Change In Hemoglobin A1c Research Articles

Cannabinoid-1 Receptor Antagonist, Rimonabant, for Management of Obesity and Related Risks

The prevalence of obesity has risen substantially during the past 25 years in the United States and most developed countries, with a related increase in type 2 diabetes mellitus.1,2 Almost one third of the adult US population is considered to be obese (body mass index [BMI] ≥30), and 1 in 20 is extremely obese (BMI ≥40).3 Nearly 17% of children and adolescents are overweight in the United States.3 Obesity is associated with increased risk for type 2 diabetes mellitus, coronary heart disease (CHD), hypertension, obstructive sleep apnea, and cancer, higher overall mortality rate,4–6 and decreased longevity.7,8 Extreme obesity can truncate life expectancy in young adults by 5 to 20 years.8 Accordingly, the expected benefits of weight reduction for obese individuals are profound. Weight loss of 5% to 10% generally lessens many health risks, including cardiovascular risks, although such improvements are most notably demonstrable in studies specifically conducted in high-risk populations, and the benefits are presumed to be greater when healthier weight is maintained for long periods.9,10 In overweight and obese individuals, weight loss achieved with most interventions over 1 to 2 years generally leads to improvements in blood pressure (BP), glycemic measures, and triglycerides (TGs). Improvements in total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) have been reported in studies using dietary interventions combined with exercise. When weight loss is achieved primarily via pharmacological interventions, these benefits have not occurred quite so consistently.11 Reduced caloric intake and increased physical activity are generally accepted as the foundations of any approach directed at weight reduction, but these lifestyle interventions do not appear to provide long-lasting success for obese individuals wishing to lose weight. About half of the weight lost with the help of lifestyle interventions is regained at 1 year; after …

Folate and Vitamin B6 Rapidly Normalize Endothelial Dysfunction In Children With Type 1 Diabetes Mellitus

Endothelial dysfunction, a precursor of vascular disease, begins early in type 1 diabetes mellitus and is associated with folate status. A randomized, double-blind, placebo-controlled study of folate (5 mg daily) and vitamin B6 (100 mg daily) in 124 children with type 1 diabetes determined the immediate and 8-week effects of these vitamins, alone and in combination, on endothelial function. Endothelial function, assessed as flow-mediated dilation and glyceryltrinitrate-induced dilation with high-resolution ultrasound of the brachial artery, was measured at baseline, at 2 and 4 hours after the first dose (n = 35), and at 4 and 8 weeks of treatment (n = 122). Flow-mediated dilation normalized in all treatment groups. From baseline to 8 weeks, flow-mediated dilation improved with folate from 2.6% +/- 4.3% (mean +/- SD) to 9.7% +/- 6.0%, with vitamin B6 from 3.5% +/- 4.0% to 8.3% +/- 4.2%, and with folate/vitamin B6 from 2.8% +/- 3.5% to 10.5% +/- 4.4%. This improvement in flow-mediated dilation occurred within 2 hours and was maintained at 8 weeks for each treatment. Flow-mediated dilation in the placebo group, and glyceryltrinitrate-induced dilation in all groups, did not change. Increases in serum folate, red cell folate, and serum vitamin B6 levels related to increases in flow-mediated dilation. Improvement in flow-mediated dilation was independent of changes in total plasma homocyst(e)ine, glucose, hemoglobin A1c, and high-sensitivity C-reactive protein levels. Baseline red cell folate levels and baseline diastolic blood pressure were related inversely to improvement in flow-mediated dilation. Serum triglyceride and low-density lipoprotein cholesterol inversely related to baseline flow-mediated dilation. High-dose folate and vitamin B6 normalized endothelial dysfunction in children with type 1 diabetes. This effect was maintained over 8 weeks, with no additional benefit from combination treatment.

Improved Type 2 Diabetes Patient Outcomes and Projected Cost Savings Following Supervised Exercise Training

Physical activity has long been a primary intervention to manage type 2 diabetes. PURPOSE: Because type 2 diabetes outpatients do not always follow the recommendation by health care professionals to exercise, this project followed 8 outpatients referred to the Diabetes Education Centre (DEC) by their primary care physician who agreed to participate in a kinesiologist-directed exercise training program offered at the Hospital for 11 months. METHODS: 2 males and 6 females (60.9 ± 10.4 years; 93.7 ± 25.9 kg; 162.3 ± 10.1 cm; means ± SD) completed testing before, after 3 months and after 11 months of training. They exercised in a supervised setting (combination of up to 25 minutes of aerobic, up to 25 minutes of resistance and 10 minutes of flexibility exercises) twice a week for ∼11 months. RESULTS: Compared to baseline measures, early (i.e. 3 months) significant findings included improvements in aerobic capacity assessed using a submaximal step test (114%), grip strength (14%), push-ups (670%), curl-ups (234%), as well as functional capacity assessed using the sit-to-stand tests (56, 15 and 14%). Long term effects (i.e. 11 months) also included significant decreases in systolic blood pressure from 131 to 122 mmHg and decreases in sum of 2 and sum of 5 skin folds by 16 and 12% respectively. There were no significant changes in blood work including lipid profile however hemoglobin A1C exhibited a clinically relevant decrease from 7.1 % to 6.1 % after 11 months of intervention in this group. Collectively, these improvements in patient outcomes have been associated with improvements in quality of life and cost savings. Based on the observed changes in hemoglobin A1C and blood pressure alone and using the data of Palmer et al. (Current Medical Research and Opinion, 2004; 20, S53-S58.), we can conservatively project a lifetime cost savings of ∼$11000 US per patient. The cost of providing the kinesiologist-directed exercise training will offset part of these savings; however, indirect costs of physical inactivity would also be reduced by a program of this type. Future research should identify the long-term adherence parameters required to maintain the observed patient outcomes and further delineate the cost-savings analysis. CONCLUSION: The results of this project suggest the addition of a kinesiologist to the multidisciplinary health care team in a DEC will have significant long term health benefits for type 2 diabetes outpatients and can contribute to reducing health care costs in this population. Supported by the Nova Scotia Health Research Foundation, Eastern Kings Memorial Health Foundation and Thera-Band ®.

Insulin Pump in Young Children with Diabetes

Endocrinology| December 01 2005 Insulin Pump in Young Children with Diabetes AAP Grand Rounds (2005) 14 (6): 68. https://doi.org/10.1542/gr.14-6-68 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Insulin Pump in Young Children with Diabetes. AAP Grand Rounds December 2005; 14 (6): 68. https://doi.org/10.1542/gr.14-6-68 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: diabetes mellitus, insulin infusion systems Source: Fox LA, Buckloh LM, Smith SD, et al. A randomized controlled trial of insulin pump therapy in young children with type 1 diabetes. Diabetes Care. 2005;28:1277–1281. In infants and toddlers with type 1 diabetes, achieving tight control of blood glucose is challenging. Investigators from Nemours Children’s Clinic in Jacksonville, Fla., randomized children aged 1 to 6 years with type 1 diabetes into 2 groups to compare glycemic control and impact on family life between children receiving traditional insulin injections and those receiving insulin by pump. Children in the injection group received 2 or 3 daily shots of long-acting insulin (NPH) and rapid-acting insulin analog. The pump group received continuous subcutaneous insulin infusion therapy. Both groups were monitored for mean blood glucose, hypoglycemia frequency, diabetes-related quality of life (QOL), parental adjustment, and changes in hemoglobin A1C. This study reports findings for a 6-month treatment period. Eleven children from each group completed the 6 months of study treatment; mean age was 46 months. At baseline, there were no significant differences between the 2 groups for hemoglobin A1C, age, sex, diabetes duration, parental quality of life, or mean blood glucose. Mean hemoglobin A1C and mean blood glucose levels did not change from baseline to 6 months in either group. The frequency of ketoacidosis, severe hypoglycemia, and hospitalizations were similar between the 2 groups throughout the study. Children on the insulin pump had more fasting and pre-dinner mild to moderate hypoglycemia at 1 and 6 months. Overall, diabetes-related QOL did not differ significantly between the 2 groups at the end of study. The authors conclude that the insulin pump is safe and well-tolerated in young children with diabetes and may have positive effects on QOL. However, the insulin pump did not improve diabetes control when compared to insulin injections. The benefits and expectations of pump therapy should be reviewed thoroughly before starting treatment in very young children, the authors suggest. Dr. Varma has disclosed no financial relationships relevant to this commentary. These authors studied the use of the insulin pump in young children with type 1 diabetes for only 6 months. Such a short study period precludes looking at complications that might occur with extended use of the pump; eg, could problems arise because the patient or playmates might disturb pump function by playing with it or pulling on it? On the other hand, this study does not show any advantage of the insulin pump for diabetes control, frequency of hypoglycemia, or other diabetes-related complications. While mothers in the injection group reported a greater impact of diabetes on the family at baseline, there were no differences between the mothers in the 2 groups at the end of the study. Fathers in the injection group reported more psychological distress than fathers in the pump group at the start of the study, but no significant difference existed at the end. No differences on the pediatric diabetes QOL scale were noted at any time during the... You do not currently have access to this content.

A low-carbohydrate, ketogenic diet to treat type 2 diabetes

BackgroundThe low-carbohydrate, ketogenic diet (LCKD) may be effective for improving glycemia and reducing medications in patients with type 2 diabetes.MethodsFrom an outpatient clinic, we recruited 28 overweight participants with type 2 diabetes for a 16-week single-arm pilot diet intervention trial. We provided LCKD counseling, with an initial goal of <20 g carbohydrate/day, while reducing diabetes medication dosages at diet initiation. Participants returned every other week for measurements, counseling, and further medication adjustment. The primary outcome was hemoglobin A1c.ResultsTwenty-one of the 28 participants who were enrolled completed the study. Twenty participants were men; 13 were White, 8 were African-American. The mean [± SD] age was 56.0 ± 7.9 years and BMI was 42.2 ± 5.8 kg/m2. Hemoglobin A1c decreased by 16% from 7.5 ± 1.4% to 6.3 ± 1.0% (p < 0.001) from baseline to week 16. Diabetes medications were discontinued in 7 participants, reduced in 10 participants, and unchanged in 4 participants. The mean body weight decreased by 6.6% from 131.4 ± 18.3 kg to 122.7 ± 18.9 kg (p < 0.001). In linear regression analyses, weight change at 16 weeks did not predict change in hemoglobin A1c. Fasting serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001) while other serum lipid measurements did not change significantly.ConclusionThe LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.

Impact of modified glucose target and exercise interventions on vascular risk factors

Potent glucose-lowering medications other than metformin may impede weight loss in type 2 diabetes (T2D). Supervised exercise programs improve glycemic control without significantly enhancing weight loss; their impact on fitness and blood pressure in T2D remains unclear. In this pilot study, 42 type 2 diabetes patients were randomized to (i) liberalized (10 mmol/l) OR strict (7 mol/l) preprandial glucose thresholds for adjustment of medication other than metformin and (ii) dietary counseling with OR without supervised exercise (2 × 2 factorial design). Weight (−1.2% versus −0.3%, p = 0.38) and hemoglobin A1C changes (−0.8% versus 0%, p = 0.37) were similar for glucose threshold-defined groups. Dietary counseling with supervised exercise participants had greater improvement in mean arterial pressure than those not randomized to an exercise program (−3.3% versus 1.1%, p = 0.02). Overall weight (−1.5% versus 0%, p = 0.06) and fitness changes (5.4% versus 1.5%, p = 0.18) were not significantly different between these groups, but weight (−1.6% versus 0%, p = 0.03) and fitness changes (21.3% versus 1.5%, p = 0.03) were significantly greater among those who attended ≥75% of exercise classes. Liberalizing preprandial thresholds neither enhances weight loss nor compromises hemoglobin A1C. T2D patients who consistently participate in supervised exercise programs may experience modest weight loss and significant improvements in fitness and blood pressure.

Effects of Pomegranate Juice Consumption on Myocardial Perfusion in Patients With Coronary Heart Disease

Pomegranate juice contains antioxidants such as soluble polyphenols, tannins, and anthocyanins and may have antiatherosclerotic properties. However, no study has investigated the effects of pomegranate juice on patients who have ischemic coronary heart disease (CHD). We investigated whether daily consumption of pomegranate juice for 3 months would affect myocardial perfusion in 45 patients who had CHD and myocardial ischemia in a randomized, placebo-controlled, double-blind study. Patients were randomly assigned into 1 of 2 groups: a pomegranate juice group (240 ml/day) or a placebo group that drank a beverage of similar caloric content, amount, flavor, and color. Participants underwent electrocardiographic-gated myocardial perfusion single-photon emission computed tomographic technetium-99m tetrofosmin scintigraphy at rest and during stress at baseline and 3 months. Visual scoring of images using standardized segmentation and nomenclature (17 segments, scale 0 to 4) was performed by a blinded independent nuclear cardiologist. To assess the amount of inducible ischemia, the summed difference score (SDS) was calculated by subtracting the summed score at rest from the summed stress score. The experimental and control groups showed similar levels of stress-induced ischemia (SDS) at baseline (p >0.05). After 3 months, the extent of stress-induced ischemia decreased in the pomegranate group (SDS -0.8 +/- 2.7) but increased in the control group (SDS 1.2 +/- 3.1, p <0.05). This benefit was observed without changes in cardiac medications, blood sugar, hemoglobin A1c, weight, or blood pressure in either group. In conclusion, daily consumption of pomegranate juice may improve stress-induced myocardial ischemia in patients who have CHD.

Assessing Quality of Diabetes Care by Measuring Longitudinal Changes in Hemoglobin A1c in the Veterans Health Administration

A1c levels are widely used to assess quality of diabetes care provided by health care systems. Currently, cross-sectional measures are commonly used for such assessments. To study within-patient longitudinal changes in A1c levels at Veterans Health Administration (VHA) facilities as an alternative to cross-sectional measures of quality of diabetes care. Longitudinal study using institutional data on individual patient A1c level over time (October 1, 1998-September 30, 2000) with time variant and invariant covariates. One hundred and twenty-five VHA facilities nationwide, October 1, 1998-September 30, 2000. Diabetic veteran users with A1c measurement performed using National Glycosylated Hemoglobin Standardization Project certified A1c lab assay methods. Characteristics unlikely to reflect quality of care, but known to influence A1c levels, demographics, and baseline illness severity. Monthly change in A1c for average patient cared for at each facility. The preponderance of facilities showed monthly declines in within-patient A1c over the study period (mean change of -0.0148 A1c units per month, range -0.074 to 0.042). Individual facilities varied in their monthly change, with 105 facilities showing monthly declines (70 significant at .05 level) and 20 showing monthly increases (5 significant at .05 level). Case-mix adjustment resulted in modest changes (mean change of -0.0131 case-mix adjusted A1c units per month, range -0.079 to 0.043). Facilities were ranked from worst to best, with attached 90 percent confidence intervals. Among the bottom 10 ranked facilities, four remained within the bottom decile with 90 percent confidence. There is substantial variation in facility-level longitudinal changes in A1c levels. We propose that evaluation of change in A1c levels over time can be used as a new measure to reflect quality of care provided to populations of individuals with chronic disease.

Home Use of the GlucoWatch G2 Biographer in Children With Diabetes

To evaluate usability, accuracy, and hypoglycemia detection of the GlucoWatch G2 Biographer (GW2B) in children aged 1 to 17 years. After a 15-hour study of device accuracy, 46 children (15 <7 years, 31 > or =7 years) with type 1 diabetes were enrolled for an extended-wear outcome study: 2 daytime and 2 nighttime 15-hr wear periods each week and blood glucose monitoring 4 times daily for 3 months. A total of 531 paired GW2B/meter readings were available for accuracy assessment. The correlation coefficients were 0.58 and 0.74 (ages <7 and > or =7 years, respectively). There was no significant change in hemoglobin A1C)or weight-adjusted insulin dose at 3 months after biographer use. Forty-two episodes of hypoglycemia were detected by the GW2B, 33 of which were confirmed by blood glucose meters. Sensitivity and specificity of audible low-glucose alerts were approximately 79% and 83%, respectively. No significant side effects were reported. The GW2B is usable and safe in children who are <7 years or older in the home setting. The GW2B can detect asymptomatic nocturnal hypoglycemia in younger children.

Glycemic control and quality of life in diabetes mellitus

Purpose This study sought to evaluate the association between quality of life (QOL) and changes in hemoglobin A1c (HbA1c) levels in diabetic patients over a 1-year period. Methods Diabetic patients were identified from clinic databases using International Classification of Diseases (ICD-9) codes. Patients were asked to complete Short Form 36 (SF-36), which measures health-related QOL, and were invited to attend monthly diabetes education workshops. From December 2000 to December 2001, data were collected on multiple parameters, including HbA1c. SF-36 surveys were again collected at project termination. Regression analysis was used to correlate change in HbA1c with change in QOL scores while controlling for potential confounders. Results Of 1679 eligible patients identified, 380 completed SF-36 at project initiation; 243 of those also completed SF-36 at project termination. Pre- and postproject HbA1c data were available for 170 of the 243 patients who completed SF-36 at both time points. After adjusting for baseline SF-36 scores and changes in SF-36's physical component scores, a 5% decrease in HbA1c values was associated with a 1% increase in mental component scores of SF-36. No association between changes in HbA1c levels and physical QOL scores was observed. Conclusion The association between better HbA1c levels and improved mental, but not physical, QOL may reflect physical inconvenience associated with increased regimen complexity as well as mental empowerment from proactive disease management. Large experimental studies are needed to elucidate the long-term relationship between glycemic control and QOL before clinical recommendations can be made.

Improved Outcomes in Indigent Patients with Ketosis-Prone Diabetes: Effect of a Dedicated Diabetes Treatment Unit

To investigate whether a specialized intervention program could improve diabetes-related health outcomes in indigent patients with type 1 diabetes who were prone to occurrence of diabetic ketoacidosis (DKA). Patients with type 1 diabetes mellitus admitted because of DKA during a 24-month period were invited to receive outpatient care in a diabetes treatment unit (DTU). We compared DKA-related readmission rates, change in hemoglobin A1c (HbA1c) values, and diabetes-related medical costs in patients who participated in the DTU program (+DTU) and in those who did not (-DTU). During the study period, 115 patients underwent assessment. Of this overall group, 57 patients (49.6%) consented to participate in the DTU program, and 58 (50.4%) did not. After the follow-up period (median duration, 657 days), the following significant improvements were observed in the +DTU group (in comparison with the -DTU group): lower frequency of readmission for DKA (16% versus 43%; P = 0.001), lower number of readmissions for DKA per patient (0.22 +/- 0.6 versus 1.17 +/- 2.2 [mean +/- standard deviation]; P = 0.003), lower HbA1c level (10.4 +/- 2.3% versus 13.5 +/- 2.3%; P<0.0001), and lower cost of diabetes-related medical care (3,427.20 US dollars +/- 6,275.60 versus 10,119.10 US dollars +/- 19,688.10; P = 0.01). Multivariate analysis revealed that participation in the DTU program was the only factor associated with a significantly decreased risk of DKA-related readmission. Low-cost intervention by a dedicated outpatient DTU resulted in significant decreases in DKA-associated readmissions, in HbA1c values, and in costs of diabetes care in a multiethnic, indigent, ketosis-prone patient population.

A retrospective review of thiazolidinediones with development of a troglitazone conversion protocol.

The objective of this paper was (1) to assess compliance with the National Veterans Affairs Guidelines for the use of troglitazone and rosiglitazone and (2) to develop and implement a conversion protocol that allows effective management of patients receiving troglitazone. A retrospective chart review was conducted to assess adherence to guidelines for all patients receiving troglitazone and rosiglitazone at the medical center. Appropriateness of therapy through indication evaluation, safety through alanine aminotransferase (ALT) monitoring compliance, and efficacy through hemoglobin A1c (HbA1c) changes were used to assess adherence. According to National Veterans Affairs (VA) Guidelines, 68% of troglitazone and 63% of rosiglitazone patients had an appropriate indication for the use of these agents. Baseline ALT levels were obtained in 40% of troglitazone and 71% of rosiglitazone patients. Full compliance with continual ALT monitoring was seen in 6 and 54% of patients, respectively. Goal HbA1c was achieved in 57 and 29% of patients, respectively. Of the 33 patients receiving troglitazone, 19 were converted to rosiglitazone therapy; 11 were maintained on current regimens without troglitazone, and 3 were lost to follow up. Adherence to guidelines needs to be reinforced, in particular, compliance with ALT monitoring. However, there were no reported cases of hepatotoxicity in the patients reviewed. Many patients did not achieve a HbA1c

“Sticking to it—Diabetes Mellitus”: A Pilot Study of an Innovative Behavior Change Program for Women with Type 2 Diabetes

The goal of this project was to evaluate an innovative educational program for women with type 2 diabetes facilitated by trained lay health advisors from the local university extension service. The program focused on adherence to behaviors recommended to achieve optimal blood glucose control. We evaluated whether primary care physicians would refer to this program, whether the program would reach diabetic women in rural areas, and whether the program improved health behaviors and glycemic control. Women over 40 with type 2 diabetes were recruited through their primary care physician's offices. Eligible participants were randomly assigned to intervention (program) or control (usual care) groups. The six-session educational program focused on encouraging behavior change through instructor and group support, learning specific behavior change skills, and developing a confident attitude about self-management of diabetes. Physicians supported referral to the program, and the utilization of a lay health advisor for delivery of the program in rural areas was feasible. At 6-month follow-up the mean change in hemoglobin A1c and body mass index did not differ significantly between the intervention (n=67) and control (n=65) groups. However, participants felt better about their ability to control their diabetes and demonstrated an improvement in behaviors related to control.

Rosiglitazone Monotherapy Is Effective in Patients with Type 2 Diabetes

This study evaluated the efficacy and safety of rosiglitazone monotherapy in patients with type 2 diabetes. After a 4-week placebo run-in period, 493 patients with type 2 diabetes were randomized to receive rosiglitazone [2 or 4 mg twice daily (bd)] or placebo for 26 weeks. The primary end point was change in hemoglobin A1c; other variables assessed included fasting plasma glucose, fructosamine, endogenous insulin secretion, urinary albumin excretion, serum lipids, and adverse events. Rosiglitazone (2 and 4 mg bd) decreased mean hemoglobin A1c relative to placebo by 1.2 and 1.5 percentage points, respectively, and reduced fasting plasma glucose concentrations relative to placebo by 3.22 and 4.22 mmol/L, respectively. Fasting plasma insulin and insulin precursor molecules decreased significantly. Homeostasis model assessment estimates indicate that rosiglitazone (2 and 4 mg bd) reduced insulin resistance by 16.0% and 24.6%, respectively, and improved β-cell function over baseline by 49.5% and 60.0%, respectively. Urinary albumin excretion decreased significantly in the rosiglitazone (4 mg bd) group. There was no increase in adverse events with rosiglitazone. In the short-term, rosiglitazone is an insulin sensitizer that is effective and safe as monotherapy in patients with type 2 diabetes who are inadequately controlled by lifestyle interventions.

Implementation and Evaluation of a Pharmacist-managed Diabetes Service

OBJECTIVE: To evaluate the impact of a pharmacist-managed diabetes service on changes in hemoglobin A1C (HbA), blood pressure, lipids, and smoking status in diabetic patients. DESIGN: A prospective analysis of the outcomes of a pharmacist-managed diabetes referral service compared to outcomes of standard medical care provided by physicians in a matched historical control. SETTING: Richmond Health Care Group, a managed care-affiliated physicians group in Virginia. PATIENTS: 16 type 2 diabetics in the historical control group; and 26 type 2 and 6 type 1 diabetics in the intervention group with a HbA" value greater than 8%, or a documented elevated systolic (over 130 mm Hg) or diastolic (over 85mm Hg) blood pressure, or elevated low density lipoprotein (LDL) cholesterol level that was 120% of goal or more. INTERVENTIONS: Patients in the intervention group received dosage adjustments, diabetes self-management training, and periodic assessment of treatment goals by pharmacists. MAIN OUTCOME MEASURES: HbA,c, systolic blood pressure (SBP), diastolic blood pressure (DBP), LDL, and smoking cessation. RESULTS: At the end of the study the mean :l:SD HbA" was 7.5 :I: 1.2% (95% CI, 7.05-7.98%) for the intervention group and 8.5 :I: 1.4% (95% CI, 7.8and-9.20%) for the historical control group, 11=0.02. There was no statistical difference in SBP and DBP between the two groups, although there was a trend toward a lower SBP in the intervention group (mean:l: SD SBP 133.5:1: 17.9 mm Hg; 95% CI, 127.2-139.9 mm Hg) compared with the historical control group (mean :I: SD SBP 140.1 :I: 14.9 mm Hg; 95% CI, 132.8-147.4 mm Hg), 11=0.22. There was no difference between baseline (mean :I: SD LDL 123.6 :I: 39.8 mg/dL; 95% CI, 108.3-138.9 mg/dL) and follow-up LDL (mean :I: SD LDL 121.2 :I:30.6 mg/dL; 95% CI, 102.2-140.2 mg/dL) by within-group analysis, 11=0.82. CONCLUSION: A pharmacist-managed diabetes service was effective in reducing HbA" values in diabetic patients. This study demonstrates the positive impact of clinical pharmacists in achieving a primary therapeutic goal in diabetic patients for overall diabetes control and possibly blood pressure.

Longitudinal study of lipoprotein(a) in peripubertal children with insulin-dependent diabetes.

We aimed to examine the longitudinal relationship between lipoprotein(a) and haemoglobin A1c, albumin excretion rate, and puberty in peripubertal children with insulin-dependent diabetes. A total of 114 patients aged 11.5 +/- 3.6 years (mean (SD)) were followed prospectively for 15.2 +/- 2.8 months. Lipoprotein(a), apolipoproteinB-100, haemoglobin A1c, mean overnight albumin excretion rate and Tanner stage were determined at the beginning and end of the study period. Lipoprotein(a) and apolipoproteinB-100 were measured using nephelometry. This method was correlated with radioimmunoassay and there was no significant change in mean bias during the study. Lipoprotein(a) fell significantly over time (214, (152, 276); 160 (84, 236) mg l-1 geometric mean (0.95 confidence intervals), p < 0.001); apolipoproteinB-100 did not change. Lipoprotein(a) and apolipoproteinB-100 did not differ in 233 cross-sectional controls of similar age. The change in lipoprotein(a) did not correlate with a small fall in haemoglobin A1c or with overnight albumin excretion rate, Tanner stage or insulin dose. Separate analysis of male and female patients and prepubertal and pubertal patients continued to show a significant fall in lipoprotein(a) independent of change in haemoglobin A1c or albumin excretion rate. Likewise, 53 patients with a change in haemoglobin A1c of greater than 1%, and 20 patients who progressed from normal albumin excretion rate to albumin excretion rate above the 95th centile, showed no relationship between lipoprotein(a) and haemoglobin A1c or albumin excretion rate. In conclusion, longitudinal changes in lipoprotein(a) do not relate to metabolic control or early changes in albuminuria in young patients with insulin-dependent diabetes.

Changes of hemoglobin A1 and A1c in workers exposed to lead

Changes of hemoglobin A1 and A1c in workers exposed to lead

U.K. prospective diabetes study. II. Reduction in HbA1c with basal insulin supplement, sulfonylurea, or biguanide therapy in maturity-onset diabetes. A multicenter study

Newly presenting maturity-onset diabetic subjects were put on diet and if, after 3-4 mo, their fasting plasma glucose continued greater than 6 mmol/L, they were randomized to three therapies: (1) continuing diet alone, (2) with additional sulfonylurea, or (3) with additional basal insulin supplement provided by ultralente insulin. Obese patients were also randomized to metformin therapy. The aim was to lower the fasting plasma glucose to less than 6 mmol/L and the degree to which this reduced the hemoglobin A1C (HbA1C) concentration was studied in 195 patients over 1 yr. Sulfonylurea and insulin similarly reduced (P less than 0.001) the fasting plasma glucose from 8.3 +/- 1.9 to 6.7 +/- 1.3 mmol/L (mean +/- 1 SD) and 8.6 +/- 2.2 to 6.8 +/- 1.4 mmol/L, respectively. This was accompanied by a significant reduction (P less than 0.001) of the HbA1C to the high normal range, from 9.1 +/- 2.1% to 7.8 +/- 1.2%, and from 9.1 +/- 1.9% to 8.1 +/- 1.3%, respectively, both values at 1 yr being significantly (P less than 0.05) lower than in patients randomized to diet alone. Patients randomized to diet alone had little change in fasting plasma glucose (8.6 +/- 1.8 to 9.3 +/- 2.3 mmol/L) or HbA1C (8.8 +/- 1.7% to 9.1 +/- 1.6%, respectively). Thus, the simple therapeutic aim of trying to reduce the fasting plasma glucose to less than 6 mmol/L is an effective means of reducing the HbA1C to a high-normal level. The HbA1C and fasting plasma glucose concentrations were similarly related for all three therapies (HbA1C [%] = 0.47 X fasting plasma glucose [mmol/L] + 4.7).(ABSTRACT TRUNCATED AT 250 WORDS)

Biphasic changes in hemoglobin A1c concentrations during normal human pregnancy

Analyses of hemoglobin A1c concentrations were performed throughout gestation in 377 nondiabetic women. We observed significant biphasic changes in hemoglobin A1c concentrations, with an initial gradual decline to a nadir level at 24 weeks, followed by a subsequent slow reascension to peak near term. All these changes fell within the usual range of normal values for hemoglobin A1c. Values for plasma glucose estimated 1 hour after a 50 gm oral glucose load in 1,756 normal gravid women showed similar biphasic excursions, with the nadir occurring 4 weeks earlier, i.e., at 20 weeks' gestation. We conclude that the small but significant changes in hemoglobin A1c during the course of normal gestation reflect, with an appropriate displacement in time, the biphasic alterations in mean blood sugar that characterize the sequential changes in glucoregulation during normal pregnancy.