HbA1c Assessment Research Articles

Does the hospitalization after a cancer diagnosis modify adherence to process indicators of diabetes care quality?

This study was designed to answer the question whether surgery due to newly diagnosed cancer may modify quality of diabetes' management, as suggested by current guidelines. Adherence to guideline composite indicator (GCI), a process indicator including one annual assessment of HbA1c and at least two among eye examination, serum lipids measurement and microalbuminuria, was evaluated between years 2011-2012 and 2014-2015 in 158,069 diabetic patients living in Tuscany, Italy, on 1 January 2011 and surviving on 31 December 2015, of whom 661 were hospitalized in index year 2013 for a surgery procedure due to a newly incident cancer. Difference in GCI modification (DELTA_GCI) of these patients was compared with that of diabetic people without cancer, strictly matched for main confounders by means of a propensity score. In diabetic patients with cancer, GCI adherence increased by about 8% between years 2011-2012 and 2014-2015. When compared with controls, DELTA_GCI increased by 6% in cancer group compared with controls (p<0.05), but any significance was lost after matching the groups by propensity score (3%; p=NS). Our study suggests that a hospitalization for a surgical procedure due to a newly diagnosed cancer does not influence the compliance to a quality process indicator of diabetes care such as GCI.

Potential Effects on Cardiorespiratory and Metabolic Status After a Concurrent Strength and Endurance Training Program in Diabetes Patients - a Randomized Controlled Trial.

BackgroundConcurrent aerobic and resistance training (CART) programs have been widely recommended as an important strategy to improve physiologic and functional performance in patients with chronic diseases. However, the impact of a personalized CART program in patients with type 2 diabetes (T2D) requires investigation. Therefore, the primary aim of the current study is to investigate the impact of CART programs on metabolic profile, glycemic control, and exercise capacity in patients with diabetes.MethodsWe evaluated 41 subjects with T2D (15 females and 19 males, 50.8 ± 7 years); subjects were randomized into two groups; sedentary (SG) and CART (CART-G). CART was performed over 1.10-h sessions (30-min aerobic and 30-min resistance exercises) three times/week for 12 weeks. Body composition, biochemical analyses, peripheral muscular strength, and cardiopulmonary exercise testing were primary measurements.ResultsThe glycated hemoglobin HbA1c (65.4 ± 17.9 to 55.9 ± 12.7 mmol/mol), cholesterol (198.38.1 ± 50.3 to 186.8 ± 35.1 mg/dl), and homeostasis model assessment insulin resistance (HOMA-IR) (6.4 ± 6.8 to 5.0 ± 1.4) decreased in the CART-G compared to the SG. Although body weight did not significantly change after training, skinfold measurement indicated decreased body fat in the CART-G only. CART significantly enhanced muscle strength compared to the SG (p < 0.05). CART was also associated with significant increase in peak oxygen uptake and maximal workload compared to the SG (p < 0.05).ConclusionsThese data support CART as an important strategy in the treatment of patients with T2D, producing both physiologic and functional improvements.Trial RegistrationEnsaiosclinicos.gov.br, RBR492q8z

MANAGEMENT OF ENDOCRINE DISEASE: The effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis.

Epidemiologic studies suggest that vitamin D status plays a role in glycaemic control in patients with type 2 diabetes. However, intervention studies yielded inconsistent results. The aim of this study is to systematically review the effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes. Systematic review and meta-analysis. We searched Medline, Embase and the Cochrane Library for RCTs examining the effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes. A random-effects model meta-analysis was performed to obtain a summarized outcome of vitamin D supplementation on HbA1c, fasting glucose and homeostasis model assessment - insulin resistance (HOMA-IR). Twenty-three RCTs were included in this systematic review representing a total of 1797 patients with type 2 diabetes. Mean (± s.d.) change in serum 25-hydroxyvitamin D varied from 1.8 ± 10.2 nmol/L to 80.1 ± 54.0 nmol/L. Nineteen studies included HbA1c as outcome variable. Combining these studies no significant effect in change of HbA1c was seen after vitamin D intervention compared with placebo. A significant effect of vitamin D supplementation was seen on fasting glucose in a subgroup of studies (n = 4) with a mean baseline HbA1c ≥ 8% (64 mmol/mol) (standardized difference in means: 0.36; 95% CI: 0.12-0.61, P = 0.003). Current evidence of RCTs does not support short-term vitamin D supplementation in a heterogeneous population with type 2 diabetes. However, in patients with poorly controlled diabetes, a favourable effect of vitamin D is seen on fasting glucose.

Association of Plasma DPP4 Activity With Mild Cognitive Impairment in Elderly Patients With Type 2 Diabetes: Results From the GDMD Study in China.

Hyperglycemia, inflammation, and oxidative stress are thought to be involved in the pathogenesis of cognitive decline. Dipeptidyl peptidase-4 (DPP4) is a newly identified adipokine related to these risk factors. Hence, we aimed to investigate the association between plasma DPP4 activities and mild cognitive impairment (MCI) in elderly patients with type 2 diabetes. We evaluated plasma DPP4 activity, inflammatory markers, and oxidative stress parameters in a cross-sectional sample of 1,160 patients with type 2 diabetes aged 60 years or older in China. MCI was diagnosed based on criteria established by the National Institute on Aging-Alzheimer's Association workgroups Patients in the highest quartile of DPP4 activity had higher HbA1c, interleukin 6 (IL-6), CRP, nitrotyrosine, 8-iso-PGF2a, and lower Montreal Cognitive Assessment (MoCA) scores compared with subjects in the lowest quartile (P < 0.001). In the highest DPP4 quartile, MCI risk was higher (odds ratio 3.49; 95% CI 1.97-4.57) than in the lowest quartile after adjustment for potential confounders. The risk for MCI increased more with higher levels of DPP4 activity, IL-6, CRP, nitrotyrosine, and 8-iso-PGF2a (P < 0.05), but not with higher levels of HbA1c. This study shows that increased DPP4 activities are independently associated with MCI in elderly patients with type 2 diabetes. The mechanisms might be partly explained by the effect of DPP4 on inflammation and oxidative stress. These observations raise further interest in DPP4 activity for its potential effect on these MCI-related risk factors as a biological marker or even a possible therapeutic target for MCI.

Vitamin D deficiency and seasonal variation over the years in São Paulo, Brazil.

We aim to examine the prevalence of vitamin D deficiency, characterize the temporal relationship between 25-hydroxyvitamin D levels (25(OH)D) and intact PTH (iPTH) according to seasons, and investigate potential associations between 25(OH)D levels and extra-skeletal outcomes in a Brazilian population. We retrospectively determined population weekly mean concentrations of unpaired 25(OH)D and iPTH using 39,004 laboratory results of Brazilian individuals of both genders aged 2 to 95years. The 25(OH)D and iPTH distributions were normalized, and the means fit with a sinusoidal function. Potential associations between 25(OH)D serum levels and inflammatory markers, fasting glucose, HbA1c and Homeostasis Model Assessment index (HOMA) were examined. Of the samples, 33.9% had 25(OH)D serum concentrations lower than 20ng/mL, while the vast majority (70.7%) were found to be vitamin D deficient or insufficient (<30ng/mL). Vitamin D deficiency was significantly higher during the winter as compared to the summer (38.4% <20ng/mL and 75.5% <30ng/mL versus 23.3% <20ng/mL and 62.5% <30ng/mL, respectively; p < 0.001). Seasonal variation was observed for both 25(OH)D and iPTH. 25(OH)D peaks occurred in March and troughs in September. iPTH levels showed an inverted pattern of peaks and troughs with a delay of 1 ± 5week. 25(OH)D was significantly associated with inflammatory markers but not with glucose homeostasis. A sinusoidal interrelationship has been detected between vitamin D and PTH in this tropical population. A large percentage of the individuals showed vitamin D deficiency. Public health strategies are needed to better understand and manage this very high and apparently contradictory prevalence of vitamin D deficiency.

Serum brain-derived neurotrophic factor levels and sleep disorders in Chinese healthy and newly diagnosed type 2 diabetic subjects.

The aims of the present study were to detect serum brain-derived neurotrophic factor (BDNF) protein concentrations in healthy and diabetic subjects with sleep disorders and to explore correlations among serum BDNF concentrations, metabolic parameters and inflammation. In all, 377 eligible subjects were recruited to the study and underwent a 75-g oral glucose tolerance test. Various clinical parameters of metabolic disorders and cytokines were measured. Sleep disorders were assessed using the Pittsburgh Sleep Quality Index (PSQI). Subjects were grouped into those with normal glucose tolerance (NGT), those with NGT and sleep disorders (NGT-SDi), those with newly diagnosed type 2 diabetes mellitus (T2DM), and those with newly diagnosed T2DM and sleep disorders (T2DM-SDi). Serum BDNF levels were higher in the NGT-SDi and T2DM-SDi subgroups than in the NGT and T2DM groups, respectively. Multiple linear regression analysis revealed that serum BDNF concentrations were independently correlated with PSQI scores, homeostasis model assessment of insulin resistance, and HbA1c, interleukin 6 and tumor necrosis factor-α concentrations (P <0.05 for all). Binary logistic regression analysis revealed that significant associations remained between serum BDNF concentrations and sleep disorders after adjustment for glucose- and metabolic-related factors in both the NGT-SDi and T2DM-SDi subgroups. Serum BDNF concentrations were higher in patients with sleep disorders and were associated with various metabolic parameters and inflammatory cytokines.

Exenatide decreases liver fat content and epicardial adipose tissue in patients with obesity and type 2 diabetes: a prospective randomized clinical trial using magnetic resonance imaging and spectroscopy.

To conduct a prospective randomized trial to investigate the effect of glucagon-like peptide-1 (GLP-1) analogues on ectopic fat stores. A total of 44 obese subjects with type 2 diabetes uncontrolled on oral antidiabetic drugs were randomly assigned to receive exenatide or reference treatment according to French guidelines. Epicardial adipose tissue (EAT), myocardial triglyceride content (MTGC), hepatic triglyceride content (HTGC) and pancreatic triglyceride content (PTGC) were assessed 45 min after a standardized meal with 3T magnetic resonance imaging and proton magnetic resonance spectroscopy before and after 26 weeks of treatment. The study population had a mean glycated haemoglobin (HbA1c) level of 7.5 ± 0.2% and a mean body mass index of 36.1 ± 1.1 kg/m(2) . Ninety five percent had hepatic steatosis at baseline (HTGC ≥ 5.6%). Exenatide and reference treatment led to a similar improvement in HbA1c (-0.7 ± 0.3% vs. -0.7 ± 0.4%; p = 0.29), whereas significant weight loss was observed only in the exenatide group (-5.5 ± 1.2 kg vs. -0.2 ± 0.8 kg; p = 0.001 for the difference between groups). Exenatide induced a significant reduction in EAT (-8.8 ± 2.1%) and HTGC (-23.8 ± 9.5%), compared with the reference treatment (EAT: -1.2 ± 1.6%, p = 0.003; HTGC: +12.5 ± 9.6%, p = 0.007). No significant difference was observed in other ectopic fat stores, PTGC or MTGC. In the group treated with exenatide, reductions in liver fat and EAT were not associated with homeostatic model assessment of insulin resistance index, adiponectin, HbA1c or fructosamin change, but were significantly related to weight loss (r = 0.47, p = 0.03, and r = 0.50, p = 0.018, respectively). Our data indicate that exenatide is an effective treatment to reduce liver fat content and epicardial fat in obese patients with type 2 diabetes, and these effects are mainly weight loss dependent.

Glycosylated haemoglobin assessment in diabetic patients with acute coronary syndromes.

Guidelines for the management of acute coronary syndromes (ACS) advocate for maintaining adequate long-term glycaemic control in diabetic patients. Glycosylated haemoglobin (HbA1c) measurement is commonly used to monitor long-term glycaemic control in diabetes. To evaluate the frequency and clinical predictors of in-hospital HbA1c measurement in diabetic patients presenting with ACS and the relationship between HbA1c assessment and mortality following discharge. This registry-based cohort study included 1743 diabetic patients from 33 representative hospitals across Australia with a final diagnosis of ACS. Independent predictors of HbA1c assessment were evaluated using a multivariable logistic generalised estimating equations analysis. The association between HbA1c assessment and mortality following discharge was evaluated using Cox proportional hazard analysis. Seven hundred and fourteen (41%) patients had HbA1c assessment during admission. Frequency of assessment varied markedly between hospitals (7.7-87.6%). HbA1c assessment was significantly more frequent in hospitals with catheterisation laboratories. Frequency of assessment was not associated with location of hospital (rural vs urban) or hospital capacity. Independent clinical predictors of HbA1c assessment across participating hospitals were younger age, ST-Elevation Myocardial Infarction, cardiac catheterisation and coronary artery bypass surgery during admission. HbA1c assessment was associated with higher rates of coronary catheterisation, revascularisation and receipt of evidence-based medicines but not with mortality during 6 months following discharge (hazard ratio, 0.48; 95% confidence interval, 0.19-1.18). Frequency of HbA1c assessment varies markedly between hospitals, and most diabetic patients admitted for ACS in Australia do not receive assessment of pre-admission glycaemic control. HbA1c assessment was associated with better evidence driven medical care.

Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus

ObjectivesThe oral glucose tolerance test (OGTT) is a cumbersome test that is time consuming, labour intensive and often poorly tolerated by pregnant women. To date, glycosylated haemoglobin (HbA1c) is the...

About the HbA1c in the elderly

HbA1c product of non enzymatic glycation of HbA increases in relation with the mean blood glucose level during the former 2-3 months. HbA1c levels are correlated with the development of diabetic complications and HbA1c assessment is now the gold standard for evaluation of diabetes control. HbA1c level should not be higher than 7% to avoid these complications. However, in aged peoples, the objectives of diabetes control vary according to their health status. It must be good with HbA1c lower than 7-7.5% in healthy subjects and more relax in subjects with symptoms of frailty and risks of non perceived and self corrected hypoglycemia. Under these conditions, HbA1c values lower than 8 to 9% are advised. Nevertheless, hypoglycemia episodes may occur in patients with high HbA1c and capillary glucose follow-up is necessary for detection of such complications.

KCNQ1 rs2237895 polymorphism is associated with Gestational Diabetes in Pakistani Women.

Background and Objective:Genetic studies on gestational diabetes (GDM) are relatively scarce; moreover, limited data is available for KCNQ1 polymorphism in Pakistani pregnant women. We aimed to determine the frequency of KCNQ1 rs2237895 in GDM and normal pregnant controls and its association with GDM-related phenotypes.Methods:A total of 637 pregnant females (429 controls and 208 cases) in their second trimester were classified according to the International Association of the Diabetes and Pregnancy Study criteria in this study. Their blood samples were genotyped for KCNQ1 SNP rs2237895 using PCR-RFLP method and sequencing. Fasting and two hour-post glucose load blood levels, serum HbA1c, insulin, and anthropometric assessment was performed.: Pearson’s Chi Square test, Mann- Whitney U test, and regression analyses were performed. A p-value of <0.05 was considered significant.Results:The variant genotyped was in Hardy-Weinberg equilibrium (p>0.05). The rs2237895 showed an association with GDM (OR 2.281; 1.388-3.746: p <0.001) and remained significant after multiple adjustments for age and body mass index (OR 2.068; 1.430-2.997: p=0.005). The C allele showed positive association with insulin level, and HOMA-IR in study subjects.Conclusions:This study identifies that KCNQ1 rs2237895 polymorphisms might be associated with risk of GDM in Pakistani population and that it is related to higher glucose levels and insulin resistance. Further large scale studies are required to consolidate on the functional aspect of this polymorphism.

Effect of aerobic exercise on glycosylated hemoglobin and VO2max values in patients with type 2 diabetes

Abstract Background/aim: The changes of glycosylated hemoglobin Hb A1c and VO2max values have been considered as an important marker of glucose control over time. Exercise training intervention is underused in the management of type 2 diabetes mellitus in East Africa. The aim of this study was to investigate the influence of aerobic exercise program on HbA1c and VO2 max values in type 2 diabetic patients Material and methods: 30 patients with type 2 diabetes, their ages range from 40 to 70 years old enrolled in the study were randomly assigned into 2groups: control and study. HbA1c and VO2 max were measured for all participants pre and post treatment period. Results: There was a significant difference between the two groups in the HbA1c and VO2 max assessment after treatment. Conclusion: We suggest additional aerobic exercise training is a necessary adjunct to the treatments of type 2 diabetes to improve glycemic control and quality of life in patients with type 2 diabetes.

Quality of diabetes care at the largest outpatient clinics in Vilnius.

Background.Essential data on the quality of diabetes care needed for the development of National Diabetes Programme in Lithuania are lacking. The aim of the study was to assess the quality of diabetes care compared to the local guidelines in Vilnius, Lithuania.Materials and methods.Retrospective data collection covering the period from 2012 to 2013 was performed in 5 Vilnius outpatient clinics assessing process and outcome indicators in type 1 (T1DM) and type 2 diabetes mellitus (T2DM) subjects.Results.In a sample of 1,719 patients (58.9% women, 92.6% T2DM) the annual HbA1c assessment rate was 88.6%. Glycaemic control was significantly better in T2DM compared to T1DM patients: average HbA1c was 7.0 ± 1.4% vs 9.1 ± 1.8% and HbA1c ≤ 7% in 59 vs 9.4%, respectively (p < 0.001); referrals to an endocrinologist were recommended in 56.3% of cases.Annual screening for diabetic foot, retinopathy, nephropathy, renal function and lipids was performed in 4.6, 24.4, 2.3, 29.3 and 13.2% of patients, respectively, with higher performance rate of retinal screening and urinary microalbumin in T1DM; BMI and blood pressure were recorded for 50.2 and 97.2% of patients, respectively.Prevalence of nephropathy, polyneuropathy, retinopathy, and angiopathy was 8.4, 36.2, 10.7 and 7.7%, respectively, with the higher prevalence in T1DM.Conclusions.The analysis revealed good glycaemic control in T2DM, but insufficient in T1DM. Continuous monitoring of diabetes complications and cardiovascular risk factors did not meet the local Diabetes Care Guidelines.

The correlation between toll like receptor 4 and carotid intima-media thickness in patients with type 2 diabetes

Objective To investigate the correlation between toll like receptor 4(TLR4)pathway and carotid intima-media thickness(CIMT)in patients with type 2 diabetes mellitus(T2DM). Methods A total of 66 patients with T2DM were classified into two groups based on the value of CIMT, T2DM without macrovascular injury group(CIMT <0.9 mm, 20 subjects)and T2DM with macrovascular injury group(CIMT≥0.9 mm, or with plaques, 46 subjects), 40 gender and age matched healthy subjects were used as the control group. The CIMT, serum levels of high-sensitivity C-reactive protein(hs-CRP), interleukin-6(IL-6), and monocyte chemotactic protein-1(MCP-1)were tested. The level of TLR4 protein expression on peripheral blood monocyte cells was detected using flow cytometry. Single-factor analysis of variance, Pearson linear analysis, multivariate linear stepwise regression model, and Logistic regression model were performed to analyze the data. Results The level of TLR4 in T2DM with macrovascular injury group was significantly higher than that in both the T2DM without macrovascular injury group and the control group[(18.60±4.64 vs 14.92±3.47, 12.80±2.60), all P<0.05]. In addition, the levels of IL-6, hs-CRP, and MCP-1 in T2DM with macrovascular injury group were significantly increased as compared with those in control group[(6.08±3.16 vs 4.52±2.04)pg/ml, (2.67±2.40 vs 1.53±1.49)mg/dl, (307.99±113.39 vs 242.50±48.04)pg/ml, respectively all P<0.05], but there was no significant difference between T2DM with macrovascular injury group and T2DM without macrovascular injury group. Pearson linear analysis showed that CIMT was positively correlated with TLR4, IL-6, hs-CRP, MCP-1 levels, age, fasting blood glucose, HbA1C, and homeostasis model assessment for insulin resistance(HOMA-IR)(r=0.540, 0.244, 0.271, 0.329, 0.381, 0.490, 0.471, 0.410, respectively, all P<0.05), while negatively correlated with the level of high density lipoprotein-cholesterol(HDL-C)(r=-0.323, P<0.05). TLR4 level was also positively correlated with the level of CIMT, HOMA-IR, IL-6, hs-CRP, and MCP-1(r=0.540, 0.428, 0.214, 0.242, 0.385, respectively, all P<0.05), while negatively correlated with the level of HDL-C(r=-0.384, P<0.05). Multivariate linear stepwise regression analysis showed that TLR4, age, and fasting blood glucose are the independent risk factors for CIMT in patients with type 2 diabetes(R2=0.292, 0.423, 0.492, all P<0.05). Logistic regression analysis showed that the increased TLR4 level was a risk factor of carotid artery plaque formation(OR=1.345, 95%CI 1.10-1.64, P<0.05). Conclusions The increased TLR4 level is a risk factor for the plaque formation in carotid, and that the TLR4 inflammatory signaling pathway seems to be involved in the pathogenesis of macrovascular injury in T2DM.(Chin J Endocrinol Metab, 2015, 31: 1017-1021) Key words: Diabetes mellitus, type 2; Toll-like receptor 4; Atherosclerosis; Carotid intima-media thickness

Assessment of electrolytes and HbA1c in type 2 diabetic patients using metformin and evaluation of guidelines obedience regarding renal impairment

Metformin is indicated as the first line treatment in type 2 diabetes mellitus (T2DM). The objectives of this studywere to assess electrolytes and glycosylated haemoglobin (Hb1Ac) in patients with T2DM using metformin for long term therapy and also to demonstrate compliance with the guidelines regarding renal impairment. This study has been conducted in Al-Nassiriya Province. It was carried out on sixty patients (with T2DM for 5 years, age: 50-60 years).We found that 43% of physicians use creatinine levels as a test for follow up while the others use urea and/ orglomerular filtration rate (GFR). Only 57.2% of physicians follow the guidelines by doing the test every three months. The results showed high potassium and low sodium levels in patients treated with metformin only compared with other oral hypoglycaemic agents (OHAs). However, both were still within the normal level and statistically insignificant (P &gt; 0.005). Calcium readings were high in patients treated with metformin compared with other OHAs and were statistically significant (P &lt; 0.005), but still within the upper normal level. HbA1c was low (7.33%) in patients treated with metformin combined with other OHAs compared with HbA1c in patients treated with metformin only which was 9.48% and was statistically significant (P &lt; 0.005). We need more clinical studies about electrolytes association with metformin. HbA1c should be taken in consideration when treating type 2 diabetes with metformin as initial therapy alone or in combination with other OHAs and /or withdrawn from metformin.

Maternal serum atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) levels in gestational diabetes mellitus

Objective: The aim of the study is to evaluate maternal serum atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) levels in patients with getational diabetes mellitus compared with a control group. Methods: We have measured maternal serum ANP and BNP levels in 35 otherwise healthy and 45 gestational diabetic women between gestational week 24 and 28 referred to our unit in a cross-sectional study. Independent samples t-test or the Mann–Whitney U-test was used for comparison of two groups where appropriate. Results: Mean maternal serum homeostasis model assessment of insulin resistance (HOMA-IR), HbA1c, fasting glucose and insulin levels in gestational diabetes mellitus (GDM) group were significantly higher than the control group (p < 0.01). Mean maternal serum ANP and BNP levels of women with GDM were significantly lower than the control group (12.9 ± 9.9 versus 34.8 ± 16.9 pg/ml, p < 0.001; 416.6 ± 209.7 versus 629.7 ± 162.2 mg/dl, p < 0.001, respectively). Maternal serum ANP and BNP levels were negatively correlated with insulin levels, HbA1c and HOMA-IR values (p < 0.05). Conclusions: Maternal serum ANP and BNP levels are significantly lower in patients with GDM. These biomarkers might be valuable in clinical setting for identifying high-risk women for developing diabetes during pregnancy.

Gender differences in the relationship between diabetes process of care indicators and cardiovascular outcomes.

Adherence to recommended guidelines in the care for diabetes has been demonstrated to significantly prevent the excess risk of hospitalization and mortality for cardiovascular diseases. Aim of this study was to evaluate whether adherence to a standardized process quality-of-care-indicator in diabetes, is able to predict, equally in men and women, first hospitalization or mortality risk after acute myocardial infarction (AMI), ischemic stroke (IS), congestive heart failure (CHF), lower extremity amputations (LEA) or any of above major adverse cardiovascular events (MACE). Guideline composite indicator (GCI), a process indicator including one annual assessment of HbA1c and at least two among eye examination, serum lipids measurement and microalbuminuria, was measured in the year 2006 in 91 826 (46 167 M/45 659 F) diabetic patients, living in Tuscany (Italy). By a Cox-proportional hazard regression model, the effect of GCI adherence was assessed on adjusted hospitalization mortality risk for AMI, IS, CHF, LEA and MACE in both genders in a follow-up period of 6 years (2007-12). After adjusting for covariates, adherence to CGI exerted a significant positive effect on AMI, CHF and LEA outcomes among men, whereas among women, GCI adherence significantly decreased hospitalization risk only for CHF and mortality risk after IS. Finally, GCI adherence significantly reduced hospitalization risk for MACE of about 15% and 11% in men and women, respectively. On the contrary, GCI adherence seemed to have no significant influence on mortality risk after hospitalization for MACE in both genders. In this cohort, over a 6-year follow-up, GCI adherence was found to be a significant predictor of lower cardiovascular risk, with some evident gender differences.

Glycemic and Cholesterol Control Versus Single-Goal Control in US Veterans with Newly Diagnosed Type 2 Diabetes: A Retrospective Observational Study.

IntroductionA majority of patients with diabetes do not have levels of glycated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C) under control, either individually or in combination. The objective was to assess the clinical benefits and patient characteristics associated with dual-goal achievement [HbA1c <7% (53 mmol/mol) and LDL-C <100 mg/dL] versus only LDL-C goal achievement in adults with newly diagnosed type 2 diabetes.MethodsNewly diagnosed patients with ≥2 measures of LDL-C and HbA1c were identified in the South Central Veterans Affairs Health Care Network (01/2004–06/2010). The index date was the first HbA1c assessment within 3 months of the first type 2 diabetes diagnosis. Multivariate Cox proportional hazards models were used to assess the association between time-varying goal achievement and post-index microvascular and cardiovascular complications. Patient characteristics associated with dual-goal achievement in the 7–12 months post-index were identified using a logistic regression.ResultsThe sample included 16,829 patients. Compared with LDL-C goal achievement, dual-goal achievement was associated with lower risk of microvascular complications [hazard ratio (95% confidence interval): 0.69 (0.63, 0.76)]. Other outcomes did not differ between those two groups. Characteristics associated with dual-goal achievement (44.2% of patients) include prior dual-goal achievement, older age, and use of lipid-lowering drugs.ConclusionDual-goal achievement in newly diagnosed type 2 diabetes is associated with a lower risk of microvascular complications versus only LDL-C goal achievement. Although dual-goal achievement rates are suboptimal, early and regular intervention will increase its likelihood.FundingDaiichi Sankyo, Inc., Parsippany, NJ, USA.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-015-0122-2) contains supplementary material, which is available to authorized users.

Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus.

Glycated haemoglobin (HbA1c) assessment for the diagnosis of diabetes mellitus overcomes many practical problems associated with traditional blood glucose measurements. However, the test is not without limitations of which the medical practitioner needs to be aware. The possibility of an individual having a medical condition that interferes with the test should always be considered, even though these conditions are rare in most Australian communities. Appropriately used, HbA1c assessment should provide a cost-effective, efficient and simple tool for the early diagnosis of type 2 diabetes.

Prediction and diagnosis of post transplant diabetes.

The identification of at-risk individuals prior to transplantation may enable implementation of measures to prevent or delay PTDM development, while early detection facilitates prompt management and may prevent acute and chronic complications. Thus, in this review, we examine proposed tools for the prediction of PTDM for use prior to and following solid organ transplantation. This includes PTDM prediction models based on biochemical assessments of glycaemia and other indices, in addition to those solely based on clinical parameters. We also examine the available methods for diagnosis of PTDM early and late post-transplant, including the advantages and limitations of fasting plasma glucose (FPG), OGTT, random plasma glucose and HbA1c assessment. Key findings are that OGTT should remain the gold standard diagnostic method for PTDM, however, there is emerging data to support a role for HbA1c beyond 3 months posttransplant. FPG has low sensitivity during the first year post-transplant. Improved prediction and diagnosis of PTDM may lead to improvements in patient survival, quality of life and health care costs in future.