Diabetes HbA1c Levels Research Articles

Description of HbA1c Levels in Fatty Liver Disease Patients in a West Jakarta Private Hospital in 2018-2019

Fatty liver disease is a chronic disease that is very often found in the community and is often called "silent" liver disease because there are no specific symptoms in patients. The incidence of fatty liver disease in Indonesia is quite high by 30 percent and this disease can develop into liver cirrhosis. The high incidence of fatty liver disease can be caused by various factors such as obesity, dyslipidemia, hypertension, unhealthy lifestyles and insulin resistance. Insulin resistance can be characterized by an increase in HbA1c levels in the blood. This study aims to determine the description of HbA1c levels in patients with fatty liver disease. This research is an observational descriptive study using a cross-sectional approach by using medical record data of fatty liver disease patients who have been on radiologic examination and doing HbA1c examination. Fatty liver disease affects more male sex groups by 55.4 percent, with the most age range at 51-60 years by 34.9 percent. Diabetes HbA1c levels (59%) are more than prediabetes (25.3%) and normal HbA1c levels (15.7%). Abnormal HbA1c levels (prediabetes and diabetes) were found to be higher in men (47 % vs 47,3%). The most accompanying diseases in patients with fatty liver disease are diabetes mellitus (51.8%), hypertension (33.7%), dyslipidemia (26.5%), dyspepsia (28.9%), and hyperuricemia (15.7%). Fatty liver disease patients were also found to have metabolic syndrome by 54.2% which was dominated by female sex by 53.3% with 91.1% having 3 components of metabolic syndrome and 8.9% having 4 components of metabolic syndrome

Increased HbA1c Levels in Diabetics During the Postoperative 3-6 Months After Rotator Cuff Repair Correlated With Increased Retear Rates

To evaluate whether glycemic control affects the integrity of the repaired rotator cuff during the postoperative healing period after arthroscopic double-row suture bridge rotator cuff repair (RCR) METHODS: We retrospectively reviewed patients with diabetes mellitus (DM) who underwent arthroscopic double-row suture bridge RCR at our institution between March 2016 and November 2019. We included the patients who evaluated for serum glycosylated hemoglobin (HbA1c) levels within 1 month before and 3-6 months after surgery. Magnetic resonance imaging was conducted 6 months after surgery to evaluate the integrity of the repaired cuff tendon. Patients were categorized into two groups based on comparison between preoperative and postoperative HbA1c values: Group I (increased postoperative HbA1c) and Group D (same or decreased postoperative HbA1c). The correlation between preoperative/postoperative HbA1c, HbA1c increase/same or decrease (during the healing period), and post-RCR integrity was evaluated, including various demographic and radiologic factors. A total of 103 patients were analyzed, group I was 47, and group D was 56, respectively. The retear rate of 51.1% (24/47) in Group I was significantly higher than 14.3% (8/56) in Group D (P < .001). HbA1c levels measured 3-6 months after surgery (mean: 6.9; 95% CI: 6.6-7.3 vs mean: 6.5; 95% CI: 6.3-6.7, P= .034), and the proportion of group I and group D were significantly different (75%/25% vs 32.4%/67.6%, P < .001) between the retear and healing groups. Multivariable logistic regression analysis identified increased HbA1c as an independent risk factor for retear (odds ratio: 5.402; 95% CI: 2.072-14.086; P < .001). The glycemic control within 3-6 months after surgery when the healing process of the tendon was in progress had a significant effect on retear rate. In particular, the retear rate was higher when the HbA1c level increased at postoperative 3-6 months compared to before surgery. Retrospective case-control comparative study, Level III.

Efek Pemberian Metformin dan Metformin+Glimepiride terhadap Kadar HbA1c pada Pasien Diabetes Mellitus Tipe 2

Diabetes is a chronic metabolic disease and management of DM begins with a helthy lifestyle with early administration of antidiabetic drug. Metformin is the first line therapy in the management of DM. Combination therapy is given if blood sugar level and HbA1c level cannot be controlled with single therapy. This study aimed to determine the effect of giving metformin and metformin+glimepiride on HbA1c levels in DM2 patients. The inclusion criteria were patients DM, received oral antidiabetic at least 6 months, completed medical record, and can speak Indonesia. Exclusion criteria included DM patients receiving insulin therapy, TB patients, patients with mental disorders, and pregnant/breastfeeding women. Sociodemographic data, description of prescribing patterns, and achievement of HbA1c levels were described descriptively. Data analysis using the Wilcoxon test. Respondents in this study were 69 patients, dominated by women (71%). The types of therapy used were metformin (59.4%) and metformin+glimepiride (40.6%). Achievement of metformin + glimepiride HbA1c levels (67.9%), metformin (48.8%). The difference in decreasing HbA1c levels with metformin (-0.31%±0.38 mg/dL) and metformin+glimepiride -0.33%±0.54 mg/dL (p = 0.000). The results of the analysis showed that there is a significant effect of metformin alone on decreasing HbA1c levels and the addition of glimepiride (metformin + glimepiride) on reducing HbA1c levels in diabetes cannot be controlled with metformin. The implication of this study is as input for comprehensive management guidelines that can be used in an effort to reduce the prevalence of DM. Good management is needed to achieve therapeutic outcomes.

Effects of a 12-Month Hybrid (In-Person + Virtual) Education Program in the Glycemic Status of Arab Youth.

This 12-month school-based intervention study investigated the effects of hybrid educational lifestyle modifications on glycemic control among Saudi youth with different glycemic statuses. A total of 2600 Arab adolescents aged 12–18 years were recruited from 60 randomly selected schools. Anthropometrics, blood glucose, and HbA1c were measured pre- and post-intervention. Participants were grouped according to baseline HbA1c into normal, prediabetes, and diabetes groups. All participants received lifestyle education at base line and at every 3-month interval to improve diet and exercise behavior. Diabetic and prediabetic participants received a tailored lifestyle intervention. Post-intervention, 643 participants were analyzed as follows: 20 participants from the diabetes group, 39 from prediabetes, and 584 from the normal group. A modest but significant improvement in the glycemic status of diabetic and prediabetic participants was observed, but not in the normal group. In the diabetes group, 11 (55%) participants achieved normal HbA1c levels, 5 had prediabetes levels, and only 4 remained within diabetes HbA1c levels. In the prediabetes group, 34 (87.2%) participants achieved normal HbA1c levels, while 2 (5.1%) participants remained prediabetic and 3 (7.7%) had diabetes HbA1c levels (p < 0.001). This hybrid lifestyle intervention program modestly reduces the risk of T2DM among youth with elevated HbA1c levels. The challenge of sustaining interest in adopting lifestyle changes for a longer duration should be addressed in further studies in this population.

Metabolic characteristics in patients with COVID-19 and no-COVID-19 interstitial pneumonia with mild-to-moderate symptoms and similar radiological severity

Background and aimsIt is known that the highest COVID-19 mortality rates are among patients who develop severe COVID-19 pneumonia. However, despite the high sensitivity of chest CT scans for diagnosing COVID-19 in a screening population, the appearance of a chest CT is thought to have low diagnostic specificity. The aim of this retrospective case–control study is based on evaluation of clinical and radiological characteristics in patients with COVID-19 (n = 41) and no-COVID-19 interstitial pneumonia (n = 48) with mild-to-moderate symptoms. Methods and resultsTo this purpose we compared radiological, clinical, biochemical, inflammatory, and metabolic characteristics, as well as clinical outcomes, between the two groups. Notably, we found similar radiological severity of pneumonia, which we quantified using a disease score based on a high-resolution computed tomography scan (COVID-19 = 18.6 ± 14.5 vs n-COVID-19 = 23.2 ± 15.2, p = 0.289), and comparable biochemical and inflammatory characteristics. However, among patients without diabetes, we observed that COVID-19 patients had significantly higher levels of HbA1c than n-COVID-19 patients (COVID-19 = 41.5 ± 2.6 vs n-COVID-19 = 38.4 ± 5.1, p = 0.012). After adjusting for age, sex, and BMI, we found that HbA1c levels were significantly associated with the risk of COVID-19 pneumonia (odds ratio = 1.234 [95%CI = 1.051–1.449], p = 0.010). ConclusionsIn this retrospective case–control study, we found similar radiological and clinical characteristics in patients with COVID-19 and n-COVID-19 pneumonia with mild-to-moderate symptoms. However, among patients without diabetes HbA1c levels were higher in COVID-19 patients than in no-COVID-19 individuals. Future studies should assess whether reducing transient hyperglycemia in individuals without overt diabetes may lower the risk of SARS-CoV-2 infection.

1037-P: Poor Adherence to Medication and High HbA1c Predict Risk of Amputation in Diabetes Mellitus: Historical Cohort Study Using a Nationwide Claims Database

Poor adherence to medication in diabetic patients leads to poor glycemic control. Previously we showed that HbA1c decreased by 0.2% with a 25% increase in medication adherence. Whether lower limb amputation is associated with medication adherence independent of or in combination with HbA1c levels in diabetes is unclear. We analyzed data from 16,590 patients with diabetes mellitus whose records on oral hypoglycemic agents were available for at least 1 year. Adherence was evaluated by the proportion of days covered (PDC), with PDC <80% defined as poor adherence. Lower limb amputation was identified by 10 codes and medical procedures. Cox regression model identified variables related to incidence of amputation. In a mean follow-up of 5.3 years, 22 amputation events occurred (0.25/1000 person-years). Multivariate Cox regression analysis indicated that HbA1c level and PDC were independently associated with incidence of amputation (HR (95%CI) 1.19 (0.92-1.54), 0.11 (0.02-0.38)). Compared with PDC ≥80% and HbA1c <8.0%, PDC <80% and HbA1c ≥8.0% had a risk of amputation approximately 5 times higher (Figure). PDC ≥80% and HbA1c <8.0% may present a lower risk of lower limb amputation through enhanced treatment. The combination of PDC and HbA1c values may lead to a more stratified approach to reduce risk of lower limb amputation.View largeDownload slideView largeDownload slide DisclosureM. Kaneko: None. K. Fujihara: None. M. H. Yamada: None. Y. Yaguchi: None. M. Yamamoto: None. M. Kitazawa: None. S. Kodama: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.

EXPLORING THE INTERRELATIONSHIP BETWEEN ELECTROLYTES, ANEMIA, AND GLYCOSYLATED HEMOGLOBIN (HBA1C) LEVELS IN TYPE 2 DIABETICS

Objective: The aim of this study is to analyze the interrelationship and pattern of electrolyte imbalance and compare the correlation between serum electrolytes, glycosylated hemoglobin (HbA1C), and hemoglobin (Hb) levels between Type 2 diabetic patients and non-diabetic subjects.Methods: This study was conducted in 300 subjects (150 diabetics and 150 non-diabetics) and further categorized as anemic and non-anemic within each group. Blood samples were analyzed for HbA1C, hemoglobin, and serum electrolyte levels.Results: Sodium (Na+) levels in diabetics were significantly lower and potassium (K+) as well as chloride (Cl−) levels were significantly higher, when compared with non-diabetics. A significant positive correlation between HbA1C and potassium as well as chloride levels in contrast to negative correlation with sodium levels was observed in both genders. Among diabetics with anemia, we found significantly lower sodium and higher potassium and chloride.Conclusion: In diabetics, levels of sodium were significantly lower, and potassium as well as chloride was significantly higher when compared with non-diabetics. Our study clearly demonstrates an association between electrolytes, hemoglobin, and HbA1C levels in diabetes. This insight should pave the way for pathophysiology-directed therapy, thus contributing to the avoidance of several deleterious effects associated with electrolyte disorders and their treatment.

RELATIONSHIP BETWEEN OXIDANT AND ANTIOXIDANT ENZYMES STATUS IN TYPE 2 DIABETIC PATIENTS WITH NEPHROPATHY IN SAUDI POPULATION.

Objective: Oxidative stress has crucial role in pathogenesis of diabetic complications. Diabetic nephropathy (DN) is an important microvascular complication of diabetes and is widely recognized as the most common cause of the end-stage renal disease (ESRD) seen in clinical practice. Chemically, oxidative stress occurs as a result of increased levels of lipid peroxides and free radical intermediates, as well as a decrease in the total antioxidant capacity. This study analyzed the relationships between oxidant and antioxidant markers of DN in patients with type 2 diabetes mellitus (T2DM).Methods: A descriptive study was taken during the period from November 2016 to August 2017. The present study included 53 patients suffering from T2DM without nephropathy and 51 patients T2DM with nephropathy along with 69 age- and sex-matched healthy controls. Various biochemical parameters, antioxidant enzymes, and malondialdehyde (MDA) levels were measured and compared.Results: The glycosylated hemoglobin (HbA1c), urea, creatinine, microalbuminuria, and MDA levels were significantly increased (p&lt;0.001), and antioxidant enzyme activities such as glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CTL) were significantly decreased (p&lt;0.001) in T2DM with nephropathy patients followed by T2DM without nephropathy and control groups. There were a good negative correlations of HbA1c and GPx (r=−0.79), SOD (r=−0.61) and CTL (r=−0.74) (p≤0.05), whereas there was an excellent positive correlation of MDA concentration (r=0.85, p≤0.05) with HbA1c levels in diabetes with nephropathy.Conclusion: The study illustrated that, in diabetic patients, there is an increased concentration of lipid peroxides which may contribute to decreased levels of cellular antioxidant enzymes, further leading to T2DM with nephropathy. Hence, monitoring of these antioxidant enzymes and microalbuminuria parameters in the early stage of diabetic patients could be vital importance in possible preventing further development of complications. We suggest potential and new multiproperty antioxidants therapy as one of the most important treatment strategies for diabetic patients without nephropathy for the prevention and slowing of diabetic with nephropathy before reaching to ESRD.

EXPLORING THE INTERRELATIONSHIP BETWEEN ELECTROLYTES, ANEMIA, AND GLYCOSYLATED HEMOGLOBIN (HBA1C) LEVELS IN TYPE 2 DIABETICS

Objective: The aim of this study is to analyze the interrelationship and pattern of electrolyte imbalance and compare the correlation between serum electrolytes, glycosylated hemoglobin (HbA1C), and hemoglobin (Hb) levels between Type 2 diabetic patients and non-diabetic subjects.Methods: This study was conducted in 300 subjects (150 diabetics and 150 non-diabetics) and further categorized as anemic and non-anemic within each group. Blood samples were analyzed for HbA1C, hemoglobin, and serum electrolyte levels.Results: Sodium (Na+) levels in diabetics were significantly lower and potassium (K+) as well as chloride (Cl−) levels were significantly higher, when compared with non-diabetics. A significant positive correlation between HbA1C and potassium as well as chloride levels in contrast to negative correlation with sodium levels was observed in both genders. Among diabetics with anemia, we found significantly lower sodium and higher potassium and chloride.Conclusion: In diabetics, levels of sodium were significantly lower, and potassium as well as chloride was significantly higher when compared with non-diabetics. Our study clearly demonstrates an association between electrolytes, hemoglobin, and HbA1C levels in diabetes. This insight should pave the way for pathophysiology-directed therapy, thus contributing to the avoidance of several deleterious effects associated with electrolyte disorders and their treatment.

RELATIONSHIP BETWEEN OXIDANT AND ANTIOXIDANT ENZYMES STATUS IN TYPE 2 DIABETIC PATIENTS WITH NEPHROPATHY IN SAUDI POPULATION.

Objective: Oxidative stress has crucial role in pathogenesis of diabetic complications. Diabetic nephropathy (DN) is an important microvascular complication of diabetes and is widely recognized as the most common cause of the end-stage renal disease (ESRD) seen in clinical practice. Chemically, oxidative stress occurs as a result of increased levels of lipid peroxides and free radical intermediates, as well as a decrease in the total antioxidant capacity. This study analyzed the relationships between oxidant and antioxidant markers of DN in patients with type 2 diabetes mellitus (T2DM).Methods: A descriptive study was taken during the period from November 2016 to August 2017. The present study included 53 patients suffering from T2DM without nephropathy and 51 patients T2DM with nephropathy along with 69 age- and sex-matched healthy controls. Various biochemical parameters, antioxidant enzymes, and malondialdehyde (MDA) levels were measured and compared.Results: The glycosylated hemoglobin (HbA1c), urea, creatinine, microalbuminuria, and MDA levels were significantly increased (p&lt;0.001), and antioxidant enzyme activities such as glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CTL) were significantly decreased (p&lt;0.001) in T2DM with nephropathy patients followed by T2DM without nephropathy and control groups. There were a good negative correlations of HbA1c and GPx (r=−0.79), SOD (r=−0.61) and CTL (r=−0.74) (p≤0.05), whereas there was an excellent positive correlation of MDA concentration (r=0.85, p≤0.05) with HbA1c levels in diabetes with nephropathy.Conclusion: The study illustrated that, in diabetic patients, there is an increased concentration of lipid peroxides which may contribute to decreased levels of cellular antioxidant enzymes, further leading to T2DM with nephropathy. Hence, monitoring of these antioxidant enzymes and microalbuminuria parameters in the early stage of diabetic patients could be vital importance in possible preventing further development of complications. We suggest potential and new multiproperty antioxidants therapy as one of the most important treatment strategies for diabetic patients without nephropathy for the prevention and slowing of diabetic with nephropathy before reaching to ESRD.

Targeted Screening Reveals High Numbers of Prediabetes and Diabetes Mellitus in Moshi, Tanzania

Objective: Chronic non-communicable diseases, such as type 2 diabetes mellitus, have become global major health problems. In the United Republic of Tanzania, previous studies showed diabetes prevalences ranging from 0.6% to 5.8% and of pre-diabetes, from 9.1% to 10.6%. The pre-diabetes screening procedure described here was a targeted screening to recruit eligible subjects for a subsequent dietary intervention in Moshi, Tanzania. Methods: The pre-diabetes screening procedure described here was used to identify subjects for a dietary intervention in Moshi, Tanzania. Main enrollment criteria for participants were fasting plasma glucose levels of 5.6- 6.9 mmol/L (100-125 mg/dL) on two days or on one day plus HbA1c in the range of 5.7-7.5% (39-58% mmol/mol), body mass index of 27-35 kg/m2, and age between 30-65 years. Results: Through pre-screening of a total of 1,256 people were examined for BMI and age; 382 people were further screened for markers of pre-diabetes. Following ADA and WHO-criteria, 51% (73%) had normal, 35% (13%) pre-diabetic, and 15% (15%) diabetic fasting plasma glucose levels. Among the individuals with hyperglycemia indicating diabetes mellitus, 60% were unaware of their condition. Applying ADA criteria for HbA1c to all people, 42% had normal, 42% had pre-diabetic, and 16% had diabetic HbA1c levels. Identified risk factors for increased fasting plasma glucose were age, waist circumference, body mass index, and a family history of diabetes mellitus. Conclusion: Although the screening sample was not representative for the study area’s population and not diagnostic, the high rates of pre-diabetic and diabetic fasting plasma glucose levels are of public health concern. The low concordance between the data for FPG and HbA1c requires further investigation, as well as the discrepancy between ADA and WHO definitions of impaired fasting glucose.

Chlorophytum borivilianum (Safed Musli) root extract prevents impairment in characteristics and elevation of oxidative stress in sperm of streptozotocin-induced adult male diabetic Wistar rats.

BackgroundWe hypothesized that C. borivilianum root, known to improve male reproductive performance, prevents impairment in characteristics, morphology and elevation of oxidative stress in sperm of diabetics. We therefore investigated the effect of aqueous root extract of C. borivilianum on these parameters in diabetic rat model.MethodsC. borivilianum root aqueous extract (250 and 500 mg/kg/day) or glibenclamide (600 μg/kg/day) were administered to streptozotocin (STZ)-induced diabetic male rats for 28 consecutive days. At the end of treatment, animals were sacrificed and sperm were collected. Sperm count and percentages of forward motility, viability, hypoosmotic swelling (HOS) tail-coiled and abnormal sperm were evaluated. Sperm lipid peroxidation product (LPO), hydrogen peroxide (H2O2) and nitric oxide (NO) levels, total antioxidant capacity (TAC), activity levels of endogenous antioxidant enzymes (superoxide dismutase-SOD, catalase-CAT and glutathione peroxidase-GPx), epididymal sperm density, serum fasting blood glucose (FBG) and HbA1c levels were measured. The expression of sperm caspase-3 was assessed. Meanwhile, in-vitro free radical scavenging activity of C. borivilianum root extract was determined and the root extract was analyzed for the presence of bioactive compounds by FTIR spectroscopy.ResultsC. borivilianum root aqueous extract prevents the decrease in sperm count, percentages of forward motility, viability, HOS and the increase in abnormal sperm percentage and caspase-3 level in diabetic rats. Sperm LPO, H2O2 and NO levels, FBG and HbA1c were lower while TAC, SOD, CAT, GPx and epididymal sperm density were higher in diabetic rats receiving C. borivilianum root extract treatment. C. borivilianum root exhibited strong in-vitro free radical scavenging activity which may be due to the phenolic compound.ConclusionsC. borivilianum root extract prevents impairment in sperm characteristics and morphology via preventing elevation of oxidative stress, apoptosis and free radicals levels of the sperm in diabetes. These effects may be achieved through maintaining sperm antioxidant level which could be related to free radical scavenging activity of the root extract by phenolic compounds. These effects could also be due to ability of the extract to maintain near normal serum FBG and HBA1c levels in diabetes.

Relationship Between Obesity and Diabetes in a US Adult Population: Findings from the National Health and Nutrition Examination Survey, 1999–2006

BackgroundObesity is one of the most important modifiable risk factors for the prevention of type 2 diabetes. The aim of this study was to examine the prevalence of diabetes with increasing severity of obesity and the distribution of HbA1c levels in diabetics participating in the latest National Health and Nutrition Examination Survey (NHANES).MethodsData from a representative sample of adults with diabetes participating in the NHANES between 1999 and 2006 were reviewed. The prevalence of diabetes and levels of fasting glucose, insulin, c-peptide, and HbA1c were examined across different weight classes with normal weight, overweight, and obesity classes 1, 2, and 3 were defined as body mass index (BMI) of <25.0, 25.0–29.9, 30.0–34.9, 35.0–39.9, and equal to 40.0, respectively. The distribution of HbA1c levels among adults with diabetes was also examined.ResultsThere were 2,894 adults with diabetes (13.6%) among the 21,205 surveyed participants. Among the adults with diabetes, the mean age was 59 years, the mean fasting glucose was 155 ± 2 mg/dl, and the mean HbA1c was 7.2%; 80.3% of diabetics were considered overweight (BMI ≥ 25) and 49.1% of diabetics were considered obese (BMI ≥ 30). The prevalence of adults with diabetes increased with increasing weight classes, from 8% for normal weight individuals to 43% for individuals with obesity class 3; the distribution of HbA1c levels were considered as good (<7.0%) in 60%, fair (7.0–8.0%) in 17%, and poor (>8.0%) in 23%. The mean fasting glucose and HbA1c levels were highest for diabetics with BMI <25.0, suggesting a state of higher severity of disease. Mean insulin and c-peptide levels were highest for diabetics with BMI = 35.0, suggesting a state of insulin resistance.ConclusionsIn a nationally representative sample of US adults, the prevalence of diabetes increases with increasing weight classes. Nearly one fourth of adults with diabetes have poor glycemic control and nearly half of adult diabetics are considered obese suggesting that weight loss is an important intervention in an effort to reduce the impact of diabetes on the health care system.

Gastric Bypass Lowers HbA1c Levels in Diabetes

Gastric Bypass Lowers HbA1c Levels in Diabetes

Gastric Bypass Reduces HbA1c Levels in Diabetes

Gastric Bypass Reduces HbA1c Levels in Diabetes

Muraglitazar may reduce HbA1c levels in diabetes

Muraglitazar may reduce HbA1c levels in diabetes

Glycemic control in diabetes in three Danish counties

Hemoglobin A1c (HbA1c) is a proxy measure for glycemic control in diabetes. We investigated the trend for glycemic control in patients from three Danish counties using HbA1c measurements. We studied 2454 patients from a population of 807,000 inhabitants for whom routine monitoring of diabetes using HbA1c-DCCT aligned was initiated in 2001. We estimated the incidence of monitored patients in the population. The progress in patients with originally diabetic HbA1c levels was investigated by cumulative probability plots, and the individual trend in clinical outcome was investigated by a modified difference plot. The age-standardized incidence of monitored patients was <0.5% in all regions. Patients with diabetic first HbA1c concentrations (>or=6.62% HbA1c) showed on average 15% improved glycemic control in the first year. Further improvement was limited. The overall percentage above the treatment target (>or=6.62% HbA1c) was 51% in 2003 compared to 59% in 2001, and the percentage with poor glycemic control (>or=10.0% HbA1c) was reduced from 19% to 4%. Of patients with originally diabetic HbA1c levels, 15% showed progress in glycemic control, and 28% reached treatment targets. In patients with originally normal HbA1c, 75% showed an upward trend in HbA1c levels, which reached diabetic concentrations in 17%. Patients with diabetic first HbA1c concentrations (>or=6.62% HbA1c) showed on average 15% improved glycemic control in the first year. Further improvement was limited. In individual patients, 75% with originally diabetic HbA1c levels showed improved glycemic control after 3 years, while 78% with originally normal concentrations showed an upward trend in HbA1c levels.

IDL can stimulate atherogenic gene expression in cultured human vascular endothelial cells

Previously, we have reported that the lipoprotein fraction containing intermediate density lipoprotein (IDL) and low density lipoprotein (LDL) isolated from diabetics stimulates an atherogenic cytokine in cultured endothelial cells. To study which lipoprotein fraction isolated from diabetics can modulate the gene expression in endothelial cells, we isolated IDL and LDL fractions from 14 type 2 diabetics and seven age- and BMI- adjusted non-diabetics. We measured the effects of the lipoproteins on mRNA expression of atherogenic molecules in cultured endothelial cells. We found that the IDL fraction stimulated monocyte chemoattractant protein-1 (MCP-1) mRNA expression in endothelial cells as time- and dose-dependent fashions, while the LDL fraction was not effective. IDL isolated from diabetics also increased not only platelet-derived growth factor B-chain, but also intercellular adhesion molecule-1 mRNA contents. Furthermore, the HbA 1c levels in diabetics were significantly correlated with their abilities of IDL to increase MCP-1 mRNA content in the cells and the increment coincided with the increase in MCP-1 protein release into culture media. These results indicate that qualitative as well as quantitative changes in IDL fraction in diabetes are atherogenic through stimulating gene expression of atherogenic molecules in endothelial cells.