Elevated HbA1c Levels Research Articles

1087-P: Managing Diabetes in the Delta—Effect of Access to Endocrinology Services in an Underserved Area

Background: The Mississippi Delta has one of the highest rates of diabetes in the nation, but patients in these rural, minority-majority counties have lower access to specialty care. At the start of a hybrid diabetes management program at two rural health clinics in the Delta, 53.1% of patients with diabetes had uncontrolled HbA1c levels. We analyze the specific effect of integrating endocrinology specialists into this intervention. Patients could access this care via telemedicine or in-person. Methods: We conducted a quasi-experimental study with clinical data from electronic health records for patients diagnosed with diabetes or prediabetes (aged ≥ 18). We followed two cohorts of the same patients over time for the first 18 months of the program, each matched on elevated HbA1c levels (≥8% at baseline). The treatment group comprised program participants; the control group comprised general clinic patients at-risk of diabetes. We also followed patients in the treatment group who received endocrine services in addition to other program benefits. Results: Among the control group, HbA1c increased an average of 0.04 points; the treatment group saw an average decrease of 0.42 points. The treatment group's endocrinology subset saw an even greater decrease of 0.85 points. The average HbA1c score for this group went down three points in a two-year period (7/20-7/22). Conclusions: The study results indicate that receiving coordinated endocrinology services has been especially effective in reducing HbA1c levels among program participants. As care continuity is associated with better glycemic control for diabetic patients, sustained program participation will likely help the patient population best manage their diabetes and avoid further adverse health outcomes. Additionally, as this diabetes program takes place in a rural, low-income minority area with low access to specialty care, the results demonstrate promising practices for strengthening the rural health care system. Disclosure C.Brindley: None. W.James: None. J.R.Bennett: None. K.F.Matthews: None. Funding Health Resources and Services Administration, Federal Office of Rural Health Policy (HRSA-20-025, D06RH37500)

Relevance of oxidative stress biomarkers, hemoglobin A1c, troponin-I, and angiotensin-converting enzyme metabolism to blood pressure in acute myocardial infarction: a case-control study

ABSTRACTThe aim was to investigate this relationship by calculating 1) the correlation between peak troponin-C (peak-cTnI), levels of oxidative stress biomarkers, including lipid peroxidation products (malondialdehyde (MDA), conjugated dienes (CD)), and antioxidant enzyme activity (glutathione peroxidase (GPx)), and HbA1c and 2) the correlation between HbA1c and serum angiotensin-converting enzyme (ACE) activity, and its impact on the rate pressure product (RPP) in acute myocardial infarction (AMI). A case-control study was performed in 306 AMI patients having undergone coronary angiography and on 410 controls. GPx activity was reduced in association with increased MDA and CD in patients. Peak-cTnI was positively correlated with HbA1c, MDA, and CD levels. Serum ACE activity was negatively correlated with GPx. HbA1c was positively correlated with ACE activity and RPP. Linear regression analysis showed that peak-cTnI, ACE activity and HbA1c are significant predictors of AMI. Elevated HbA1c and peak-cTnI levels are associated with RPP elevation causing AMI. In conclusions, patients with elevated HbA1c, elevated ACE activity and cTnI are at increased risk of AMI with increasing RPP. Patients at risk of AMI can be identified at an early stage if the biomarkers HbA1c, ACE activity, and cTnI are measured and preventive measures are taken in a targeted manner.

Association of Preoperative Hba1c Level with Incidence of New-Onset Atrial Fibrillation during Early Postoperative Period after On-Pump Coronary Artery Bypass Grafting Surgery in Diabetic Patients

Introduction: Atrial fibrillation (AF) is a common complication following coronary artery bypass grafting (CABG) surgery, particularly in diabetic patients. Elevated preoperative HbA1c levels have been suggested as a potential risk factor for postoperative AF; however, the association remains unclear. This study aimed to investigate the association between preoperative HbA1c levels and the incidence of new-onset atrial fibrillation during the early postoperative period in diabetic patients undergoing on-pump CABG surgery in Bangladesh. Methods: This observational cross-sectional study was conducted at the Department of Cardiac Surgery, National Institute of Cardiovascular Disease, Dhaka, Bangladesh. A total of 60 diabetic patients undergoing on-pump CABG were included and divided into two groups: Group-1 (HbA1c <7%, n=30) and Group-2 (HbA1c ≥7%, n=30). Data were collected using a preformed data collection sheet, and statistical analysis was performed using the chi-square test, Fisher's test, and student's t-test. Result: In this study, Group-1 (HbA1c <7%) consisted of 30 patients, while Group-2 (HbA1c ≥7%) also comprised 30 patients. The mean age of Group-1 was 58.50±6.80 years, and that of Group-2 was 50.53±6.01 years (p < 0.001). The distribution of preoperative variables such as single, double, and triple vessel disease, hypertension, history of antiarrhythmic drug use, and NYHA class III and IV showed no significant differences between the groups (p > 0.05). However, preoperative HbA1c levels were significantly different between the two groups (6.11±0.44 in Group-1 vs. 7.98±0.55 in Group-2, p < 0.001). The incidence of new-onset atrial fibrillation during the early postoperative period was significantly higher in Group-2 (63.33%) than in Group-1 (30.00%, p < 0.05). A significant association was also observed between postoperative atrial fibrillation and hypertension (p < 0.05). Patients in Group-2 experienced a higher rate of postoperative complications, .......

Assessment of Serum Electrolytes and Glycated Hemoglobin Level in Non-diabetic Iron-Deficient Anaemic Patients.

The WHO has recognised iron deficiency anaemia (IDA) as the most common nutritional deficiency in the world, with 30% of the population being affected by this condition. The patient's glycemic status during the past three months is shown by the glycated haemoglobin A1C (HbA1c) test. According to several studies, iron deficiency can increase HbA1C levels without affecting blood sugar levels. HbA1C levels of≥6.5% have been approved by the American Diabetes Association (ADA) as a diagnostic indicator for diabetes mellitus (DM). An imbalance in serum electrolyte levels and anaemia havebeenlinked by several studies. Aim: To analyze the effect of iron deficiency anaemia on HbA1c levels and serum electrolytes in an adult non-diabetic population. This was a descriptive cross-sectional studyconducted in Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India from January 2021 to June 2022. A total of 65 moderate to severe normoglycemic iron deficiency anemia patients between 18 to 75 years were enrolled in the studyafter fulfilling inclusion and exclusion criteria. A detailed history, clinical and biochemical examination was performed including HbA1c levels. The results were pooled and statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY, USA). We found elevated HbA1c levels (5.67±1.1%) in non-diabetic iron-deficient anaemia individuals, and elevation was more in women of reproductive age group (30.8%). There was a statistically significant Spearman negative correlation between hemoglobin and HbA1C levels. Also, 16 patients had hyponatremia with a mean haemoglobin (Hb) of 4.8 g/dL and one patient had hyperkalemia with a mean Hb of 3.2 g/dL which was statistically non-significant. In this study haemoglobin and HbA1c had a statistically significant positive correlation with serum sodium and a negative correlation with serum potassium in moderate to severely iron-deficient anaemic patients, especially females of the reproductive age group.

Factors Indicating a Bad Prognosis in Patients of Emphysematous Pyelonephritis with Diabetes

Aim: To evaluate our experience with emphysematous pyelonephritis in a tertiary care facility and to describe our approach. Study design: Cross-sectional retrospective study Place and duration of study: Dept of Urology, Shaikh Zayed Hospital, Lahore from 1st January 2017 to 31st December 2020. Methodology: Thirty six patients who died of emphysematous pyelonephritis out of the 976 patients and between 34-82 years were enrolled. Used classification systems include Wan and Huang. We examined potential predictive indicators for mortality as well as the clinical and treatment characteristics of these patients. Results: There were 2.27 female for every male. Poor prognosis is correlated with advanced grade. The biggest number of unfavourable prognostic variables is accounted for by deranged HbA1C 27.8% and advanced grades 33.3%. However, DIC causing thrombocytopenia 13.9% and hypotensive shock 13.9% are significant causes of mortality in emphysematous pyelonephritis. The low protein content 11.1% has the lowest mortality risk. The most frequent clinical signs were tachycardia in 14, fever in 9, pyuria in 8 and flank pain in 5 patients. Conclusion: Advanced Huang and Tseng Classification grade is the principal reason for death in our study, followed by shock, hypoprotenemia, DIC-induced thrombocytopenia, and elevated HbA1C levels. Keywords: Emphysematous pyelonephritis, Diabetes, Prognostic factor

Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus

BackgroundFluid retention and endothelial dysfunction have been related to use of nonsteroidal anti-inflammatory drugs (NSAIDs), and type 2 diabetes mellitus (T2DM) has been linked to both a decline in kidney function and subclinical cardiomyopathy. ObjectivesThe authors hypothesized that short-term use of NSAIDs could lead to subsequent development of incident heart failure (HF) in patients with T2DM. MethodsUsing nationwide Danish registers, we identified patients diagnosed with T2DM during 1998 to 2021 and included patients without previous HF, rheumatic disease, or use of NSAIDs 120 days before diagnosis. Associations between NSAIDs and first-time HF hospitalization were investigated using a case-crossover design with 28-day exposure windows, and ORs with 95% CIs were reported. ResultsIncluded were 331,189 patients with T2DM: 44.2% female, median age of 62 years (IQR: 52-71 years); 23,308 patients were hospitalized with HF during follow-up, and 16% of patients claimed at least 1 NSAID prescription within 1 year. Short-term use of NSAIDs was associated with increased risk of HF hospitalization (OR: 1.43; 95% CI: 1.27-1.63), most notably in subgroups with age ≥80 years (OR: 1.78; 95% CI: 1.39-2.28), elevated hemoglobin (Hb) A1c levels treated with 0 to 1 antidiabetic drug (OR: 1.68; 95% CI: 1.00-2.88), and without previous use of NSAIDs (OR: 2.71; 95% CI: 1.78-4.23). ConclusionsNSAIDs were widely used and were associated with an increased risk of first-time HF hospitalization in patients with T2DM. Patients with advanced age, elevated HbA1c levels, and new users of NSAID seemed more susceptible. These findings could guide physicians prescribing NSAIDs.

Monocyte response in myocardial infarction in patients with type 2 diabetes

Aim. To reveal the features of monocyte response in myocardial infarction (MI) in pa­­tients with type 2 diabetes (T2D).Material and methods. The study included 121 patients with MI and T2D as follows: 76 — with target glycated hemoglobin (HbA1c), 45 — with elevated HbA1c values. In addition to the standard examination, all patients underwent a blood test for HbA1c on day 1 of MI, while on days 1, 3, 5, and 12±1, monocyte subpopulations were assessed by flow cytometry.Results. Patients with target HbA1c were older than patients with elevated HbA1c levels. In the group with target HbA1c, the number of CD16(+) monocytes on the 1st day of MI was significantly higher: 61,38 (39,2; 100,08) cells/µl vs 35,7 (28,98; 40,33) cells/µl, p=0,03; on the 3rd day of MI, the number of "intermediate" CD14(+)CD16(+) monocytes was higher: 74,82 (71,78; 83,2) cells/µl vs 25,90 (14,04; 57,12) cells/µl, p=0,03, while the CD16(-) to CD16(+) monocyte ratio on the 3rd day of MI was lower: 8,32 (6 ,87; 10,03) vs 10,81 (8,90; 21,10), p=0,04. At the same time, in the group of patients with target HbA1c values, the level of CD16(+) monocytes on the 3rd day of MI was significantly higher in patients aged <71 years compared with patients ≥71 years: 104,55 (63,64; 149,7) cells/µl vs 55,20 (36,92; 76,59) cells/µl, p=0,03.Conclusion. In patients with T2D and target HbA1c values, compared with patients with elevated HbA1c, the inflammatory response in MI is associated with higher levels of CD16(+) monocytes on days 1 and 3 of MI, which is more typical for people aged <71 years.

Preoperative HbA1c and Blood Glucose Measurements in Diabetes Mellitus before Oral Surgery and Implantology Treatments

Diabetes mellitus has become a worldwide epidemic and is frequently accompanied by a number of complications proportional to the duration of hyperglycemia. The aim of this narrative review is to assess the most up-to-date guidelines on DM provided by both diabetes and dental associations. Furthermore, to gather evidence on the uni/bidirectional relationships of elevated HbA1c levels on dental surgery, implantology, bone augmentation, and periodontology and to demonstrate the importance of measuring HbA1c levels before invasive dental treatments. HbA1c and blood glucose measurements are a minimally invasive method for preventing complications in diabetes mellitus. The authors conducted a literature review to determine which oral conditions are affected by diabetes mellitus. MEDLINE served as a source with the use of a specific search key. Regarding oral complications of diabetes, prevention is the most vital factor. With this publication, we hope to assist physicians and dentists to make prompt diagnoses and to help in recognizing various oral manifestations of diabetes and follow the existing guidelines.

"Pesto" Mutation: Phenotypic and Genotypic Characteristics of Eight GCK/MODY Ligurian Patients.

Maturity Onset Diabetes of the Young (MODY) is a monogenic form of diabetes mellitus (DM) that accounts for around 2-5% of all types of diabetes. Autosomal dominant inheritance in pathogenic variations of 14 genes related to β-cell functions can lead to monogenic types of diabetes. In Italy, GCK/MODY is the most frequent form and it is caused by mutations of the glucokinase (GCK). Patients with GCK/MODY usually have stable mild fasting hyperglycaemia with mildly elevated HbA1c levels and rarely need pharmacological treatment. Molecular analysis of the GCK coding exons was carried out by Sanger sequencing in eight Italian patients. All the probands were found to be heterozygous carriers of a pathogenic gross insertion/deletion c.1279_1358delinsTTACA; p.Ser426_Ala454delinsLeuGln. It was previously described for the first time by our group in a large cohort of Italian GCK/MODY patients. The higher levels of HbA1c (6.57% vs. 6.1%), and the higher percentage of patients requiring insulin therapy (25% vs. 2%) compared to the previously studied Italian patients with GCK/MODY, suggest that the mutation discovered could be responsible for a clinically worse form of GCK/MODY. Moreover, as all the patients carrying this variant share an origin from the same geographic area (Liguria), we postulate a possible founder effect and we propose to name it the "pesto" mutation.

A comparative study to assess the blood sugar level of post Covid patients with diabetes patients and non diabetic clients

Background: The present study aims to compare and assess the blood sugar level among post COVID patients with diabetes patient and non diabetic clients in Saveetha Medical College and Hospital. Material and Methods: The quantitative approach with comparative study was conducted in host institution of Saveetha Medical College and Hospital. A total of 30 participants were recruited using Non-probability convenient sampling technique based on the inclusion criteria, the demographic and clinical data was collected by using structured questionnaire and the HbA1c test was used to assess the blood sugar level among the patients during post COVID period of time. Result: The outcome results identified that the mean score of HbA1c among post COVID diabetic patients was 9.82±3.22 and the mean score of HbA1c among post COVID non-diabetic patients was 5.83±3.32. The mean difference score was 3.99. The calculated Student Independent ‘t’ test value of t = 3.345 was found to be statistically significant t p<0.001 level. This clearly infers that there was significant difference in the level of HbA1c among post COVID diabetic and non-diabetic patients in which post COVID diabetic patients had elevated HbA1c level than the non-diabetic patients. Conclusion: This study concluded that there was significant difference in the blood sugar level among the post COVID diabetic patients and non diabetic patients. Overall, the understanding of Post COVID Syndrome is improving however further research is needed for future references .In particular, patients with diabetes would require care in glycemic and risk factor control to prevent the development and severity of Post COVID Syndrome. Data on bidirectional adverse effects of diabetes and PCS are clearly needed.

Study of Cutaneous Manifestations and Nail fold Capillaroscopic findings in Diabetes Mellitus and their correlation with Diabetic Retinopathy and Nephropathy- A Cross Sectional Observational Study

Objective: Long-term diabetes can lead to complications including diabetic macro- and microangiopathy. Capillaroscopy is a non-invasive method to evaluate capillary microvasculature which can be used to demonstrate changes in capillary microarchitecture noted in diabetic microangiopathy. The objective of this study was to study cutaneous manifestations of diabetes mellitus (DM), nailfold capillaroscopic changes due to diabetic microangiopathy, as well as to determine association between nailfold capillaroscopy (NFC) and cutaneous manifestations due to DM. Materials and Methods: Two hundred cases suffering from type 2 DM having cutaneous manifestations were enrolled in the study. Patients with autoimmune diseases, smokers and on long-term corticosteroids were excluded from the study. Detailed history was taken and the cutaneous manifestations related to type 2 DM were noted. NFC was done for all ten fingers of all patients. Additional investigations including HbA1c, urine microalbumin and fasting lipid profile were performed. Results: Out of 200 cases, 88 showed positive findings on NFC with the most common finding being altered tortuosity (seen in 85.2% cases). Chi-square test was done to demonstrate association between duration of DM and NFC which showed P-value of 0.027, which is statistically significant. Of the cases having nailfold capillaroscopic findings, 69/88 (78.4%) were found to have elevated HbA1C levels, 57/88 (57.9%) were found to have changes of diabetic retinopathy and 56/88 (63.6%) were found to have changes of diabetic nephropathy. Conclusion: NFC can provide key data for determination of vascular damage in diabetic patients and, thus, allows evaluation of progression of the disease making this technique a potential future utility in microvascular disease evaluation.

Elevated serum HbA1c level, rather than previous history of diabetes, predicts the disease severity and clinical outcomes of acute pancreatitis

IntroductionThe aim of our study is to explore the value of serum glycosylated hemoglobin A1c (HbA1c) in disease severity and clinical outcomes of acute pancreatitis (AP).Research design and MethodsPatients with...

Preoperatively elevated HbA1c levels can meaningfully improve following total joint arthroplasty.

Prior literature has demonstrated that diabetic (DM) patients undergoing total joint arthroplasty (TJA) with elevated preoperative HbA1c scores have poorer clinical outcomes. However, no literature has reported the effect of undergoing TJA on laboratory markers of glycemic control. This study sought to evaluate effect of undergoing TJA on postoperative glycemic control and outcomes. This retrospective study reviewed all patients with DM who underwent primary, elective TJA at our high volume orthopedic institution. Included patients had at least one HbA1c value 3months to 2weeks pre-surgery and 3-6months after surgery. Changes in HbA1c from before to after surgery were calculated. Change in HbA1c greater than 1.0% was considered clinically meaningful. Change in HbA1c was analyzed and stratified into subgroups. In total, 770 primary TJA patients were included. Patients with preoperative HbA1c > 7% vs. ≤ 7% were significantly more likely to have clinically meaningful post-TJA decrease in HbA1c (24.5 vs. 2.9%, p < 0.001). Patients with preoperative HbA1c > 8 were significantly more likely to have decrease of > 2.0 compared to those with HbA1c < 8 (p < 0.001). Multivariate regression revealed that preop HbA1c > 7.0, former and current smokers, males, and African-Americans were significantly more likely to achieve clinically meaningful decrease in HbA1c. Additionally, postoperative increase in HbA1c > 1% was associated with significantly higher 90-day ED visits. Patients with higher preoperative HbA1c were more likely to have clinically meaningful decreases in HbA1c postoperatively. A combination of preoperative medical optimization and improvements in mobility after TJA may play a role in these changes. Those with elevated HbA1c can have meaningful improvement in HbA1c after TJA.

Clinical characteristics of 683 children and adolescents, aged 0–18 years, newly diagnosed with type 1 diabetes mellitus in Henan Province: a single-center study

BackgroundType 1 diabetes mellitus (T1DM) is a common chronic systemic disease that threatens the health of children worldwide. Diabetic ketoacidosis (DKA) is the most severe acute complication of diabetes and can lead to death. This study aimed to explore the epidemiological features, clinical manifestations, and risk factors for DKA in children and adolescents newly diagnosed with T1DM in the Department of Endocrinology of the Children’s Hospital of Henan Province.MethodsMedical records of 683 children and adolescents newly diagnosed with T1DM in our center from March 2014 to November 2021 were retrospectively analyzed. The data included the general condition, laboratory indexes, and clinical symptoms. The patients were divided into three groups according to age: Group I, 0–3 years; Group II, 4–9 years; and Group III, 10–18 years.ResultsThe incidence of DKA was 62.96% and was highest in Group I. Group I had the lowest C-peptide and hemoglobin A1c, but the highest blood glucose at first diagnosis, and 25-hydroxyvitamin D3 levels, hospitalization lengths, and medical costs. 25.5% of the children were delayed in diagnosis. Logistic regression analysis showed that elevated HbA1c levels and hyperglycemia were independent risk factors for DKA. On the other hand, C-peptide and 25- hydroxyvitamin D were protective factors for DKA.ConclusionsThe incidence of DKA among children and adolescents in the Henan Province is very high. Moreover, DKA can be easily delayed in diagnosis. Newly diagnosed infants with T1DM are more likely to present with DKA, suffer more severe metabolic disorders, endure longer hospital stays, and accrue higher medical costs.

Impact of glycosylated hemoglobin on early neurological deterioration in acute mild ischemic stroke patients treated with intravenous thrombolysis.

In patients with acute mild ischemic stroke treated with intravenous thrombolysis, the relationship between chronic hyperglycemic status and their early neurological deterioration (END) and clinical outcomes is unclear. We attempted to analyze the relationship between glycated hemoglobin (HbA1c) levels and END and 90-day functional outcomes. The research comprised 267 patients with acute mild ischemic stroke. The incidence of END and functional outcomes at 90 days were evaluated between subgroups. END was defined in this study as a rise of at least 1 point in the National Institutes of Health Stroke Scale (NIHSS) score within 72 h of admission, with an excellent outcome of a modified Rankin Scale (mRS) score of 0-1 at 90 days following stroke beginning. The association between HbA1c and END, and clinical outcomes in patients with mild stroke, was assessed by logistic regression after adjusting for confounding factors. In addition, we used receiver operating characteristic (ROC) curves to predict the predictive value of HbA1c for the incidence of END. There were 38 patients who suffered END and 105 patients who had disabled functional outcomes at 90 days. In multivariate analysis, elevated HbA1c levels were associated with END (adjusted OR = 1.476; 95% CI: 1.129-1.928; p = 0.004). With HbA1c greater than 7.75%, the ROC curve predicted a higher risk of END. However, they were not associated with patients' functional outcomes at 90 days. HbA1c levels were an independent predictor of END in patients with mild stroke, while there was no effect on functional outcomes at 90 days. The impact of HbA1c on functional prognosis may be a contributing factor rather than a direct factor.

RELATIONSHIP BETWEEN HbA1C AND eGFR IN DIABETES MELLITUS (DM) PATIENTS FOLLOWING PROLANIS AT ULTRA MEDICA TULUNGAGUNG CLINIC LABORATORY

Diabetes mellitus is a condition of abnormal blood glucose metabolism characterized by prolonged hyperglycemia and elevated HbA1c levels as a standard test for diabetes mellitus. HbA1c describes the level of sugar in the blood for the last 3 months. One of the complications of diabetes mellitus is kidney damage. The state of kidney function can be described from the GFR (Glomerular Filtration Rate) examination as a standard examination for abnormalities in kidney disease. The purpose of this study was to determine the relationship between HbA1c levels and eGFR values ​​in people with diabetes mellitus. The design of this study was a cross-sectional approach to 30 samples of DM patients who took Prolanis at the Ultra Medica Tulungagung Clinical Laboratory. The results showed that the average HbA1c level in all samples was 6.2% and the average eGFR value was 88.7 ml/min/1, 73m2. The Pearson correlation test obtained a ρ value = 0.000 so that it can be concluded that there is a relationship between HbA1c levels and eGFR values ​​in people with diabetes mellitus who take Prolanis at the Ultra Medica Clinical Laboratory Tulungagung.

Health and wellbeing in refugee families from Syria resettled in Denmark

AimsThe aim was to evaluate self-reported health status and wellbeing in a well-defined group of refugee families from Syria 2–4 years after resettlement in Denmark, and, where possible, compare it with a Danish reference population. The purpose was to determine the need for specialized health care to resettled refugees. MethodsThis cross-sectional study involved 90 individuals from Syria aged 13–56 years. We used questionnaire survey to assess the general health and wellbeing in the study population in relation to a Danish reference population. Objective measurements of selected health indicators like overweight, hypertension and levels of cholesterol and blood glucose (HbA1c) were also determined for the study population. ResultsMean wellbeing scores and the proportion of study participants rating their health as good were lower among the study participants compared with the Danish population for all age groups. The proportion of participants who reported often being alone against their will was significantly higher than among Danes, as was the proportion who had nobody to talk to when having problems. A significantly higher proportion of participants experienced various forms of pain or discomfort than in the Danish population. Overall, 23.6% and 3.4% of participants had elevated cholesterol and HbA1c levels, respectively, and the prevalence of overweight (BMI ≥ 25) was 70%. Hypertension was more frequent (16.2%) than in another refugee population in Denmark (9%). ConclusionsThe study demonstrated various mental and physical health challenges among the Syrian refugee families, and their health and wellbeing appeared to be substantially poorer as compared to the Danish reference population. The findings emphasize the need for systematic and specialized health care services at a municipality level to resettling refugees as a prerequisite for the refugees to become contributing citizens.

Elevated HbA1c level associated with disease severity and surgical extension in diabetic foot patients.

Diabetic foot is a complex syndrome that is associated with other diabetic complications, such as peripheral arte-rial disease and peripheral neuropathy. Optimization of plasma glucose and glycated hemoglobin (HbA1c) is one of the main principles of standard care and treatment approaches in individuals with diabetes mellitus (DM). In this study, the relationship of HbA1c level at the time of diagnosis was evaluated with diabetic foot disease severity score and surgical extension in patients with Type 2 DM. This study included 301 consecutive patients who were diagnosed with diabetic foot in the general surgery diabetic foot clinic and were hospitalized for surgery. The relationships between the HbA1c levels of the patients with the Wagner and PEDIS (Perfusion, Extent, Dept, Infection, Sensation) classification system grades, and the surgical procedures performed were analyzed and the treatment outcomes were evaluated. It was determined that there was a 90% statistically significant relationship between HbA1c values of ≥10.1% and the de-velopment of Wagner Grade 4 diabetic foot ulcer (DFU) (P=0.037). A strong statistically significant relationship at the rate of 85% was determined between HbA1c values of ≥10.1% and the development of PEDIS Grade 3 ulcers. As the HbA1c values increased, so there was determined to be a statistically significant relationship with the development of PEDIS Grade 3 ulcer (P=0.003). In the comparison of the HbA1c values according to the type of surgery performed, a weak relationship was determined at the rate of 26%, and it was determined that as the HbA1c values increased, so there could be an increase in the amputation level. The results of this study showed that as HbA1c values at diagnosis increased in patients with diabetic foot; Wagner/PEDIS grades, disease severity, surgical extension, amputation level, and tissue loss increased. To reduce the severity of diabetic foot disease and prevent amputation, compliance with diabetic treatment and glycemic control should be increased.

Continuous Glucose Monitoring in Non-Insulin Type 2 Diabetes

Abstract Diabetes mellitus, a global health concern, is characterized by complex pathophysiology and presents diverse clinical challenges. Effective management of diabetes hinges on key principles such as glycemic control, lifestyle modifications, and adherence. In non-insulin-requiring Type 2 diabetes (T2D), persistent elevated HbA1c levels remain a challenge. Continuous glucose monitoring (CGM) is pivotal, serving as a cornerstone for optimizing therapy, mitigating hypoglycemia, and reducing the financial burden. Unlike traditional self-monitoring of blood glucose (SMBG), CGM offers continuous, pain-free data, aiding treatment decisions. This review explores CGM’s multifaceted role in non-insulin requiring T2D, scrutinizing HbA1c reduction, glycemic variability, time in range (TIR), exercise, dietary management, early comorbidity detection, and cost-effectiveness. CGM empowers users to monitor and manage their glycemic levels, making it an effective tool for HbA1c reduction. Glycemic variability poses risks, and CGM provides valuable metrics like time below range (TBR), time in range (TIR), and time above range (TAR). CGM effectively minimizes glycemic variability and improves TIR in non-insulin requiring T2D. Additionally, CGM aids in real-time decision-making for physical activity and dietary choices, enhancing the effectiveness of lifestyle modifications. It also assists healthcare providers in identifying early signs of comorbidities, particularly cardiovascular disease, and diabetic retinopathy, through monitoring glycemic variability. While CGM devices may incur costs, studies suggest their cost-effectiveness, considering long-term benefits and complications prevention. This review underscores CGM’s importance in T2D management, even for non-insulin-requiring individuals. Recommendations include CGM use for newly diagnosed people with T2D, those with uncontrolled diabetes, and those adjusting treatments. Personalized glycemic control goals are proposed, aligning CGM’s role in managing hypoglycemia, hyperglycemia, and glycemic variability in T2D. As CGM technology advances and becomes more accessible, it is poised to play an increasingly pivotal role in diabetes management. Crucially, CGM should be employed in consultation with healthcare providers, considering regional disparities in cost-effectiveness and accessibility influenced by insurance coverage and government interventions.

ASSOCIATION OF INTRAOCULAR PRESSURE AND HYPERGLYCEMIC LEVEL IN DIABETIC PATIENTS

Background- To determine whether hyperglycemic levels as determined from high hemoglobin A1c (HbA1c) levels inuence intraocular pressure (IOP) in patients with non-proliferative diabetic retinopathy (NPDR). Methods-Across sectional Study was performed on subjects with a diagnosis of NPDR and a corresponding HbA1c level measured within 90 days before or after an IOP measurement. Exclusion criteria included a diagnosis of glaucoma or treatment with IOP lowering medications or oral or topical steroids. Results- Mean Hb1Ac in low IOP patients(&lt;14.5) was 8.67±2.14% and high IOP patients was (&gt;14.5) was 9.12±3.02%. Conclusion- In conclusion our ndings in this study showed that diabetic subjects with elevated HbA1c levels exhibited signicantly higher IOPs compared to those with lower HbA1c levels.