosed in third trimester of pregnancy: an observation at a Hospital of Women and Children in Vietnam

Background. Gestational diabetes mellitus (GDM) remains a significant concern within the medical community due to its high risk, as well as its serious side effects on both the mothers and the fetuses. This study aims to assess the prevalence and the risk factors of gestational diabetes mellitus in pregnant women at Da Nang Hospital for Women and Children. Methods. A cross-sectional study was conducted on 706 pregnant women at 2428 weeks of gestation at Da Nang hospital to determine the prevalence of gestational diabetes. Multivariate regression analysis was used to clarify the independent risk factors associated with gestational diabetes. All participants were interviewed and tested for the oral glucose tolerance test (OGTT) to identify the number of gestational diabetes, which was diagnosed according to the American Diabetes Association (ADA) diagnostic criteria in 2014. Results. Gestational diabetes prevalence was 10.2%; categorized by the number of matched diagnostic criteria: 1 criterion: 7.1%; 2 criteria: 2.1%; 3 criteria: 1.0%. There are four independent risk factors for gestational diabetes determined through multivariate regression analysis: maternal age > 30 years (OR = 2.376), a history of gestational diabetes (OR = 12.211), pre-pregnancy BMI ≥ 23 kg/m2 (OR = 10.775), a history of fetal macrosomia > 3800 g (OR = 4.655). The risk of gestational diabetes in the group with risk factors was 6.21 times higher than that in the group with no risk factors. Conclusion. More attention should be paid to the risk factors for gestational diabetes, such as maternal age > 30 years, a history of gestational diabetes, pre-pregnancy BMI ≥ 23 kg/m2, a history of fetal macrosomia > 3800 g in all pregnant women.

Lifetime risk to progress from pre-diabetes to type 2 diabetes among women and men: comparison between American Diabetes Association and World Health Organization diagnostic criteria

IntroductionPre-diabetes, a status conferring high risk of overt diabetes, is defined differently by the American Diabetes Association (ADA) and the WHO. We investigated the impact of applying definitions of pre-diabetes...

Regular use of proton pump inhibitors and risk of type 2 diabetes: results from three prospective cohort studies

ObjectiveThe association between the regular use of proton pump inhibitors (PPIs) and the risk of type 2 diabetes remains unclear, although a recent randomised controlled trial showed a trend towards...

Allopurinol use and type 2 diabetes incidence among patients with gout: A VA retrospective cohort study.

To assess the impact of allopurinol on diabetes in a retrospective cohort of Veterans' Affairs patients with gout.The New York Harbor VA computerized patient record system was searched to identify patients with an ICD-9 code for gout meeting at least 4 modified 1977 American Rheumatology Association gout diagnostic criteria. Patients were divided into subgroups based on >30 continuous days of allopurinol, versus no allopurinol. New diagnoses of diabetes, defined according to American Diabetes Association diagnostic criteria or clinical documentation explicitly stating a new diagnosis of diabetes, were identified during an observation period from January 1, 2000 through December 31, 2015.Six hundred six gout patients used allopurinol >30 continuous days, and 478 patients never used allopurinol. Over an average 7.9 ± 4.8 years of follow-up, there was no significant difference in diabetes incidence between the allopurinol and non-allopurinol groups (11.7/1000 person-years vs 10.0/1000 person-years, P = .27). A lower diabetes incidence in the longest versus shortest quartiles of allopurinol use (6.3 per 1000 person-years vs 19.4 per 1000 person-years, P<.0001) was attributable to longer duration of medical follow-up.In this study, allopurinol use was not associated with decreased diabetes incidence. Prospective studies may further elucidate the relationship between hyperuricemia, gout, xanthine oxidase activity, and diabetes, and the potential impact of gout treatments on diabetes incidence.

TRATAMIENTO MÉDICO NUTRICIONAL EN LA MUJER EMBARAZADA CON DIABETES

Introducción: se ha observado un incremento en el diagnóstico de diabetes gestacional (DG) en mujeres embarazadas a nivel mundial durante los últimos años, siendo la prevalencia estimada de 14% a nivel global y de 10,36% en Argentina según el criterio diagnóstico de la Asociación Latinoamericana de Diabetes (ALAD). El plan de alimentación adecuado y el cambio en el estilo de vida asociados al automonitoreo de la glucemia capilar (AMGC) constituyen pilares fundamentales para alcanzar el objetivo glucémico en dos tercios de los casos de DG. A pesar de su importancia y de su recomendación en la práctica clínica, existe información científica limitada respecto de cuál es la prescripción alimentaria óptima para mejorar los resultados tanto en la madre como en el niño.Objetivos: analizar el componente nutricional en el tratamiento de la mujer embarazada con diabetes y conocer cuáles podrían ser las recomendaciones para lograr los objetivos mencionados a través del análisis de la evidencia científica actual. La información proveniente de estudios randomizados y controlados es heterogénea, pero de dichos estudios surge que la intervención temprana con dieta, ejercicio y consejos sobre cambio de estilo de vida durante el primer trimestre o al inicio del segundo puede disminuir el riesgo de DG.El tratamiento médico nutricional en DG se basa en el control de la cantidad y la distribución de los hidratos de carbono para obtener el control glucémico óptimo sin hipoglucemias ni cetosis. El otro componente esencial es la ingesta calórica para la adecuada ganancia de peso.

MiRNAs profile as biomarkers of nutritional therapy for the prevention of type 2 diabetes mellitus: From the CORDIOPREV study

The incidence of type 2 diabetes mellitus (T2DM) has increased worldwide. One of the first actions to reduce the risk of this disease is to implement healthy dietary models; however, no universal dietary strategies have so far been established. In addition, MicroRNAs (miRNAs) are emerging as new biomarkers to predict disease. We aimed to study whether miRNAs could be used to select the nutritional therapy to prevent T2DM development in patients with cardiovascular disease. All patients from the CORDIOPREV study without T2DM at baseline according to the American Diabetes Association (ADA) diagnostic criteria (n=462) were included in the present study. Of them, after a median dietary intervention period of 60 months with two diets (Low fat or Mediterranean diets), 107 developed T2DM and 355 subjects did not develop the disease. The plasma levels of 24 miRNAs were measured at baseline by qRT-PCR. The risk of T2DM was evaluated by Cox regression analysis based on the plasma levels of the miRNAs at baseline and according to the dietary intervention. Finally, pathways analyses were carried out to identify target genes regulated by the miRNAs studied and cellular processes which could be associated with T2DM development. Cox regression analyses showed that patients with low plasma levels of miR-145 at baseline showed a higher risk of developing T2DM after consumption of an LFHCC diet. In addition, patients with low levels of miR-29a, miR-28-3p and miR-126 and high plasma levels of miR-150 at baseline showed a higher risk of developing T2DM after consumption of the Med diet. Finally, pathways analysis showed an interaction of miR-126 and miR-29a in the modulation of FoxO, TNF-α, PI3K-AKT, p53 and mTOR signaling, associated with T2DM development. Our results suggest that circulating miRNAs could be used in clinical practice as a new tool for selecting the most suitable diet to prevent type 2 diabetes mellitus development in patients with cardiovascular disease. NCT00924937.

2267-PUB: 1,5-Anhydroglucitol X Glycated Hemoglobin A1c/100: A Potential Biomarker for Islet ß-Cell Function in Type 2 Diabetes Mellitus

Aims: The goals of the current study were to explore the level of and changes in the AH index (AHI, defined as 1,5-anhydroglucitol × glycated hemoglobin A1c/100) associated with different glucose metabolism statuses, and to evaluate the islet function and insulin sensitivity of type 2 diabetes mellitus (T2DM) patients with different AHI levels. Methods: A total of 3562 individuals were enrolled in the study. According to the 2010 American Diabetes Association (ADA) diagnostic criteria, 1697 subjects were diagnosed as T2DM. The disposition index (DI) was defined as the product of insulin sensitivity-related indexes and islet secretion function. Results: The overall AHI level was 1.0 (0.7-1.3), while the AHI level of the T2DM group was 0.8 (0.5-1.2), which was significantly lower than that of the normal glucose tolerance group and the impaired glucose regulation group [both AHI 1.2 (0.9-1.5), and P &amp;lt; 0.01]. The T2DM group was further divided into four subgroups according to the quartile of AHI level. The results demonstrated that the homeostasis model assessment of insulin resistance (HOMA-IR) decreased with the increase of AHI level (P for trend &amp;lt; 0.01). However, other parameters [i.e., HOMA of β-cell function (HOMA-β), insulin generation index, insulin sensitivity index, and DI] increased while AHI level increased (all P for trend &amp;lt; 0.01). Multivariate logistic regression illustrated that the odds ratios for a low DI for increasing levels of AHI were 1.00, 0.22 (0.16-0.29), 0.16 (0.11-0.22), and 0.09 (0.06-0.13), respectively, showing a decreasing trend (P for trend &amp;lt; 0.01). Conclusion: AHI could reflect the changes in the trend of glucose metabolism disorder and the function of islet β cells to some extent. The lower AHI was associated with worsening of the glucose metabolism disorder in recent years, and the islet β-cell function was correspondingly poor. Disclosure X. Ma: None. H. Su: None. Y. Shen: None. X. He: None. L. Ying: None. W. Zhu: None. Y. Wang: None. Y. Bao: None. J. Zhou: None.

Grip Strength Cut Points for Diabetes Risk Among Apparently Healthy U.S. Adults

Early detection screening tools are needed to aid in preventing vascular complications associated with type 2 diabetes. As low muscular strength is linked to increased diabetes risk, the purpose of this study is to establish muscular strength cut points for determining diabetes risk using a large, nationally representative U.S. Using the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey data, 5,108 participants aged 20-80 years (68.6% aged 20-50 years; young male participants, n=1,813, mean age=33.43 years; young female participants, n=1,692, mean age=33.39 years; older male participants, n=813, mean age=59.92 years; older female participants, n=790, mean age=60.45 years) and free of common diabetes comorbidities were included. Muscular strength was assessed using a handgrip dynamometer and normalized by adjusting for body weight. A logistic regression for survey data controlling for covariates was used to determine normalized grip strength cut points. Diabetes risk was determined using American Diabetes Association diagnostic criteria. Analyses were conducted in the summer of 2019. Normalized grip strength significantly predicted diabetes (p=0.0332), and the cut points for detecting diabetes risk included 0.78 (young male participants), 0.57 (young female participants), 0.68 (older male participants), and 0.49 (older female participants). The risk percentages for diabetes and estimated rates reported for all subgroups were comparable, and the risk percentages included 6.84 (95% CI=5.32, 8.36; younger male participants), 7.49 (95% CI=5.87, 9.10; younger female participants), 5.76 (95% CI=2.34, 9.19, older male participants), and 4.27 (95% CI=2.44, 6.10; older female participants). Normalized grip strength using the cut points proposed in this paper may be a useful screening tool for diabetes risk in apparently healthy, normotensive adults.

Foot practices in patients with type 2 diabetes: Where do we stand?

Background: Diabetic foot ulcer is a major cause of morbidity, mortality, hospitalisation, poor quality of life and socio-economic burden in diabetic patients. Educating patients about foot care and improving foot care practices can help in the prevention of foot ulcer and thus reduce the rate of lower extremity amputations. Objective: The aim of this study is to evaluate the knowledge and practices regarding foot care in diabetic patients presenting with foot ulcers in a tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at a specialised foot clinic of Baqai Institute of Diabetology and Endocrinology, a tertiary care hospital of Karachi, Pakistan. All patients with type 2 diabetes presenting with a history of foot ulcers were included in the study after taking informed consent. Only those patients with either already diagnosed diabetes mellitus or diagnosed in the clinic according to the American Diabetes Association diagnostic criteria were included in the study. Information regarding history, physical examination, Hba1c levels were collected in all patients through hospital HMS software. Ankle-brachial index and vibration perception threshold were done as part of foot examination in every patient. X-ray and tissue culture/sensitivity were done where indicated. The Nottingham assessment of functional foot care revised 2015 questionnaire was used to evaluate patients’ foot care knowledge and practices before presenting to our institute. The interview was conducted by a trained healthcare professional on one-to-one basis. Patients who scored >70% had good knowledge and practices of foot care, those between 50% and 70% had average and those who scored <50% had poor knowledge and practices of foot care. Results: A total of 358 patients were included in the study. Out of which 243 were male and 115 were female. The average age was 54.43 ± 11.4 years, and the mean duration of diabetes was 13.35 ± 8.30 years, and the mean HbA1c was 9.60 ± 2.30. All the patients included were of type 2 diabetes mellitus. Out of the total respondents, 153 (43.2%) respondents had never received any foot care education from any healthcare professional prior to the development of ulcer and presenting to this institute, ten (0.8%) had received some information of foot care from print or electronic media or through family and friends, whereas 191 (54%) received foot care education formally by a health care professional. Only 148 (41.6%) got their feet examined by some healthcare professional before developing foot ulcer, while 196 (55.1%) never got their feet examined before presenting to this institute. Overall, 7% of the study participants had good foot care knowledge and practices, 55.3% had average and 37.7% had poor foot care knowledge and practices. Conclusion: Knowledge and practices of foot care were found to be unsatisfactory in most of the patients. This is of utmost importance to introduce foot care education programs at primary as well as tertiary care level with regular periodic physician reinforcement to reduce the incidence of diabetic foot ulceration and amputations.

Evaluation of Fluid Therapy by Point-of-Care Ultrasound in Hyperglycemic Emergencies

Aim: Diabetic ketoacidosis (DKA) and Hyperosmolar hyperglycemic state (HHS) are among the cases where total body fluid deficit is high. Although it is known that dehydration is one of the main determinants of mortality and morbidity, it is difficult to determine and follow up fluid treatment in patients with multiple comorbidities. Measurement of the respiratory variability of the vena cava inferior diameter and vena cava inferior / aortic diameter measurement can be performed easily and quickly at the bedside and have a high objectivity compared to physical examination. In this study, we evaluated the follow-up of fluid therapy by POCUS with vena cava inferior diameter and vena cava inferior diameter / abdominal aortic diameter ratio in patients presenting with hyperglycemic emergencies (DKA, HHS, severe hyperglycemia).&#x0D; Methodology: 56 patients diagnosed with severe hyperglycemia, DKA and HHS according to the American Diabetes Association (ADA) diagnostic criteria were included in the study. Vital signs, laboratory tests(venous blood gas analysis, complete urinalysis, osmolarity, fingertip blood glucose level), fluid volume and bedside ultrasonographic measurements [vena cava inferior inspiration and expiration (iVCI and eVCI) diameter,vena cava inferior colapsiability index (VCI index), abdominal aorta diameter and ratio of vena cava inferior to abdominal aorta diameter (VCI/Ao)] were recorded.&#x0D; Results: Of the 56 patients, 21.4% were diagnosed with DKA 8.9%, HHS and 69.6% with severe hyperglycemia. There was a significant difference in osmolarity and although pH values ​​were not statistically significant, it tended to improve with the amount of fluid given. There was a significant difference in iVCI, VCI index and VCI/Ao.&#x0D; Conclusion: We believe that planning and monitoring fluid treatment with bedside ultrasonographic VCI diameter and VCI/Ao ratio measurements will reduce the undesirable complications, the intensity of emergency services, long waiting time and follow-up periods and will contribute to patient benefit and emergency departments.

Progression of glucose intolerance and cardiometabolic risk factors over a decade in Chinese women with polycystic ovary syndrome: A case-control study.

BackgroundPolycystic ovary syndrome (PCOS) is associated with increased metabolic risk, though data on long-term follow-up of cardiometabolic traits are limited. We postulated that Chinese women with PCOS would have higher risk of incident diabetes and cardiometabolic abnormalities than those without PCOS during long-term follow-up.Methods and findingsOne hundred ninety-nine Chinese women with PCOS diagnosed by the Rotterdam criteria and with a mean age of 41.2 years (SD = 6.4) completed a follow-up evaluation after an average of 10.6 ± 1.3 years. Two hundred twenty-five women without PCOS (mean age: 54.1 ± 6.7 years) who underwent baseline and follow-up evaluation over the same period were used for comparison. Progression of glycaemic status of women both with and without PCOS was assessed by using 75-g oral glucose tolerance test (OGTT) screening with the adoption of 2009 American Diabetes Association diagnostic criteria. The frequency of impaired glucose regulation, hypertension, and hyperlipidaemia of women with PCOS at follow-up has increased from 31.7% (95% CI 25.2%–38.1%) to 47.2% (95% CI 40.3%–54.2%), 16.1% (95% CI 11.0%–21.2%) to 34.7% (95% CI 28.1%–41.3%), and 52.3% (95% CI 45.3%–59.2%) to 64.3% (95% CI 57.7%–71.0%), respectively. The cumulative incidence of diabetes mellitus (DM) in follow-up women with PCOS is 26.1% (95% CI 20.0%–32.2%), almost double that in the cohort of women without PCOS (p < 0.001). Age-standardised incidence of diabetes among women with PCOS was 22.12 per 1,000 person-years (95% CI 10.86–33.37) compared with the local female population incidence rate of 8.76 per 1,000 person-years (95% CI 8.72–8.80) and 10.09 per 1,000 person-years (95% CI 4.92–15.26, p < 0.001) for women without PCOS in our study. Incidence rate for women with PCOS aged 30–39 years was 20.56 per 1,000 person-years (95% CI 12.57–31.87), which is approximately 10-fold higher than that of the age-matched general female population in Hong Kong (1.88 per 1,000 person-years, [95% CI 1.85–1.92]). The incidence rate of type 2 DM (T2DM) of both normal-weight and overweight women with PCOS was around double that of corresponding control groups (normal weight: 8.96 [95% CI 3.92–17.72] versus 4.86 per 1,000 person-years [95% CI 2.13–9.62], p > 0.05; overweight/obese: 28.64 [95% CI 19.55–40.60] versus 14.1 per 1,000 person-years [95% CI 8.20–22.76], p < 0.05). Logistic regression analysis identified that baseline waist-to-hip ratio (odds ratio [OR] = 1.71 [95% CI 1.08–2.69], p < 0.05) and elevated triglyceride (OR = 6.63 [95% CI 1.23–35.69], p < 0.05) are associated with the progression to T2DM in PCOS. Limitations of this study include moderate sample size with limited number of incident diabetes during follow-up period and potential selection bias.ConclusionsHigh risk of diabetes and increased cardiovascular disease risk factors among Chinese women with PCOS are highlighted in this long-term follow-up study. Diabetes onset was, on average, 10 years earlier among women with PCOS than in women without PCOS.