Glycated Hemoglobin Levels Research Articles

Improving glycemic control by transitioning from the MiniMedTM 640G to 770G in Japanese adults with type 1 diabetes mellitus: a prospective, single-center, observational study.

The effectiveness of a hybrid closed-loop (HCL) system in improving glycemic control is unclear in Japanese individuals. Therefore, we assessed the effect impact of the MiniMed 770G HCL system on glycemic control in this population. This prospective, single-center, 24-week observational study (registration number: UMIN000047394) enrolled 23 individuals with type 1 diabetes mellitus using the Medtronic MiniMed 640G system. The primary endpoint was the improvement in time in the range of 70-180 mg/dL after transitioning to the MiniMed 770G HCL system. We observed an increase in time in range (from 64.1 [55.8-69.5] to 70.9 [67.1-74.4] %, interquartile range 25-75%, p < 0.001) and a decrease in glycated hemoglobin level (from 7.4 [7.0-7.9] to 7.1 [6.8-7.4] %, p = 0.003). There was a significant reduction in time above the range (181-250 mg/dL: 25.8 [20.9-28.6] to 19.5 [17.1-22.1] %, p < 0.001; >251 mg/dL: 8.7 [4.0-13.0] to 4.7 [3.6-9.1] %, p < 0.001). Time below the range remained unchanged (54-69 mg/dL: 1.8 [0.4-2.4] to 2.1 [0.4-3.9] %, p = 0.24; <54 mg/dL: 0.2 [0.0-1.0] to 0.5 [0.1-1.3] %, p = 0.14). In a subgroup of 12 patients with a high HCL implementation rate, the basal insulin infusion decreased immediately after mealtime insulin administration and increased after approximately 120 minutes. The ratings from questionnaires assessing treatment burden, satisfaction, and quality of life remained unchanged. The MiniMed 770G HCL system improved glycemic control and optimized insulin delivery, particularly in patients with high implementation rates.

Systemic inflammation and quality of life in patients with coronavirus disease: interrelation features.

Aim: To characterize the features of the interrelation of systemic inflammation with the quality of life of patients with coronary virus disease. Materials and Methods: 30 patients were examined 1 month after inpatient treatment for COVID-19. Quality of life (QoL) of patients was determined according to the questionnaire Medical Outcomes Study - 36-item Short Form (SF-36). The glucose level, circulating immune complexes (CICs), concentration of immunoglobulin (Ig) A, interleukin (IL)-8 and IL-33 levels were determined in the blood serum of patients. Results: QoL of patients after coronavirus disease is significantly deteriorated: patients note a significant limitation in physical functioning, pain perception, vitality, role-physical and social functioning and mental health. The increase in glycemia and glycated hemoglobin levels in post-COVID-19 patients was significantly associated with the deterioration of patients` general health (GH) (r = -0,228; (p=0,040) and (r = -0,280; (p=0,014), respectively). The IL-33 concentration in such patients correlated directly with role-physical functioning (RP) (r = 0,385; p=0,029). The CICs level decline was associated with deterioration of RP (r = 0,227; p=0,042) and GH (r = 0,227; p=0,041). Conclusions: The study of clinical-functional, biochemical, immunological and psychological indicators, quality of life, and their mutual influences should be included in the development of the program for the diagnosis, treatment, and rehabilitation of patients after the transfer of COVID-19 at the outpatient stage of treatment by doctors of general practice-family medicine.

Arterial stiffness assessment in obese black South African patients.

Increased arterial stiffness is a determinant of cardiovascular mortality and an independent marker of cardiovascular disease. The objective of this study was to asses arterial elasticity by determination of pulse-wave velocity (PWV) and augmentation index (Aix) in obese black patients. PWV and Aix were assessed non-invasively using the AtCor SphygmoCor® system (AtCor Medical, Inc, Sydney, Australia). The study participants were divided into four groups; healthy volunteers (HV) (n = 29), patients with concomitant diseases but normal body mass index (Nd) (n = 23), obese patients without concomitant diseases (OB) (n = 29) and obese patients with concomitant diseases (OBd) ( n = 29). The difference in the mean levels of PWV was statistically significant in the obese group with and without concomitant disease. The PWV in the OB group (7.9 ± 2.9 m/s) and in the OBd group (9.2 ± 4.4 m/s) was, respectively, 19.7 and 33.3% higher than in the HV group (6.6 ± 2.1 m/s). PWV was directly correlated with age, glycated haemoglobin level, aortic systolic blood pressure and heart rate. The risk of cardiovascular diseases in the obese patient without additional diseases was increased by 50.7%. The presence of concomitant diseases (type 2 diabetes mellitus and hypertension) in addition to obesity increased arterial stiffness by a further 11.4% and therefore also increased the risk of cardiovascular diseases by a further 35.1%. Aix was increased in the OBd and Nd groups by 8.2 and 16.5%, respectively, however the increase was not statistically significant. Aix was directly correlated with age, heart rate and aortic systolic blood pressure. The obese black patients had a higher PWV, indicating increase in arterial stiffness and therefore a higher risk for cardiovascular disease. In addition, aging, increased blood pressure and type 2 diabetes mellitus contributed further to arterial stiffening in these obese patients.

The effectiveness of Baduanjin on metabolic syndrome: An overview of systematic reviews and meta‐analyses

AbstractObjectiveThis meta‐analysis evaluated the effects of Baduanjin on the metabolic status of individuals with metabolic syndrome (MetS). The aim was to identify effective interventions for MetS prevention and treatment.MethodsWe conducted a comprehensive search of English (PubMed, Embase, Web of Science, and Cochrane Library) and Chinese (CNKI, Wanfang, Chinese Biomedical Database, VIP) databases till August 19, 2022. Randomized controlled trials (RCTs) focusing on Baduanjin for MetS patients were included. Data were pooled and assessed using the Cochrane risk‐of‐bias tool. The Grades of Recommendation, Assessment, Development, and Evaluation for Systematic Reviews was used to evaluate literature quality.ResultsEight RCTs involving 435 participants were included. Baduanjin showed significant improvements in fasting blood glucose (mean difference [MD] = −0.41, 95% confidence interval [CI] [−0.22, −0.61], p &lt; 0.0001) and glycated hemoglobin levels (MD = −0.99, 95% CI [−0.38, −1.60], p &lt; 0.00001). Waist‐to‐hip ratio (MD = −0.04, 95% CI [−0.03, −0.06], p = 0.002), body mass index (MD = −1.60, 95% CI [−0.10, −3.10], p = 0.04), fasting insulin (MD = −4.82, 95% CI [−0.15, −8.59], p = 0.01), systolic blood pressure (MD = −7.16, 95% CI [−5.16, −9.17], p &lt; 0.00001), diastolic blood pressure (MD = −3.43, 95% CI [−0.62, −6.24], p = 0.02), total cholesterol (MD = −0.48, 95% CI [−0.10, −0.85], p = 0.01), triglycerides (MD = −0.39, 95% CI [−0.14, −0.64], p = 0.003), and low‐density lipoprotein cholesterol (MD = −0.52, 95% CI [−0.10, −0.94], p = 0.01) also significantly improved. No adverse events were reported. Literature quality ranged from very low to moderate.ConclusionsBaduanjin effectively improves metabolic status in individuals with MetS, including blood glucose, lipid profile, obesity‐related indicators, insulin levels, and blood pressure. However, the overall literature quality is moderate to low. Further rigorous RCTs are needed to explore Baduanjin's effects on MetS, considering intervention methods, content, and research methodologies.

Associations between antimony exposure and glycated hemoglobin levels in adolescents aged 12-19 years: results from the NHANES 2013-2016.

This study aimed to investigate the association between antimony (Sb) exposure and glycated hemoglobin (HbA1c) levels in adolescents. A cross-sectional study of 751 adolescents aged 12-19 years was conducted via the National Health and Nutrition Examination Survey (NHANES, 2013-2016). Survey-weighted linear regression and restricted cubic spline (RCS) analyses were applied to evaluate the relationship of urinary Sb exposure with HbA1c. A significant relationship was observed between urinary Sb concentrations and HbA1c levels (percent change: 0.93; 95% CI: 0.42, 1.45) after full adjustment. After converting urinary Sb levels to a categorical variable by tertiles (T1-T3), the highest quantile was associated with a significant increase in HbA1c (percent change: 1.45; 95% CI: 0.38, 2.53) compared to T1. The RCS models showed a monotonically increasing relationship of urinary Sb with HbA1c. Subgroup analyses revealed a sex-specific relationship between urinary Sb exposure and HbA1c with a significant positive association in males and a non-significant positive association in females. Sensitivity analyses further confirmed the relationship between urinary Sb and HbA1c, even after excluding participants who were overweight or obese (percent change: 1.58%, 95% CI: 0.88, 2.28) and those with serum cotinine levels ≥ 1 ng/mL (percent change: 1.14%, 95% CI: 0.49, 1.80). Our findings indicated that increased Sb exposure may correlate with higher HbA1c levels, especially in male adolescents. More studies are needed to further explore and validate the potential mechanisms.

Causal relationship between type 1 diabetes mellitus and mycoses: a Mendelian randomization study.

Type 1 diabetes mellitus (T1DM) is frequently associated with various infections, including mycoses; however, the direct link between T1DM and fungal infections remains under-researched. This study utilizes a Mendelian randomization (MR) approach to investigate the potential causal relationship between T1DM and mycoses. Genetic variants associated with T1DM were sourced from the European Bioinformatics Institute database, while those related to fungal infections such as candidiasis, pneumocystosis, and aspergillosis were obtained from the Finngen database, focusing on European populations. The primary analysis was conducted using the inverse variance weighted (IVW) method, with additional insight from Mendelian randomization Egger regression (MR-Egger). Extensive sensitivity analyses assessed the robustness, diversity, and potential horizontal pleiotropy of our findings. Multivariable Mendelian randomization (MVMR) was employed to adjust for confounders, using both MVMR-IVW and MVMR-Egger to evaluate heterogeneity and pleiotropy. Genetically, the odds of developing candidiasis increased by 5% in individuals with T1DM, as determined by the IVW method (OR = 1.05; 95% CI 1.02-1.07, p = 0.0001), with a Bonferroni-adjusted p-value of 0.008. Sensitivity analyses indicated no significant issues with heterogeneity or pleiotropy. Adjustments for confounders such as body mass index, glycated hemoglobin levels, and white blood cell counts further supported these findings (OR = 1.08; 95% CI:1.03-1.13, p = 0.0006). Additional adjustments for immune cell counts, including CD4 and CD8 T cells and natural killer cells, also demonstrated significant results (OR = 1.04; 95% CI: 1.02-1.06, p = 0.0002). No causal associations were found between T1DM and other fungal infections like aspergillosis or pneumocystosis. This MR study suggests a genetic predisposition for increased susceptibility to candidiasis in individuals with T1DM. However, no causal links were established between T1DM and other mycoses, including aspergillosis and pneumocystosis.

Association between neutrophil-to-lymphocyte ratio and diabetic retinopathy in patients with type 2 diabetes: a cohort study.

Chronic inflammation is implicated in the development of diabetic retinopathy (DR). The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been linked to cardiovascular and diabetic kidney diseases. However, the link between NLR and DR remains unclear. As such, this study investigated the association between NLR and DR in Chinese patients. A total of 857 adults diagnosed with type 2 diabetes mellitus (T2DM) without DR at baseline between 2018 and 2021, from a single center in Ningbo, China, were included. Baseline clinical data, including age, sex, T2DM duration, hypertension, smoking, drinking, glycated hemoglobin level, lipid profile, renal function, and NLR, were recorded and analyzed. Cox proportional hazard regression analysis was used to assess the association between NLR and the risk for incident DR. During a median follow-up of 3.0 years, 140 patients developed DR. The multivariable-adjusted hazard ratio (HR) for incident DR across ascending NLR quartiles (≤1.46 [reference], 1.47-1.90, 1.91-2.45 and > 2.45) were 1.000, 1.327 (95% confidence interval [CI] 0.754-2.334), 1.555 (95% CI 0.913-2.648) and 2.217 (95% CI 1.348-3.649), respectively. For each 1-standard deviation increase in NLR, the risk for DR increased by 29.2% (HR 1.292 [95% CI 1.112-1.501) after adjusting for confounding factors. Results revealed that a higher NLR at baseline was associated with an increased risk for incident DR. NLR has the potential to be an inexpensive, reliable, and valuable clinical measure that merits further exploration in future studies.

Evaluating the cost-effectiveness of diabetic foot ulcer management by wound care specialists in Indonesia.

Diabetic foot ulcers affect quality of life and economically burden patients and the Indonesian healthcare system. The comparative cost-effectiveness of wound care specialists in private practices (e.g., wound clinics) and wound care nurses in national hospitals remains unknown. Thus, we used a decision tree to compare the cost and healing rates for patients after 12 weeks of wound care. Uncertainty was addressed using one-way and probabilistic sensitivity analyses. Among 89 participants (42 in the national hospital and 47 in the private practice), no significant differences were observed between the two groups in terms of sex, age, education level, smoking status, duration of diabetes, Wagner wound classification, glycated haemoglobin levels, neuropathy status, ankle-brachial index, baseline characteristics, quality of life, DMIST (depth, maceration, inflammation/infection, size, tissue type of the wound bed, type of wound edge, and tunnelling/undermining) score and wound location (p > 0.05). However, significant differences were observed for days from first visit/assessment until complete healing, mean quality of life (p ≤ 0.001) and wound size (p = 0.047). Wound care specialists in private practices had a significantly lower cost of 2,804,423.3 Indonesian rupiah compared to 6,483,493.4 Indonesian rupiah for wound care nurses in national hospitals. The incremental cost-effectiveness ratio was -165,723.9. Therefore, wound care specialists in private practices are more cost-effective for managing diabetic foot ulcers. Probability sensitivity analysis confirmed that 80%-90% of the scenarios were cost-effective. These findings may inform healthcare resource allocation in Indonesia. Additionally, evidence-based cost-effectiveness measures were strengthened in private practices and national hospitals.

Predictors of macrovascular complications in Al-Madinah Al-Munawara type 2 diabetes mellitus patients, Saudi Arabia: A cross-sectional study

Background/aim Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia, which causes macrovascular complications that account for most of the morbidity, hospitalizations, and deaths. The goal of this study is to evaluate the relationship between macrovascular complications and associated risk factors in Al-Madinah Al-Munawara patients suffering from type 2 diabetes mellitus. Patients and methods This descriptive cross-sectional study involved 275 type 2 diabetes mellitus patients who resided in Al-Madinah Al-Munawara and visited the diabetic clinic at King Fahd Hospital on a regular basis. Participants in the study ranged in age from 20 to 65. Hemoglobin, glycated hemoglobin, serum calcium, fasting blood glucose, and lipid profile were analyzed. Results Out of 275 patients with type 2 diabetes mellitus, 113 have had macrovascular complications. A significant association (P&lt;0.05) has been observed between the age of the patients and different forms of macrovascular complications, which impact 62.7% of the elderly (41–65 years old). The prevalence of macrovascular complications was higher among females. Glycated hemoglobin levels positively correlated with the number of hospitalizations, high blood pressure, hemoglobin, and serum cholesterol levels. Macrovascular complications are positively correlated with age, sex, hypertension, and therapy type (P&lt;0.05), while physical activity has a negative significant effect on the appearance of macrovascular complications by multiple regression analysis. Conclusion In this study, diabetic macrovascular complications were prevalent. The age, sex of participants, and type of treatment were independent predictors of macrovascular complications. Hypertension has a significant positive effect on the appearance of macrovascular complications. Physically inactive patients have a higher risk of macrovascular complications.

Confounding Factors Responsible for Elevated Lp(a) Levels in Patients with Coronary Artery Disease.

Cardiovascular diseases (CVDs) are a leading cause of global mortality, motivating research into novel approaches for their management. Lipoprotein(a) (Lp(a)), a unique lipoprotein particle, has been implicated in atherosclerosis and thrombosis, suggesting its potential as a therapeutic target for CVDs. This study aimed to investigate the association of Lp(a) levels with various cardiovascular parameters and events among patients with confirmed cardiovascular disease. A prospective study was conducted, enrolling 600 participants, predominantly comprising males (79%), with a mean age of 52.78 ± 0.412 years diagnosed with cardiovascular disease. The follow-up was done for 18 months. Patient demographics, blood investigations, and occurrence of major adverse cardiac events (MACE) were collected. SPSS version 21 was used to statistically analyze the relationships between elevated Lp(a) levels and factors such as age, glycated hemoglobin, mortality, MACE, cardiac death, target vessel revascularization, and stroke. The study revealed significant (P < 0.05) associations between elevated Lp(a) levels and advanced age, increased glycated hemoglobin levels, as well as occurrences of all-cause mortality, MACE, cardiac death, target vessel revascularization, and stroke. Notably, a significant (P < 0.05), association between high Lp(a) levels and acute coronary syndrome (ACS) emerged, suggesting Lp(a)'s role in advanced cardiac events. The findings highlight the potential significance of Lp(a) as a notable risk factor in cardiovascular health. The observed associations between elevated Lp(a) and adverse cardiovascular events, including ACS, underscore its pathogenic role. Consequently, this study supports the rationale for further research into Lp(a)-specific therapeutic interventions, offering substantial promise in refining the management strategies for cardiovascular diseases.

Nutritional Risk Factors in Albuminuria and Retinopathy in Patients Newly Diagnosed With Type 2 Diabetes: A Cross-sectional Case Series Study.

Although nutritional risk factors for developing complications in type 2 diabetes mellitus (T2DM) have been examined, the effect of protein intake on nephropathy is debated, and there is little research on retinopathy. This cross-sectional case-series study aimed to examine the risk factors, including nutritional status, for complications in patients newly diagnosed with T2DM. Fifty-four patients were recruited, based on the results of examinations of blood glucose and/or glycated hemoglobin level for T2DM. To evaluate nutritional status, blood and urine examinations were performed and the Food Frequency Questionnaire was administered. Two-way analysis of variance, Fisher's exact test and logistic regression analyses were performed. The patients were categorized into four groups: 24 without albuminuria and without retinopathy, four without albuminuria with retinopathy, 21 with albuminuria without retinopathy, and five with albuminuria with retinopathy. Logistic analysis of albuminuria revealed that estimated sodium intake was significantly independent as the explanatory factors of age, sex, and body mass index. Patients with retinopathy had significantly higher blood urea nitrogen, and significantly lower plasma total protein levels than patients without retinopathy, suggesting that retinopathy is related to a higher catabolic state. Through a questionnaire on food intake, patients with retinopathy had a significantly lower intake of fat and monounsaturated fatty acids and a significantly higher intake of iodine based on intake of seaweed, corrected for energy intake, than patients without retinopathy. The present study may lead to planning a large cohort study for examining nutritional risk factors related to complications in patients newly diagnosed with T2DM in Japan.

T2DM may exert a protective effect against digestive system tumors in East Asian populations: a Mendelian randomization analysis.

Type 2 diabetes mellitus (T2DM) was associated with digestive system tumors. We analyzed publicly available data from GWAS studies using Mendelian randomization methods to clarify its causal relationship and mechanisms. Five common digestive system tumors and four diabetes-related phenotypes were included. Inverse variance weighted method was the main analytical method. Meta-analysis was used to summarize results of multiple data sources. Horizontal pleiotropy was tested using Egger-intercept method and validated by MRPRESSO method. Heterogeneity and sensitivity analysis were conducted by Cochran's Q test and leave-one-out method, respectively. T2DM is associated with a reduced risk of esophageal (OR: 0.77, 95% CI: 0.71 to 0.83, P< 0.001), gastric (OR: 0.87, 95% CI: 0.84 to 0.90, P< 0.001) and colorectal cancer (OR: 0.88, 95% CI: 0.85 to 0.91, P< 0.001) and hepatocellular carcinoma (OR: 0.92, 95% CI: 0.86 to 0.97, P = 0.005) and an increased risk of pancreatic cancer (OR: 1.92, 95% CI: 1.47 to 2.50, P< 0.001) in East Asian population. T2DM causes decreased fasting insulin levels (OR = 0.966, 95% CI: 0.95 to 0.98, P< 0.001) and increased glycated hemoglobin levels (OR=1.41, 95% CI: 1.39 to 1.44, P<0.001). Elevated fasting insulin levels increase the risk of esophageal cancer (OR = 10.35, 95% CI: 1.10 to 97.25, P = 0.041), while increased glycated hemoglobin levels increase pancreatic cancer risk (OR=2.33, 95% CI: 1.37 to 3.97, P=0.002) but decrease gastric cancer risk (OR=0.801, 95% CI: 0.65 to 0.99, P=0.044). T2DM is associated with a reduced risk of esophageal, gastric and colorectal cancer and hepatocellular carcinoma in East Asian populations. The causal relationships between T2DM with esophageal and gastric cancer are partially mediated by decreased fasting insulin and increased glycated hemoglobin levels, respectively. T2DM indirectly increases the risk of pancreatic cancer by increasing glycated hemoglobin levels.

Culturally adapted mobile application for optimizing metabolic control in type 1 diabetes: a pilot study.

To evaluate whether use of a culturally adapted mobile application (app) for adolescents with type 1 diabetes is associated with improved metabolic control. The Dominican Republic's National Institute of Diabetes, Endocrinology, and Nutrition and the Learning to Live clinic recruited 23 pediatric participants for the study. Blood tests were performed before and after use of the app for a period of 3 months. Based on the user profile, participants were encouraged to use the app's bolus insulin calculator after each meal. The app included a list of regionally and culturally specific foods, color-coded to indicate a high glycemic index (GI) as red; medium GI as yellow; and low GI as green. The color-coding was designed to assist participants in making healthier eating choices. There were statistically significant improvements in lipid profile. Mean high-density lipoprotein values rose to acceptable levels, while low-density lipoproteins and triglyceride levels fell to the recommended values. The overall quality of life increased, although glycated hemoglobin levels showed no statistically significant changes. The findings of this study suggest that using this culturally tailored app can help young patients with type 1 diabetes to improve metabolic health.

Возможности применения препаратов рекомбинантного интерферона α-2b в комплексной терапии кандидозной инфекции слизистых оболочек у пациентов групп риска

Background: despite the availability of various antifungal medications, achieving complete relief of fungal infections can be challenging, particularly in cases where Candida spp. exhibit resistance to antimycotic agents or in patients who are at increased risk of developing candidiasis, such as those with immunosuppression, decompensated diabetes mellitus, or undergoing prolonged antibacterial treatment. The limited success of antifungal monotherapy in treating candida infections highlights the necessity for alternative treatment tactics. Aim: this study aims to assess the impact of recombinant interferon α-2b combined with antioxidants, administered as rectal suppositories, on extending the relapse-free period in high-risk patients following successful antifungal treatment of oral and genital mucosal candidiasis. Patients and Methods: the study comprised 50 patients with different forms of oral and genital mucosal candidiasis, all having insulin- independent diabetes mellitus and suboptimal glycated hemoglobin levels. Initial antifungal treatment involved drugs from the imidazole or triazole groups. Patients were then randomized into two cohorts: one receiving recombinant interferon α-2b with antioxidants (n=17) and the other receiving a placebo (n=18). Clinical outcomes and microbial content of Candida fungi were evaluated pre- and post-treatment. Results: the median age of participants was 55.5 years, with females constituting 56% (28 patients) of the cohort. Vulvovaginal candidiasis was the most prevalent diagnosis, affecting 42% of patients. The initial mean microbial load of Candida was 1.4×105 CFU/ml. Post initial antifungal treatment, 70% (35 patients) exhibited full symptom regression and marked reduction in CFU levels. The group treated with interferon α-2b experienced a mean clinical remission duration of 53.6±7.5 days, with 76.5% (13 patients) maintaining remission throughout the 60-day follow-up and CFU levels dropping below 1×103. In contrast, the placebo group had a mean remission duration of 30.1±9.6 days post- antimycotic therapy. Conclusion: integrating recombinant interferon α-2b with antioxidants into the treatment regimens for oral and genital mucosal candidiasis in high-risk patients significantly extends clinical remission periods. These findings suggest that this combination therapy could be a promising option for rehabilitation and potentially preventive interventions for patients susceptible to candida infections. KEYWORDS: Candida spp., mucosal candidiasis, diabetes mellitus, interferon alpha-2b. FOR CITATION: Zlobin D.E., Gureeva M.A., Molochkov A.V., Misnikova I.V., Polesko I.V., Guseva T.S. Possibilities of recombinant interferon α-2b drugs in the complex therapy of mucosal candidiasis infection in patients at risk. Russian Medical Inquiry. 2024;8(7):433–438 (in Russ.). DOI: 10.32364/2587-6821-2024-8-7-10.

Correlation of glycated hemoglobin with serum uric acid levels among type 2 diabetic patients: a cross-sectional study

Background: Diabetes Mellitus Type 2 (DMT2) is one of the commonest disorders of endocrinology which is characterized by the raised blood glucose level due to insulin resistance in body cells. This study was aimed to determine the correlation between the glycated hemoglobin (HbA1c) and serum uric acid (SUA) in patients with DMT2. Methods: This cross-sectional study was conducted in a tertiary care hospital of Lahore. 73 Patients’ recruitment was made via convenient sampling technique and a developed inclusion and exclusion criteria. Self-structured proforma was used for data collection. Data analysis was done in SPSS version 25.0. Results: From total patients, 40 (54.79%) were women while 33 (45.21%) were men. Means of different variables like age, HbA1c, and serum uric acid level were 54.98 years with standard deviation (SD) of ±11.67 years, 7.90 with SD of ±1.85%, and 7.51 with SD of ±0.81 respectively. 32 (43.83%) patients had good glycemic control whereas 41 (56.17%) patients had poor glycemic control. The frequencies of hyperuricemia and normal SUA in study population were 35 (47.94%) and 38 (52.06%) respectively. The means of the HbA1c across gender had statistically significant difference. Difference in the means of the SUA level, across gender and between patients with hyperuricemia and normal SUA level, was also statistically significant. Moreover, correlation between the HbA1c and SUA was positive and statistically significant. Conclusions: In a nutshell, this study suggests that increase in SUA level, worsen the glycemic control by raising glycated hemoglobin level among patients with DMT2.

Effect of blood glucose &amp; glycated hemoglobin levels on the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease

The connection to hyperglycaemia &amp; intense intensifications of persistent obstructive pneumonic infection (COPD) are presently starting to arise. Expanded blood glucose is related with unfriendly clinical results among patients with significant ailments. Hyperglycemia might be related with expanded mortality, length of stay (LOS), &amp; re-confirmations in COPD patients. This study was finished in 80 hospitalized patients with intense compounding of persistent obstructive aspiratory sickness in the Department of pneumonic medication between June 2021 to January 2022. The segment, clinical data, lab results, radiographic outcomes, &amp; data on Length of stay (LOS), mortality &amp; re-confirmation were gathered. Point of the review is to concentrate on the impact of blood glucose, HbA1c levels on the mean length of medical clinic stay in patients of AECOPD. Out of 80 COPD individuals, 61(76%) were male &amp; 19(24%) were female. Majority belonged to 56-65 years (38.8%), followed by 66-75 years (28.8%). Of the total 80 COPD individuals, 100% of male patients (n=61) were smokers, 15% of females (n=3) were smokers. Duration of the hospital stay was more with higher RBS values of ≥200mg/dl (9.2 ± 3.5 days) when compared to RBS value of 171-200 mg/dl (7.6±2.3 days) which was more than the RBS group with values of 141-170 (7.2±1.9 days). Whereas for normal RBS values of ≤140 mg/dl mean duration of hospital stay was (5.12±0.82 days). The conclusion arrived from our study, Higher the RBS at the time of admission, longer the mean duration of stay in the hospital. At admission, RBS more than 170 mg/dl is detrimental in AECOPD patients. High HbA1C levels (&amp;#62;6%) were associated with a high risk of exacerbations.

Association Between Serum Glycated Hemoglobin Levels at Early Gestation and the Risk of Subsequent Pregnancy Loss in Pregnant Women Without Diabetes Mellitus: Prospective Cohort Study.

As a severe morbidity during pregnancy, the etiology of spontaneous pregnancy loss (SPL) remains largely unknown. Serum glycated hemoglobin (HbA1c) level is an established predictor of SPL risk among women with diabetes, but little is known about whether such an association exists among pregnant women without diabetes when glycemic levels are within the normal range. This study aimed to quantify the association between maternal HbA1c levels in early pregnancy and subsequent SPL risk in a cohort of pregnant women without diabetes. This prospective cohort study involved 10,773 pregnant women without diabetes enrolled at their first antenatal care visit at a hospital's early pregnancy clinic from March 2016 to December 2018 in Shanghai, China. HbA1c and fasting blood glucose (FBG) levels were examined at enrollment. Participants with diabetes before or pregnancy or those diagnosed with gestational diabetes were excluded. Diagnosis of SPL, defined as fetal death occurring before 28 gestational weeks, was derived from medical records and confirmed via telephone interviews. We used generalized linear models to quantify the associations of continuous and dichotomized maternal HbA1c levels with SPL risk and reported crude and adjusted risk ratios (RRs) and 95% CIs. A restricted cubic spline (RCS) regression model was used to assess the potential nonlinear dose-response relationship. Adjusted covariates included maternal age, education level, preconception BMI, gestational weeks, gravidity, history of adverse pregnancy outcomes, family history of diabetes, folic acid supplementation, and smoking and drinking during the periconception period. In total, 273 (2.5%) SPL cases occurred. Every 0.5% increase in HbA1c levels was linearly associated with a 23% increase in SPL risk (adjusted RR [aRR] 1.23; 95% CI 1.01-1.50). The RCS model revealed that this association was linear (P=.77 for the nonlinearity test). Analyses based on dichotomized HbA1c levels showed a significantly increased risk of SPL when HbA1c levels were ≥5.9% (aRR 1.67; 95% CI 0.67-3.67), and the significance threshold was ≥5.6% (aRR 1.60; 95% CI 1.01-2.54). Sensitivity analyses showed similar results when including the participants with missing SPL records or HbA1c data. Linear associations of HbA1c levels remained significant even in the subgroups without overweight, alcohol consumption, and a family history of diabetes and adverse pregnancy outcomes. Every 1 mmol/L increment in maternal FBG levels was associated with a >2-fold higher risk of SPL (aRR 2.12; 95% CI 1.61-2.80; P<.001). Higher HbA1c levels in early pregnant women without diabetes are associated with an increased SPL risk in a dose-response manner. Pregnant women with an HbA1c level above 5.6% at early gestation need attention for its potentially increased risk for SPL. Our findings support the need to monitor HbA1c levels to identify individuals at high risk of subsequent SPL in the general population of pregnant women. ClinicalTrials.gov NCT02737644; https://clinicaltrials.gov/study/NCT02737644.

Baricitinib and β-Cell Function in Patients with New-Onset Type 1 Diabetes

BackgroundJanus kinase (JAK) inhibitors, including baricitinib, block cytokine signaling and are effective disease-modifying treatments for several autoimmune diseases. Whether baricitinib preserves β-cell function in type 1 diabetes is unclear.MethodsIn this phase 2, double-blind, randomized, placebo-controlled trial, we assigned patients with type 1 diabetes diagnosed during the previous 100 days to receive baricitinib (4 mg once per day) or matched placebo orally for 48 weeks. The primary outcome was the mean C-peptide level, determined from the area under the concentration–time curve, during a 2-hour mixed-meal tolerance test at week 48. Secondary outcomes included the change from baseline in the glycated hemoglobin level, the daily insulin dose, and measures of glycemic control assessed with the use of continuous glucose monitoring.ResultsA total of 91 patients received baricitinib (60 patients) or placebo (31 patients). The median of the mixed-meal–stimulated mean C-peptide level at week 48 was 0.65 nmol per liter per minute (interquartile range, 0.31 to 0.82) in the baricitinib group and 0.43 nmol per liter per minute (interquartile range, 0.13 to 0.63) in the placebo group (P=0.001). The mean daily insulin dose at 48 weeks was 0.41 U per kilogram of body weight per day (95% confidence interval [CI], 0.35 to 0.48) in the baricitinib group and 0.52 U per kilogram per day (95% CI, 0.44 to 0.60) in the placebo group. The levels of glycated hemoglobin were similar in the two trial groups. However, the mean coefficient of variation of the glucose level at 48 weeks, as measured by continuous glucose monitoring, was 29.6% (95% CI, 27.8 to 31.3) in the baricitinib group and 33.8% (95% CI, 31.5 to 36.2) in the placebo group. The frequency and severity of adverse events were similar in the two trial groups, and no serious adverse events were attributed to baricitinib or placebo.ConclusionsIn patients with type 1 diabetes of recent onset, daily treatment with baricitinib over 48 weeks appeared to preserve β-cell function as estimated by the mixed-meal–stimulated mean C-peptide level. (Funded by JDRF International and others; BANDIT Australian New Zealand Clinical Trials Registry number, ACTRN12620000239965.)

Assessing medication adherence and their associated factors amongst type-2 diabetes mellitus patients of Jazan Province, Saudi Arabia: A single-center, cross-sectional study.

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) globally is reaching epidemic proportions. By 2035, it is projected to increase to 417 million, which is of significant concern as T2DM represents the most oversized budget item in many healthcare systems, primarily due to the high rates of morbidity and mortality associated with the disease. The worldwide cost burden of T2DM has been inexorably growing. A key contributor to the remarkably high morbidity and mortality rates is poor glycemic control potentially associated with medication non-adherence. AimThe present research’s main objective included assessing medication adherence among patients with T2DM in a single center in Jazan Province. MethodsThree hundred nine patients with T2DM participated in a cross-sectional survey over three months (September to November 2022). The study participants comprised 50.8 % (females) and 49.2 % (males), with a mean age of 44.12 years (SD ± 12.70). A 31-item self-report questionnaire was used for data collection. ResultsSixty-six percent of the sample were found to be adherent to their T2DM therapy. A positive association was noticed between the GMAS score and the participant’s age (r = 0.24; p < 0.01). The participants’ medication adherence was significantly associated with having age above 50 years (χ2 = 13.62; p = 0.001), residing in urban localities (χ2 = 21.37; p < 0.001), being married (χ2 = 12.80; p = 0.002), having glycated hemoglobin level more than 8 % (χ2 = 6.99; p = 0.03) and taking between one to three medications per day (χ2 = 17.63; p < 0.001). ConclusionThe majority of T2DM patients in the present study were found adherent to their anti-diabetic medications, particularly older patients. Future studies should focus on exploring the reasons for the reported high adherence among older patients and non-adherence among younger patients, as this could facilitate the development of a strategy to enhance adherence.

Prevalence and Risk Factors of Erectile Dysfunction in Patients with Type 2 Diabetes Mellitus in Erbil-Iraq

Background and Objectives: Erectile dysfunction is a highly prevalent disease. It affects multiple aspects of health and can have a serious adverse effect on both the patients and their partners. Diabetes mellitus is a metabolic disorder associated with many chronic complications including erectile dysfunction. The aim of this study was to find out the prevalence and risk factors of erectile dysfunction in patients with type 2 diabetes mellitus. Patients and Methods: A cross-sectional study had been done on 100 adult male patients with type 2 diabetes mellitus, attending endocrinology outpatient at Erbil Teaching Hospital between June and December 2021, and another 50 age-matched non-diabetic controls. Each one of them underwent detailed history taking, clinical examination, and relevant biochemical study. Results: Sixty-three diabetic patients (63%) had erectile dysfunction compared to 6 nondiabetic subjects (12%). Mild, mild-to-moderate, moderate, and severe erectile dysfunction among these patients were 17 (27%), 21 (33.3%), 16 (25.4%), and 9 (14.3%), respectively. Among diabetics, erectile dysfunction was significantly associated with age, obesity, glycated hemoglobin level, duration of diabetes, presence of hypertension, dyslipidemia, and neuropathy (p= 0.001, 0.005, &lt;0.001, 0.038, 0.02, 0.017 and 0.025 respectively) Conclusion: Erectile dysfunction was significantly more prevalent in patients with type 2 diabetes than in non-diabetic patients. Being older than 50 years old, obesity, glycated hemoglobin level higher than 9, diabetes more than 10 years duration, presence of hypertension, dyslipidemia, and neuropathy were significantly in favor of a higher prevalence of erectile dysfunction in this group.