Elevated Levels Of HbA1c Research Articles

Fasting glucose and HbA1c levels as risk factors for the presence of intracranial atherosclerotic stenosis.

Intracranial atherosclerotic stenosis (ICAS) is the most common cause of stroke, but the relationship of ICAS with fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) is unclear. This study aimed to investigate the effects of increased FBG and HbA1c concentration on ICAS. A total of 4,012 patients aged over 40 years who underwent cerebral magnetic resonance angiography (MRA) were enrolled in this study, including 1,434 non-stroke controls and 2,578 patients with ischemic stroke. Participants were classified into four groups according to stroke and ICAS status. ICAS was defined as the presence of ≥50% stenosis in any intracranial artery. Multivariate regression analysis was used to evaluate the associations of FBG and HbA1c with ICAS. Levels of fasting glucose and HbA1c in patients with ICAS were significantly higher than those in patients without ICAS among both stroke and non-stroke groups. Multivariate regression analysis showed that elevated levels of fasting glucose (OR 1.14, 95% CI, 1.11-1.18, P<0.001) and HbA1c (OR 1.22, 95% CI, 1.16-1.28, P<0.001) were independent risk factors for ICAS. In addition, patients with the DM (FBG ≥7.0 mmol/L) were at the high risk of ICAS in both non-stroke (OR 2.90, 95% CI, 2.11-3.99, P<0.001) and stroke (OR 1.99, 95% CI, 1.67-2.39, P<0.001) groups. Besides, subjects with the high risk of ICAS were found in the fourth HbA1c quartile in both non-stroke (OR 3.50, 95% CI, 2.23-5.61, P<0.001) and stroke (OR 1.98, 95% CI, 1.50-2.63, P<0.001) groups. The results suggest that elevated fasting glucose and HbA1c levels are associated with high risk for ICAS.

Risk Factors for Atrial Fibrillation in People With Type 1 Diabetes: An Observational Cohort Study of 36,258 Patients From the Swedish National Diabetes Registry.

This study identified variables associated with increased risk of atrial fibrillation in people with type 1 diabetes. We performed a cohort study of people with type 1 diabetes from the Swedish National Diabetes Registry followed up between 1 January 2001 and 31 December 2013. Median follow-up was 9.7 years (interquartile range 5.2-13.0). The association between potential risk factors and incident atrial fibrillation was investigated using adjusted Cox regression. To compare the impact of each risk factor, the gradient of risk per 1 SD was estimated. In this cohort of 36,258 patients with type 1 diabetes, 749 developed atrial fibrillation during follow-up. Older age, male sex, renal complications, increased BMI and HbA1c, coronary artery disease, heart failure, and heart valve disease increased the risk of atrial fibrillation. Age, signs of renal dysfunction with macroalbuminuria, and decreasing estimated glomerular filtration rate were associated with the highest gradient of risk for atrial fibrillation. High blood pressure, severe obesity (BMI >35 kg/m2), and elevated levels of HbA1c (>9.6%) were associated with increased risk, but no associations were found with hyperlipidemia or smoking. The most prominent risk factors for atrial fibrillation in people with type 1 diabetes were older age, cardiovascular comorbidities, and renal complications, while obesity, hypertension, and hyperglycemia had more modest affects.

Short and long-term prognostic value of admission glycosylated hemoglobin and plasma glucose in nondiabetic patients with acute myocardial infarction

In nondiabetic patients with acute myocardial infarction (AMI), acute hyperglycemia is associated with high-risk of cardiovascular (CV) mortality but the prognostic value of glycosylated haemoglobin (HbA 1c ) remains uncertain. In a large observational study, we aimed to identify the prognostic values of admission HbA1c and plasma glucose for acute MI in non-diabetic patients regarding in-hospital and one-year CV mortality. From the RICO survey database all the consecutive non-diabetic patients with AMI ( N = 6884) from January 2001 to June 2016 were included. Cut off levels (high/low) were determined by ROC curve analysis for the prediction of CV one-year death (HbA 1c : 5.9% and glucose: 156 mg/dL) to set up 4 groups: low HbA 1c /low glucose ( N = 3849), low HbA 1c /high glucose ( N = 734), high HbA 1c /low glucose ( N = 1802) and high HbA 1c /high glucose ( N = 499). Elevation of glucose or HbA1c was associated with elevated rate of hospital mortality, when compared to all other groups ( Fig. 1 ). By multivariate logistic regression analysis, only high glucose remains a prognostic factor of hospital death (OR(95%CI): 1.59 (1.16–2.17)). In survivors at discharge, group with elevated levels of both plasma glucose and HbA 1c had a higher rate of one-year CV mortality compared to all other groups ( P < 0.001). High HbA 1c was an independent predictive factor of one-year CV mortality, beyond high glucose (OR(95%CI): 1.75(1.35–2.27) and 1.98(1.49–2.61), respectively) and covariates ( Fig. 1 ). In our large population-based study in nondiabetic patients with AMI, high levels of admission HbA 1c and/or plasma glucose give different prognostic information and were associated with increased risk of mortality at short or long-term. Early mortality risk was mainly driven by acute hyperglycemia and one-year mortality by HbA 1c , independently of plasma glucose. Our findings may help identifying high-risk patients to target for aggressive secondary prevention after AMI.

Short and long-term prognostic value of admission glycosylated hemoglobin and plasma glucose in nondiabetic patients with acute myocardial infarction

In nondiabetic patients with acute myocardial infarction (AMI), acute hyperglycemia is associated with high risk of cardiovascular (CV) mortality but the prognostic value of glycosylated hemoglobin (HbA1c) remains uncertain. In a large observational study, we aimed to identify the prognostic values of admission HbA1c and plasma glucose for acute MI in nondiabetic patients regarding in-hospital and one-year CV mortality. From the RICO survey database all the consecutive nondiabetic patients with AMI ( n = 6884) from January 2001 to June 2016 were included. Cut off levels (high/low) were determined by ROC curve analysis for the prediction of CV one-year death (HbA1c: 5.9% and glucose: 156 mg/dL) to set up 4 groups: low HbA1c/low glucose ( n = 3849), low HbA1c/high glucose ( n = 734), high HbA1c/low glucose ( n = 1802) and high HbA1c/high glucose ( n = 499). Elevation of glucose or HbA1c was associated with elevated rate of hospital mortality, when compared to all other groups ( Fig. 1 ). By multivariate logistic regression analysis, only high glucose remains a prognostic factor of hospital death [OR(95% CI): 1.59 (1.16–2.17)]. In survivors at discharge, group with elevated levels of both plasma glucose and HbA1c had a higher rate of one-year CV mortality compared to all other groups ( P < 0.001). High HbA1c was an independent predictive factor of one-year CV mortality, beyond high glucose [OR(95% CI): 1.75 (1.35–2.27) and 1.98 (1.49–2.61), respectively] and covariates ( Fig. 1 ). In our large population-based study in nondiabetic patients with AMI, high levels of admission HbA1c and/or plasma glucose give different prognostic information and were associated with increased risk of mortality at short or long term. Early mortality risk was mainly driven by acute hyperglycemia and one-year mortality by HbA1c, independently of plasma glucose. Our findings may help identifying high-risk patients to target for aggressive secondary prevention after AMI.

A Study of hypogonadism in type 2 Diabetes Mellitus male patients attending Shebin ElKoum Teaching Hospital- Egypt

Objective To the objective of this article is to evaluate serum-free testosterone levels as an indicator of hypogonadism in male patients with type 2 diabetes mellitus (DM). Background DM is considered to be one of the most common chronic diseases. Male hypogonadism is characterized by low levels of serum testosterone and is closely linked to the development of diabetes. Patients and methods This study included 80 individuals recruited from the Internal Medicine Department of Shebin El-Kom Teaching Hospital, Menoufia, Egypt. They were classified into: a case group which included 40 patients of type 2 DM in the age group of 30–65 years and a control group which included 40 healthy control persons matched for age and sex. After providing written informed consent, all patients were clinically evaluated, had routine laboratory investigations and assessment of glycated hemoglobin% (HbA1c%) and free testosterone and those who had low levels of free testosterone underwent assessment of the circulating levels of the follicle-stimulating hormone and luteinizing hormone. Results There was significant difference between the two groups regarding the presence of erectile dysfunction and hypogonadism as their percentages were increased in the case group. A comparison between diabetic patients with hypogonadism and diabetic patients with eugonadism regarding HbA1c has shown that diabetic patients with hypogonadism had significant elevated levels of HbA1c. Conclusion This study demonstrates the presence of a significant relationship between type 2 DM and presence of hypogonadism and erectile dysfunction in men.

Prognostic Implications of Single-Sample Confirmatory Testing for Undiagnosed Diabetes: A Prospective Cohort Study.

Current clinical definitions of diabetes require repeated blood work to confirm elevated levels of glucose or hemoglobin A1c (HbA1c) to reduce the possibility of a false-positive diagnosis. Whether 2 different tests from a single blood sample provide adequate confirmation is uncertain. To examine the prognostic performance of a single-sample confirmatory definition of undiagnosed diabetes. Prospective cohort study. The ARIC (Atherosclerosis Risk in Communities) study. 13346 ARIC participants (12268 without diagnosed diabetes) with 25 years of follow-up for incident diabetes, cardiovascular outcomes, kidney disease, and mortality. Confirmed undiagnosed diabetes was defined as elevated levels of fasting glucose (≥7.0 mmol/L [≥126 mg/dL]) and HbA1c (≥6.5%) from a single blood sample. Among 12268 participants without diagnosed diabetes, 978 had elevated levels of fasting glucose or HbA1c at baseline (1990 to 1992). Among these, 39% had both (confirmed undiagnosed diabetes), whereas 61% had only 1 elevated measure (unconfirmed undiagnosed diabetes). The confirmatory definition had moderate sensitivity (54.9%) but high specificity (98.1%) for identification of diabetes cases diagnosed during the first 5 years of follow-up, with specificity increasing to 99.6% by 15 years. The 15-year positive predictive value was 88.7% compared with 71.1% for unconfirmed cases. Confirmed undiagnosed diabetes was significantly associated with cardiovascular and kidney disease and mortality, with stronger associations than unconfirmed diabetes. Lack of repeated measurements of fasting glucose and HbA1c. A single-sample confirmatory definition of diabetes had a high positive predictive value for subsequent diagnosis and was strongly associated with clinical end points. Our results support the clinical utility of using a combination of elevated fasting glucose and HbA1c levels from a single blood sample to identify undiagnosed diabetes in the population. National Institute of Diabetes and Digestive and Kidney Diseases and National Heart, Lung, and Blood Institute.

The Potential Role of PTPN-22 C1858T Gene Polymorphism in the Pathogenesis of Type 1 Diabetes in Saudi Population

ABSTRACTBackground: Recent investigations have reported an association between protein tyrosine phosphatase non-receptor type-22 (PTPN-22) gene polymorphism and susceptibility to the development of type 1 diabetes (T1D) in some populations and not in others. In this study, we aimed to investigate the association of PTPN-22 C1858T polymorphism with T1D in Saudi children.Methods: A cohort of 372 type 1 diabetic children and 372 diabetes-free subjects was enrolled in the current investigation. The PTPN-22 C1858T polymorphism was identified using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.Results: Our data showed that the frequency of CT and TT genotypes of PTPN-22 C1858T was higher in T1D children (17.7% and 4.3%, respectively) compared to healthy controls (4.8% and 1.6%, respectively), and both genotypes were statistically associated with T1D patients (OR = 4.4, 95% CI: 2.55–7.58, p < 0.001; and OR = 3.2, 95% CI: 1.23–8.28, p = 0.017, respectively). Moreover, the 1858T allele was significantly associated with T1D patients compared to the C allele (OR = 3.2, 95% CI: 1.59–6.88, p < 0.001). In addition, the T allele was significantly associated with elevated levels of HbA1c, anti-GAD, and anti-insulin antibodies (p < 0.001) and a lower concentration of C-peptide (p < 0.001) in T1D children.Conclusion: The data presented here suggests that the T allele of PTPN-22 C1858T polymorphism might be a risk factor for T1D development in Saudi children.

Exposure to perchlorate, nitrate and thiocyanate, and prevalence of diabetes mellitus.

It is known that perchlorate, nitrate and thiocyanate have the property of inhibiting sodium iodide symporter. Animal studies have suggested that these compounds, especially perchlorate, might also interfere with insulin secretion. However, the association between their exposure and diabetes risk is largely unknown in humans. Among 11 443 participants (mean age 42.3 years) from the National Health and Nutritional Examination Survey 2001-14, urinary perchlorate, nitrate and thiocyanate were measured by using ion chromatography coupled with electrospray tandem mass spectrometry. Diabetes was defined as self-reported doctor diagnosis, use of oral hypoglycaemic medication or insulin, fasting plasma glucose ≥ 126 mg/dl or glycated haemoglobin A1c (HbA1c) ≥ 6.5%. The median (interquartile range) levels of urinary perchlorate, nitrate and thiocyanate were 3.32 (1.84, 5.70) μg/l, 46.4 (27.9, 72.0) mg/l and 1.23 (0.59, 2.78) mg/l, respectively. Higher levels of urinary perchlorate were associated with elevated levels of fasting glucose, HbA1c, insulin and homeostatic model assessment of insulin resistance (all Ptrend < 0.001). After multivariate adjustment including urinary creatinine, smoking status and body mass index (BMI), higher urinary perchlorate, but not nitrate or thiocyanate, was associated with an increased prevalence of diabetes mellitus. Comparing extreme quintiles, the odds ratio (95% confidence interval) of diabetes was 1.53 (1.21, 1.93; Ptrend < 0.001) for perchlorate, 1.01 (0.77, 1.32; Ptrend = 0.44) for nitrate and 0.98 (0.73, 1.31; Ptrend = 0.64) for thiocyanate. When urinary perchlorate, nitrate and thiocyanate were further mutually adjusted, the results did not materially change. Similar results were observed when analyses were stratified by smoking status, as well as by age, gender, kidney function and BMI. Higher urinary perchlorate levels are associated with an increased prevalence of diabetes mellitus, independent of traditional risk factors. Future prospective studies are needed to confirm these findings.

Показники глікемічних профілей крові в осіб із цукровим діабетом, що зазнали малоінвазивного лікування з приводу уретеролітіазу

The objective: to study the state of the glycemic profile in patients with ureterolithiasis and concomitant diabetes mellitus (DM) who underwent various methods of minimally invasive surgical treatment. Patients and methods. The study involved 204 people, 130 (63.7%) men and 74 (36.3%) women, the average age – 34.6±5.5 years. Subjects were divided into VI clinical groups: I – persons with diabetes and ureterolithiasis, who underwent TUСL and CS therapy per os (n=57); II – persons with DM and ureterolithiasis, who underwent TUСL without HS therapy (n=44); III – persons with DM and ureterolithiasis who were treated with ECU without HS therapy (n=32); IV – persons with ureterolithiasis without diabetes who underwent TUСL without HS therapy (n=41); V (control 1) – of the person with diabetes, who had an independent passage of stones from the ureter (n=18); VI (control 2) – healthy volunteers, with no signs of pathology (n=12). The diagnosis of ureterolithiasis was verified using clinico-anamnestic, laboratory and instrumental methods of investigation, according to the MHP protocols, before and after the disintegration of the stones by the method of transurethral contact lithotripsy (TUСL) and ESWL. Results. Elevated levels of HbA1c indicated chronic hyperglycemia for a long time, with the presence of violations of carbohydrate homeostasis and the need for its correction before and during surgery for ureterolithiasis. At this minimally invasive treatment of ureterolithiasis, the presence of an operational injury factor, with manifestations of permanent obstruction in the upper urinary tract (ESWL operation) did not contribute to a decrease in glucose levels in plasma and urine, unlike states with rapid elimination of acute calculous process (TUCL operation). Conclusion. Assistance to patients with diabetes mellitus, which is planned surgical treatment, allows to improve the condition of patients in the postoperative period and reduce the risk of postoperative сomplications. Key words: ureterolithiasis, diabetes mellitus, glycosylated hemoglobin, glucosuria, minimally invasive methods of lithotripsy.

Advanced glycation end products in children with type 1 diabetes and early reduced diastolic heart function

BackgroundReduced diastolic function is an early sign of diabetes cardiomyopathy in adults and is associated with elevated levels of HbA1c and advanced glycation end products (AGEs).ObjectiveTo assess the associations between early reduced diastolic function and elevated levels of HbA1c and AGEs in children and adolescents with type 1 diabetes (T1D).MethodsOne hundred fourty six T1D patients (age 8–18 years) without known diabetic complications were examined with tissue Doppler imaging and stratified into two groups according to diastolic function. A clinical examination and ultrasound of the common carotid arteries were performed. Methylglyoxal-derived hydroimidazolone-1 (MG-H1) was measured by immunoassay.ResultsAt inclusion, 36 (25%) participants were stratified into a low diastolic function group (E’/A’-ratio < 2.0). Compared to the rest of the T1D children, these participants had higher body mass index (BMI), 22.8 (SD = 4.0) vs. 20.1 (SD = 3.4) kg/m2, p < 0.001, higher systolic blood pressure 104.2 (SD = 8.7) vs. 99.7 (SD = 9.3) mmHg, p = 0.010, and higher diastolic blood pressure, 63.6 (SD = 8.3) vs. 59.9 (SD = 7.9) mmHg, p = 0.016. The distensibility coefficient was lower, 0.035 (SD = 0.010) vs. 0.042 (SD = 0.02) kPa−1, p = 0.013, Young’s modulus higher, 429 (SD = 106) vs. 365 (SD = 143), p = 0.009, and MG-H1 higher, 163.9 (SD = 39.2) vs. 150.3 (SD = 33.4) U/ml, p = 0.046. There was no difference in carotid intima-media thickness between the groups. There were no associations between reduced diastolic function and years from diagnosis, HBA1c, mean HBA1c, CRP or calculated glycemic burden. Logistic regression analysis showed that BMI was an independent risk factor for E’/A’-ratio as well as a non-significant, but relatively large effect size for MG-H1, indicating a possible role for AGEs.ConclusionsEarly signs of reduced diastolic function in children and adolescents with T1D had higher BMI, but not higher HbA1c. They also had elevated serum levels of the advanced glycation end product MG-H1, higher blood pressure and increased stiffness of the common carotid artery, but these associations did not reach statistical significance when tested in a logistic regression model.

Long-term outcome and risk assessment in premature acute myocardial infarction: A 10-year follow-up study

BackgroundPremature acute myocardial infarction (AMI) is a rare disease carrying significant morbidity and mortality. Existing data on outcome in these patients is based on retrospective analysis of angiographic reports or refer to time periods with incomparable treatment regimes, making them unusable for risk assessment in times of widespread use of reperfusion therapy. Aim of this study was to assess the outcome of premature AMI in a prospectively recruited study population enrolled in the times of modern reperfusion therapy. MethodsWe included 102 consecutive AMI survivors (≤40years) in this prospective multicentre study. Outcome was assessed via retrieval query of the Austrian Death Registry and the centralized patient management system of Vienna. ResultsDuring a median follow up time of 10.3years (IQR:8.9–11.1), 23% of all patients experienced MACE, of those 6% died, 17% experienced re-AMI and 5% patients an ischemic stroke. Furthermore, forty patients underwent cardiac re-catheterization and twenty-five needed recurrent revascularization. MACE were associated among the classic cardiovascular risk factors with elevated levels of HbA1c (adj. HR 1.32; 95%CI 1.06–1.64; P=0.012), total cholesterol (adj. HR 2.16; 95%CI 1.27–3.48; P=0.004), and c-reactive protein (adj. HR 1.67; 95%CI 1.29–2.17; P=0–003) for an increase of 1-standard deviation. ConclusionAlthough myocardial re-infarction was the driving force of morbidity in premature myocardial infarction, we observed an excellent long-term survival opposed to previous reports. We found that persistence risk factors rather than the clinical risk profile at baseline influences the outcome in these patients, emphasizing the importance of secondary prevention in young patients after AMI.

Prevalence of high HbA1c levels in Brazilian adolescents: The Study of Cardiovascular Risk in Adolescents.

To evaluate the prevalence of elevated glycated haemoglobin (HbA1c) levels in a population of adolescents participating in the Study of Cardiovascular Risk in Adolescents. This is a school-based cross-sectional study based on a complex sample of adolescents 12-17years old representative at the national and macro-regional levels and for each Brazilian state capital. Blood was collected in schools and then evaluated in a single laboratory. HbA1c levels were considered elevated if ⩾5.7% (39mmol/mol) and were analyzed according to sex, age, macro-region, type of school, skin color, and nutritional status. Data from 37,804 adolescents were analyzed. The mean level of HbA1c was 5.4% (95%CI 5.4-5.4) (36mmol/mol [95%CI 36-36]), and 20.5% (95%CI 19.1-22.0) of adolescents presented values ⩾5.7% (⩾39mmol/mol). Among males, 23.6% (95%CI 21.8-25.6) showed elevated HbA1c levels compared to 17.5% (95%CI 15.9-19.2) observed in females. The prevalence of elevated levels of HbA1c was higher in adolescents with black skin color (27.6%; 95%CI 23.2-32.4) vs. white skin color (16.9%; 95%CI 15.4-18.5), and higher in those who studied in public schools (21.6%; 95%CI 20.0-23.4) vs. private schools (16.7%; 95%CI 14.7-19.0). Among obese adolescents, 29.7% (95%CI 25.4-34.3) had elevated levels of HbA1c, compared to 19.3% (95%CI 18.0-20.7) in normal weight students and 19.7% (95%CI 17.1-22.6) in overweight adolescents. Obese male adolescents of lower socioeconomic status had a higher prevalence of elevated HbA1c levels. Our findings highlight the importance of focusing on this high risk group for interventions to prevent diabetes.

Reduced Venous Compliance in Young Women with Type 1 Diabetes - Further Aggravated by Prolonged Elevated Levels of HbA1c.

Young patients with diabetes present with reduced compensatory responses to hypovolemic stress. Less compliant veins could be a contributing factor, since roughly two-thirds of the blood volume resides in the venous system as a blood reservoir, adjusting proper venous inflow to the heart. The aim of this study was to measure venous compliance and lower limb blood pooling during hypovolemic stress, and to correlate them to indices of diabetes severity and glucose control. Fifteen young women with type 1 diabetes (DW) and 18 healthy age-matched women (C) were subjected to lower body negative pressure (LBNP) (11-44 mmHg), creating hypovolemic stress. Lower limb blood pooling was measured with strain gage technique and venous compliance calculated as the relationship between ∆V/∆P. DW presented with reduced blood pooling (e.g., blood pooling during LBNP of 44 mmHg, DW, 1.69 ± 0.10; C, 2.10 ± 0.08 (ml/100 ml), and P = 0.003). Calculated venous compliance was also reduced in DW (e.g., compliance at 20 mmHg, DW, 0.046 ± 0.003; C, 0.059 ± 0.002 (ml/100 ml/mmHg), and P = 0.002). A progressive reduction in both venous compliance (P < 0.007) and blood pooling (P < 0.005) was seen with increasing level of HbA1c, and furthermore, less strongly associated with presence of microvascular disease (signs of retinopathy). Women with type 1 diabetes present with both reduced venous compliance and blood pooling. The reductions were particularly present in patients with long-standing poor glycemic control.

Association between impaired fasting glycaemia in pediatric obesity and type 2 diabetes in young adulthood.

Objectives:In adults, impaired fasting glycemia (IFG) increases the risk for type 2 diabetes mellitus (T2DM). This study aimed to investigate to which extent children with obesity develop T2DM during early adulthood, and to determine whether IFG and elevated hemoglobin A1c (HbA1c) in obese children are risk markers for early development of T2DM.Methods:In this prospective cohort study, 1620 subjects from the Swedish Childhood Obesity Treatment Registry – BORIS who were ⩾18 years at follow-up and 8046 individuals in a population-based comparison group, matched on gender age and living area, were included. IFG was defined according to both ADA (cut-off 5.6 mmol l−1) and WHO (6.1 mmol l−1). Elevated HbA1c was defined according to ADA (cut-off 39 mmol l−1). Main outcome was T2DM medication, as a proxy for T2DM. Data on medications were retrieved from a national registry.Results:The childhood obesity cohort were 24 times more likely to receive T2DM medications in early adulthood compared with the comparison group (95% confidence interval (CI): 12.52–46). WHO-defined IFG predicted future use of T2DM medication with an adjusted hazard ratio (HR) of 3.73 (95% CI: 1.87–7.45) compared with those who had fasting glucose levels <5.6 mmol l−1. A fasting glucose level of 5.6–6.0 mmol l−1, that is, the IFG-interval added by American Diabetes Association (ADA), did not increase the use of T2DM medication more than pediatric obesity itself, adjusted HR=1.72 (0.84–3.52). Elevated levels of HbA1c resulted in an adjusted HR=3.12 (1.50–6.52). More severe degree of obesity also increased the future T2DM risk.CONCLUSION:IFG according to WHO and elevated HbA1c (39–48 mmol l−1), but not the additional fasting glucose interval added by ADA (5.6–6.0 mmol l−1), can be considered as prediabetes in the obese pediatric population in Sweden.

Associations between long-term exposure to ambient particulate air pollution and type 2 diabetes prevalence, blood glucose and glycosylated hemoglobin levels in China

BackgroundThe evidence for an association between particulate air pollution and type 2 diabetes mellitus (T2DM) in developing countries was very scarce. ObjectiveTo investigate the associations of long-term exposure to fine particulate matter (PM2.5) with T2DM prevalence and with fasting glucose and glycosylated hemoglobin (HbA1c) levels in China. MethodsThis is a cross-sectional study based on a nation-wide baseline survey of 11,847 adults who participated in the China Health and Retirement Longitudinal Study from June 2011 to March 2012. The average residential exposure to PM2.5 for each participant in the same period was estimated using a satellite-based spatial statistical model. We determined the association between PM2.5 and T2DM prevalence by multivariable logistic regression models. We also evaluated the association between PM2.5 and fasting glucose and HbA1c levels using multivariable linear regression models. Stratification analyses were conducted to explore potential effect modification. ResultsWe identified 1760 cases of T2DM, corresponding to 14.9% of the study population. The average PM2.5 exposure for all participants was 72.6μg/m3 during the study period. An interquartile range increase in PM2.5 (41.1μg/m3) was significantly associated with increased T2DM prevalence (prevalence ratio, PR=1.14), and elevated levels of fasting glucose (0.26mmol/L) and HbA1c (0.08%). The associations of PM2.5 with T2DM prevalence and with fasting glucose and HbA1c were stronger in several subgroups. ConclusionsThis nationwide cross-sectional study suggested that long-term exposure to PM2.5 might increase the risk of T2DM in China.

A lateral flow immunosensor for direct, sensitive, and highly selective detection of hemoglobin A1c in whole blood.

An immunosensor that operates based on the principles of lateral flow was developed for direct detection of hemoglobin A1c (HbA1c) in whole blood. We utilized colloidal gold-functionalized antibodies to transduce the specific signal generated when sandwich immuno-complexes were formed on the strip in the presence of HbA1c. The number and intensity of the test lines on the strips indicate normal, under control, and elevated levels of HbA1c. In addition, a linear relationship between HbA1c levels and immunosensor signal intensity was confirmed, with a dynamic range of 4-14% (20-130 mmol mol(-1)) HbA1c. Using this linear relationship, we determined the HbA1c levels in blood as a function of the signal intensity on the strips. Measurements were validated using the Bio-Rad Variant II HPLC and DCA Vantage tests. Moreover, the immunosensor was verified to be highly selective for detection of HbA1c against HbA0, glycated species of HbA0, and HbA2. The limit of detection was found to be 42.5 μg mL(-1) (1.35 mmol mol(-1)) HbA1c, which is reasonably sensitive compared to the values reported for microarray immunoassays. The shelf life of the immunosensor was estimated to be 1.4 months when stored at ambient temperature, indicating that the immunoassay is stable. Thus, the lateral flow immunosensor developed here was shown to be capable of performing selective, accurate, rapid, and stable detection of HbA1c in human blood samples.

The Relationship Between Chronic Inflammation and Glucidic-Lipidic Profile Disorders in Kidney Transplant Recipients

Abstract Introduction: Chronic inflammation has a proven role in atherogenesis, lipid profile parameters being related to cytokine production. In kidney transplant recipients, interleukin 6 (IL-6) is significantly associated with graft-related outcomes and also alterations of cholesterol and triglyceride metabolism. The aim of this study was to investigate the relationship between chronic inflammation and glucidic-lipidic metabolism disorders in a group of patients with kidney transplantation as renal replacement therapy. Methods: A prospective observational study which enrolled thirtysix non-diabetic kidney transplant recipients was conducted in the Nephrology and Peritoneal Dialysis Department, County Clinic Hospital of Tirgu Mures. The study group was divided as following: recipients with serum IL-6 concentration higher than 3.8 pg/ml (group A) and IL-6 within the normal range (group B). Results: Allograft recipients with higher serum IL-6 had significant higher erytrocyte sedimentation rate(ESR, p=0.0067). Patients with over-the-range levels of IL-6 had significant higher levels of serum cholesterol and LDL-cholesterol respectively (p=0.0242 and p=0.0081). Serum Apo-B was also significant higher in Group A than Group B. Protein excretion was significant higher in patients from group A (p=0.0013). No statistical significant relationship could be proven between elevated levels of IL-6 and hbA1c, insulin and glycosuria disturbances in the two groups. Also, we found no statistical significant association between resistivity and pulsatility indices (both hilum and intragraft) or carotid intima media thickness. Conclusion: Serum interleukin 6 is related to lipid profile disorders and less to glucidic metabolism anomalies in non-diabetic kidney transplant recipients.

Association of Exposure to Radio-Frequency Electromagnetic Field Radiation (RF-EMFR) Generated by Mobile Phone Base Stations with Glycated Hemoglobin (HbA1c) and Risk of Type 2 Diabetes Mellitus.

Installation of mobile phone base stations in residential areas has initiated public debate about possible adverse effects on human health. This study aimed to determine the association of exposure to radio frequency electromagnetic field radiation (RF-EMFR) generated by mobile phone base stations with glycated hemoglobin (HbA1c) and occurrence of type 2 diabetes mellitus. For this study, two different elementary schools (school-1 and school-2) were selected. We recruited 159 students in total; 96 male students from school-1, with age range 12–16 years, and 63 male students with age range 12–17 years from school-2. Mobile phone base stations with towers existed about 200 m away from the school buildings. RF-EMFR was measured inside both schools. In school-1, RF-EMFR was 9.601 nW/cm2 at frequency of 925 MHz, and students had been exposed to RF-EMFR for a duration of 6 h daily, five days in a week. In school-2, RF-EMFR was 1.909 nW/cm2 at frequency of 925 MHz and students had been exposed for 6 h daily, five days in a week. 5–6 mL blood was collected from all the students and HbA1c was measured by using a Dimension Xpand Plus Integrated Chemistry System, Siemens. The mean HbA1c for the students who were exposed to high RF-EMFR was significantly higher (5.44 ± 0.22) than the mean HbA1c for the students who were exposed to low RF-EMFR (5.32 ± 0.34) (p = 0.007). Moreover, students who were exposed to high RF-EMFR generated by MPBS had a significantly higher risk of type 2 diabetes mellitus (p = 0.016) relative to their counterparts who were exposed to low RF-EMFR. It is concluded that exposure to high RF-EMFR generated by MPBS is associated with elevated levels of HbA1c and risk of type 2 diabetes mellitus.

Возможности комплексной терапии пациентов c метаболическим синдромом на ранних стадиях его развития

This paper deals with the combination therapy of patients in the early stages of development of the metabolic syndrome (MS) according to the results of the survey and the 6-month treatment of 54 patients aged 20 to 55 years with a BMI ≥25 kg / m2 and signs of abdominal obesity. In the control group 15 of the surveyed persons with a BMI &amp;#60; 25,0 kg/m2 at age 20 to 50 years were included . According to the classification proposed in the recommendations of the experts of GFCF for the diagnosis and treatment of MS (2009), MS source in the group of patients with a BMI ≥ 25 kg/m2 was determined in 94.2% of cases. In this study the authors used laboratory examination, including general and biochemical blood tests to determine the level of glycated hemoglobin (Hb A1c), the concentration of magnesium and malondialdehyde (MDA) in serum levels of C-peptide immuno-reactive insulin (IRI) to the calculation of indices: HOMO IR, characterizing insulin resistance (IR) and Caro, which characterizes the degree of impairment of glucose uptake. The instrumental methods were measurement of blood pressure by auscultatory method, ECG, echocardiography, ultrasound of the abdomen, CGMS-monitoring of blood glucose levels. According to the obtained data in the studied group of patients with a BMI of 25 kg/m2 statistically significant increase in blood pressure, severe insulin resistance with compensatory hyper-insulinemia, elevated levels of Hb A1c were identified. It is established that the formation of overweight in 68.5% of cases is accompanied by hypomagnesemia and activation of oxidative stress&amp;#34;. It was confirmed by statistically significant increase in MDA content. Number of newly diagnosed diseases - hypertension, ischemic heart disease, diabetes type 2, NAFLD, patients with a BMI ≥ 25 kg/m2 was significantly higher than the con-trol, which confirms the dominant influence of overweight as a risk factor for CVD formation with impaired metabolism of glucose and lipids. To study the stages of development of MS in both groups of patients oral glu-cose tolerance test (PGT) was conducted. According to the obtained results, the patients of the studied group were divided into 3 subgroups (without carbohydrate metabolism, with IGT, with newly diagnosed type 2 diabe-tes). In the 1st subgroup concentrations of insulin and C-peptide at 30 min of the test was higher than in other subgroups and the control group, but this concentration was decreased to 120 minute test. In the 2nd subgroup of these indicators for 30 minutes were significantly lower and grew to 120 minute test. In the subgroup with newly diagnosed type 2 diabetes, this concentration of insulin and C-peptide at 30 min of the test was lower than in the control group, but the concentration was increased to 120 minute test. Monitoring blood glucose lev-els using the CGMS system helped to identify: in the 1st subgroup intermittent episodes of hyperglycemia to 5.5% daily time; significant episodes of hyperglycemia in the 3rd subgroup – 19% of the time during the day. Therefore, the first stage of correction of hyper-insulinemia and IR were: changing the receiving regime of low-calorie food and incretin mimetics appointment - exenatide. At the same time, the patients in the treatment group received drugs magnesium – Magnesium Orotate (if hypomagnesemia) and antioxidants – coenzyme Q10 and vitamin E. After 24 weeks of therapy, clinical examination demonstrated the effectiveness of treat-ment: BMI statistically significantly decreased by 8.5%, IL by 43.3%, normalization of the level of glycated hemoglobin and reduced levels of atherogenic lipids, as well as the achievement of target values of blood pressure on average for the study group were identified. Restoring the sensitivity of insulin receptors was accompanied by an increase in the level of magnesium in the blood by 47.5% and a simultaneous decrease in activity of oxidative system by 42.7%. The obtained results suggest the usefulness of the use of incretin mimetics drugs with antioxidant activity and therapy by preparations of magnesium in the prevention and treatment of MS in the early stages of development.

Elevated Levels of Hemoglobin A1c Are Associated With Cerebral White Matter Disease in Patients With Stroke

This study was conducted to investigate the association of cerebral white matter disease (WMD) on MRI with vascular risk factors and laboratory findings in consecutive first acute ischemic stroke patients. Acute ischemic stroke patients underwent MRI ≤24 hours after stroke onset and follow-up on day 2. WMD was scored on fluid attenuated inversion recovery MRI according to the Wahlund score. Vascular risk factors and laboratory parameters were assessed during hospital stay. Univariate and multiple logistic regression analyses were performed. We included 512 patients with first acute ischemic stroke (mean age, 68.5 [SD, 13.2] years; 192 women (37.5%); median National Institutes of Health Stroke Scale on admission, 3 [interquartile range, 1-6]; and median Wahlund score, 4 [interquartile range, 2-9]). WMD was present in 460 (89.8%) patients. In univariate analysis, age, arterial hypertension, reduced estimated glomerular filtration rate, hemoglobin A1c (HbA1c) levels, diabetes mellitus, and female sex were associated with the presence of WMD (P<0.05). In multiple regression analysis, age, arterial hypertension, and elevated levels of HbA1c (P<0.05) remained independently associated with the extent of WMD. Among known risk factors, higher levels of HbA1c were associated with cerebral WMD in stroke patients. This may suggest that chronic disturbance of glycemia measured by HbA1c plays a role in the pathophysiology of WMD. http://www.clinicaltrials.gov. Unique identifier: NCT00715533.