Glycated Hemoglobin Values Research Articles

A-222 Comparative Analysis of Clinical and Laboratory Parameters of Brazilian Patients with Severe Hipertriglyceridemia

Abstract Background The presence of elevated and sustained levels of triglycerides (TG) should raise the suspicion of primary causes of hypertriglyceridemia (HT), in which related genetic mutations would be identified. Thus, the aim of this study was to compare clinical and laboratory parameters of Brazilian patients with different etiologies of severe hypertriglyceridemia. Methods All patients with severe HT (considered as detection of TG above 880 mg/dL on at least 2 occasions) followed in the dyslipidemia outpatient clinic of Federal University of Ceará/Brazil, whose molecular study to investigate genetic variants potentially related to hypertriglyceridemia and pancreatitis has been previously performed (ABCA1 AGPAT2 AKT2 APOA5 APOC2 BSCL2 CAV1 CFTR CIDEC CTRC CYP27A1 GPIHBP1 LIPA LIPE LMF1 LMNA LMNB2 LPL PLIN1 POLD1 PPARG PRSS1 PSMB8 SMPD1 SPINK1 ZMPSTE24) were evaluated. Results Sixty-six patients were evaluated, identifying 39 (59%) with severe primary HT. Familial Chylomicronemia Syndrome (FCS) was identified in 14 (36%) of the 39 cases of severe primary HT. The main findings are shown in table 1. Compared with other etiologies, FCS patients presented an increased, precocious and recurrent incidence of pancreatitis, earlier detection and higher levels of TG. In patients with severe HT without identification of primary causes, a high incidence of alcoholism and diabetes was observed, with a tendency to higher glycated hemoglobin values among these, in addition to median Body Mass Index compatible with obesity. Conclusion FCS patients had the most severe clinical presentation of HT. The high prevalence of secondary factors for HT in patients with a negative genotype reinforces the indication of adequate management of these variables even in cases of primary etiology, aiming at not overlapping pathological mechanisms. In cases of severe HT, metabolic control is still a challenge.

The effectiveness of mobile application for monitoring diabetes mellitus and hypertension in the adult and elderly population: systematic review and meta-analysis

ContextArterial Hypertension (AH) and Diabetes Mellitus (DM) are diseases that are getting worse all over the world. Linked to this advance, is the growing digital health market with numerous mobile health applications, which aim to help patients and professionals in the proper management of chronic diseases. The aim of this study was to analyze, through a systematic review and meta-analysis, the effectiveness of using mobile health applications in monitoring AH and/or DM in the adult and elderly population.MethodsThe systematic review and meta-analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Metanalyses guidelines and involved searching five databases – Medline/PubMed, Embase, CINAHL, Virtual Library in Health and Cochrane Library. The review included randomized and cohort clinical trials testing the effects of the intervention on changing biochemical parameters and clinical efficacy in people treated for AH and/or DM. The quality of the selected studies was assessed based on the evaluation criteria of the Joanna Briggs Institute tool. The random effects meta-analysis method was used to explain effect distribution between studies, by Stata® software (version 11.0) and publication bias was examined by visual inspection of graphs and Egger test.ResultsWe included 26 studies in the systematic review and 17 in the meta-analysis. These studies were published between 2014 to 2022 in 14 countries. Were reported improvement in knowledge and self-management of AH and DM, social motivation with treatment and behavioral change, reduction in glycated hemoglobin values, fasting glucose and blood pressure, improvement in adherence to drug treatment, among others. The result of the meta-analysis showed that there is evidence that the use of mobile applications can help reduce glycated hemoglobin by 0.39% compared to the usual care group.ConclusionsMonitoring and self-monitoring of behaviors and health care related to AH and DM in adults and the elderly through mobile applications, has clinically significant effectiveness in reducing glycated hemoglobin levels. Future studies should provide more evidence and recommendations for best practices and development of digital health interventions.Trial registrationPROSPERO. International Prospective Registry of Systematic Reviews. CRD42022361928.

Influence of the duration of type 2 diabetes mellitus on colorectal cancer outcomes

Type 2 diabetes mellitus (T2DM) is a progressive disease, which affects colorectal cancer (CRC) survival. However, data on the relationship between CRC survival and T2DM duration is scarce and controversial. A retrospective observational study was conducted. Sub-cohorts were created based on the duration of T2DM as follows, ≤ or > 5/10/15/20 years. 204 of the 817 (24.95%) included study participants had T2DM at any point of CRC. 160 of the 204 CRC + T2DM patients had detailed T2DM duration data. At the time of CRC diagnosis, 85, 50, 31, and 11 patients had T2DM for > 5/10/15/20 years, respectively, which increased to 110, 71, 45, and 17 during the course of the study. Despite constant glycated hemoglobin values throughout the study, shorter overall and disease-specific survival times were observed for the > 5/10/15 years cohorts and longitudinal survival modeling techniques confirmed the significant effect of T2DM duration in all cohorts. While in the first 3 years after CRC diagnosis, the best survival was found for the ≤ 5 years cohort, all diabetes cohorts had the same survival thereafter. T2DM duration affected CRC survival significantly, therefore, a closer follow-up of this sub-populations is suggested.

Identification of clinical and pharmacogenetic factors influencing metformin response in Type 2 diabetes mellitus.

Metformin, a hypoglycemic drug for Type 2 diabetes mellitus, shows variability in pharmacokinetics and response due to membrane transporters. This study followed 34 Type 2 diabetes mellitus patients on metformin treatment. Genetic variants in 11 metformin transport-related genes were analyzed, revealing associations. Specifically, SLC47A1 rs2289669 A/A and SLC22A4 rs1050152 T/T genotypes correlated with glycated hemoglobin values at 6months. SLC47A1 rs2289669 G/A genotype influenced glucose levels at 6months, while SLC29A4 rs3889348 A/A, SLC47A1 rs2289669 A/A, SLC22A4 rs1050152 C/T and SLC47A2 rs12943590 A/A genotypes were linked to glucose levels at 12months. Additionally, ABCB1 rs2032582 C/A and ABCG2 rs2231137 C/T genotypes impacted cholesterol levels at 12months. These findings shed light on metformin response determinants, offering insights for further research.

Development and validation of a real-world model to predict 1-year Level 3 (severe) hypoglycaemia risk in adults with diabetes (the iNPHORM study, United States).

We aimed to develop and internally validate a real-world prognostic model for Level 3 hypoglycaemia risk compatible with outpatient care in the United States. iNPHORM is a 12-month, US-based panel survey. Adults (18-90 years old) with type 1 diabetes mellitus or insulin- and/or secretagogue-treated type 2 diabetes mellitus were recruited from a nationwide, probability-based internet panel. Among participants completing 1 follow-up questionnaire(s), we modelled 1-year Level 3 hypoglycaemia risk using Andersen and Gill's Cox survival and penalized regression with multiple imputation. Candidate variables were selected for their clinical relevance and ease of capture at point-of-care. In total, 986 participants [type 1 diabetes mellitus: 17%; men: 49.6%; mean age: 51 (SD: 14.3) years] were analysed. Across follow-up, 035.1 (95% CI: 32.2-38.1)% reported ≥1 Level 3 event(s), and the rate was 5.0 (95% CI: 4.1-6.0) events per person-year. Our final model showed strong discriminative validity and parsimony (optimism corrected c-statistic: 0.77). Numerous variables were selected: age; sex; body mass index; marital status; level of education; insurance coverage; race; ethnicity; food insecurity; diabetes type; glycated haemoglobin value; glycated haemoglobin variability; number, type and dose of various medications; number of SH events requiring hospital care (past year and over follow-up); type and number of comorbidities and complications; number of diabetes-related health care visits (past year); use of continuous/flash glucose monitoring; and general health status. iNPHORM is the first US-based primary prognostic study on Level 3 hypoglycaemia. Future model implementation could potentiate risk-tailored strategies that reduce real-world event occurrence and overall diabetes burden.

Prolonged clinical remission of type 1 diabetes sustained by calcifediol and low-dose basal insulin: a case report.

Herein, we describe an unusually prolonged duration (31months) of the clinical remission phase in a 22-year-old Italian man with new-onset type 1 diabetes. Shortly after the disease diagnosis, the patient was treated with calcifediol (also known as 25-hydroxyvitamin D3 or calcidiol), coupled with low-dose basal insulin, to correct hypovitaminosis D and to exploit the anti-inflammatory and immunomodulatory properties of vitamin D. During the follow-up period, the patient retained a substantial residual β-cell function and remained within the clinical remission phase, as evidenced by an insulin dose-adjusted glycated hemoglobin value <9. At 24 months, we detected a peculiar immunoregulatory profile of peripheral blood cells, which may explain the prolonged duration of the clinical remission sustained by calcifediol as add-on treatment to insulin.

Effect of Scaling and Root Planing in Conjunction with Antimicrobial Therapy on Glycated Hemoglobin Levels in Type 2 Diabetes Mellitus Patients.

Scaling and root planing with systemic doxycycline had an effect on blood glucose levels in type 2 diabetes patients, according to the results of a glycosylated hemoglobin assay. The trial was conducted to determine whether periodontal therapy affected blood sugar regulation as a result of this finding. A total of 60 people with type 2 diabetes (diabetes mellitus not caused by insulin deficiency) were split into three groups. Group I (control group) consists of patients who are only taking an oral anti-diabetic medication. Patients on an oral anti-diabetic drug plus scaling and root planing make up group II. Patients on an oral anti-diabetic drug, scaling, root planing, and doxycycline constitute Group III. The patients were re-evaluated for glycated hemoglobin levels and periodontal status using the clinical parameters of gingival index by Loe and Silness and clinical attachment level at baseline, 30th, 60th, and 90th day. Compared with group II, the findings showed a statistically significant decrease in glycated hemoglobin values (p =0.001) and improvements in clinical attachment level (p =0.022, 0.05) and gingival index (p = 0.009.,01) in group III. In the control group (group I), no such finding was made. The average gingival index, however, increased statistically significantly (p = 0.032, 0.05). Various studies have been showing the benefits of non-surgical periodontal therapy as a benefit for improving the overall glycemic status of the patient. Non-surgical mechanical periodontal therapy combined with systemic administration of antimicrobials such as doxycycline enhances the metabolic status of type 2 diabetes mellitus patients better than non-surgical mechanical periodontal therapy alone.

Hypogonadism among Type 2 Diabetes Mellitus Patients with Male Erectile Dysfunction

Abstract Introduction Testosterone levels and erectile function are known to decline as men age, leading to hypogonadism and erectile failure. Men with type 2 diabetes mellitus (T2DM) have a high prevalence of hypogonadism and erectile dysfunction. We aimed to estimate the prevalence of hypogonadism in T2DM patients complaining of erectile dysfunction. Patients and Methods A cross-sectional study was conducted at Specialized Diabetes, Endocrine, and Metabolism Center from early September 2021 to the end of January 2022. The study included 115 fully anonymized randomly selected patients. Patients with diabetes were assessed for erectile dysfunction through a questionnaire derived from “The International Index of Erectile Function (IIEF).” Additionally, hypogonadism has been diagnosed with serum testosterone levels lower than 264 mg/dL according to the Endocrine Society 2018 criteria for the diagnosis of male hypogonadism. Results The average duration of diabetes was 6.2 years, and the mean glycated hemoglobin value was 9.3%. Dyslipidemia was the most prevalent chronic comorbid condition (84.3%) accompanying diabetes and erectile dysfunction, followed by hypertension (56.5%). An approximately similar rate of hypogonadism was observed in patients with diabetes and erectile dysfunction regardless of whether the other chronic disease was also present. From 115 patients included in this study, hypogonadism was diagnosed in 26% of patients with diabetes and erectile dysfunction. Conclusion A significant number of hypogonadisms occur in patients with diabetes and erectile dysfunction, which require particular emphasis.

The association between baseline patient characteristics and alpelisib-induced hyperglycaemia in patients with HR+, HER2-, PIK3CA-mutated metastatic breast cancer.

e13059 Background: Alpelisib (A) is a PI3Kα-selective inhibitor and degrader which, in combination with fulvestrant, has been approved for the treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-), PIK3CA-mutated advanced breast cancer (ABC). Hyperglycemia is the most commonly observed adverse event of A. A pooled analysis of X2101 AND SOLAR-1 trials showed the association between five baseline patient characteristics (age, fasting plasma glucose (FPG), glycated haemoglobin, body mass index (BMI) and blood monocyte count (BMC)) and the development of A-induced hyperglycaemia (HG). We examined the association between baseline factors and the A-induced HG grade (G) ≥2 in a real-world setting. Methods: We performed the retrospective observational study and included patients (pts) with HR+, HER2-, PIK3CA-mutated metastatic breast cancer who received A + fulvestrant between Oct 18, 2019, and Oct 13, 2022, at the Institute of Oncology Ljubljana. Electronic records were reviewed. Baseline age, FPG, glycated haemoglobin, BMI and BMC before the start of A therapy and glucose levels during treatment with A were collected. Random plasma glucose values (RPG) were used for HG grading according to CTCAE V. The chi-square test was used to determine the association between the baseline characteristics and A-induced HG G ≥2. Results: Thirty-one female pts were included in the analysis. The median follow-up was 21 months, and the median duration of A treatment was 5.4 months. The baseline pts characteristics were as follows: median age 58 years (range 33–80), median FPG 5.6 mmol/L (range 3.10–8.6), median BMI 21.7 kg/m² (range 18.7–30.4), and median BMC was 10.3% (range 5.3–16.6). Baseline glycated haemoglobin values were only known for 58.1% of patients, so we did not further analyse them. The highest HG grades during treatment with A were as follows: G0 in 14 pts (45.2%), G1 in 5 pts (16.1%), G2 in 6 pts (19.4%), G3 in 6 pts (19.4 %). The calculated cut-off values associated with A-induced HG ≥2 were: age above 65 years, FPG above 5.9 mmol/L and BMC more than 11.5. None of the BMI cut-off values was associated with HG G≥2. Association between the baseline age, FPG and BMC and A-induced HG G≥2. Conclusions: Age over 65 years, FPG more than 5.9 mmol/L and BMC more than 11.5% have a statistically significant higher probability for A-induced HG G≥2. Therefore, these patients need more frequent blood glucose measurements, lifestyle adjustments and early treatment with metformin and/or other oral glucose-lowering agents. [Table: see text]

Metabolic markers of short and long-term exogenous DL-beta-hydroxybutyrate supplementation in episodic migraine patients: an exploratory analysis of a randomized-controlled-trial.

Background: Emerging findings propose that the pathophysiology of migraine may be associated with dysfunctional metabolic mechanisms. Recent findings suggest that migraine attacks are a response to the cerebral energy deficit, and ingestion of ketone bodies stabilizes the generation of a migraine attack. Based on these findings, ketone body supplementation is postulated as a prophylactic treatment approach to restore cerebral metabolism deficiency. Metabolic markers are unexplored after exogenous ketone body supplementation in episodic migraineurs. Therefore, the present single-arm uncontrolled explorative analysis evaluated blood ketone body and glucose concentration after short and long-term 6g exogenous DL-Mg-Ca-beta-hydroxybutyrate (DL-βHB) supplementation. Methods: The presented data are part of the MigraKet randomized-control cross-over clinical trial of 41 episodic migraineurs (Number NCT03132233). Patients were given a single dose of 6g DL-βHB. Ketone body and glucose blood concentration were assessed before intake, 20, and 40min after DL-βHB intake. Ketone body, glucose concentration and glycated hemoglobin values were evaluated after 12weeks of 18g DL-βHB ingestion (total dose), taken three times daily (6g/dose; 3x/day). Linear models explored the association between the ketone body and glucose levels. Results: Ketone body concentration increased within-group to a mean of 0.46 (0.30) mmol/L after 40min post- DL-βHB supplementation [estimate = 0.24mmol/L, CI = (0.20.0.27), p < 0.01]. This within-group increase of ketone body concentration did not change after repeated daily intake of DL-βHB supplementation over 12weeks [estimate = 0.00mmol/L, CI = (-0.03.0.04), p = 0.794]. DL-βHB intake significantly reduced blood glucose concentration within-group from a mean baseline of 4.91 (0.42) mmol/L to 4.75 (0.47) mmol/L 40min post-DL-βHB supplementation [estimate = -0.16mmol/L, CI = (-0.15, 0.03), p < 0.01]. Repeated DL-βHB supplementation for 12weeks showed no change within-group in acute ketone bodies concentration [estimate = 0.00mmol/L, CI = (-0.03.0.04), p = 0.794] and in the HbA1c value [estimate = 0.02, CI = (-0.07.0.11), p = 0.69]. Conclusion: A single dose of 6g DL-βHB significantly elevated blood ketone bodies and decreased blood glucose concentration within-group in episodic migraineurs. Long-term DL-βHB supplementation for 12weeks showed no effect within-group on acute ketone body concentration and had not impact on HbA1c. The elevation of the ketone body concentration was moderate, indicating that nutritional ketosis was not reached. Therefore, a dose higher than 6g of DL-βHB is required to reach the nutritional level of ketosis. ClinicalTrials.gov Identifier: NCT03132233.

Diabetes mellitus: relation between cardiovascular events and pharmacological treatment.

Cardiovascular diseases are characterized by problems affecting the circulatory system, specifically the heart and blood vessels. This study evaluates the relationship between cardiovascular events and pharmacological treatment for Type II Diabetes Mellitus (T2DM). We recruited 227 individuals, 191 with T2DM (EG) and 36 pre-diabetics (CG), with a mean age of 70.3 years (SD=8.3), and 62 years (SD=10.3) respectively. The individuals were distributed into five groups concerning the following variables: body mass index (BMI), age, diagnosis age of T2DM, glycated hemoglobin value (HbA1c), Homeostatic model that estimates the function of β cells value (HOMA2-B), and Homeostatic model that estimates insulin resistance (HOMA-IR) value. At the time of data collection, there were no individuals with T1DM, so it was decided to use prediabetic individuals (with a high risk of developing T2DM). Group 1 had the pre-diabetic patients (15.9%), while diabetic individuals were divided into groups 2 (1.8%), 3 (17.6%), 4 (21.1%) and 5 (43.6%). It was possible to conclude that most of the patients in the different groups had a history of acute myocardial infarction (AMI). Regarding the prevalence of pharmacological treatment, it was possible to conclude that metformin was the most used drug in most of the groups. It was possible to create different groups and to observe the existence of dependency relationships between different cardiovascular events and pharmacological treatment.

Systematic review of the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes.

Type 1 and 2 diabetes care, especially within primary health-care settings, has traditionally involved doctor-led clinics. However, with increasing chronic disease burden, there is scope for nurses to expand their role in assisting diabetes self-management. This study aimed to determine the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes. Methodology from the Joanna Briggs Institute Method for Systematic Review Research and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, including identifying publications, assessing study quality, summarizing evidence and interpreting findings. The search strategy involved using the Medical Subject Headings and keyword variations when searching MEDLINE (Ovid), Scopus, PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Inclusion criteria were samples with Type 1 or 2 diabetes, mean age of ≥18 years, English language studies and publication date of January 2011-December 2021. Overall, 34 articles from 16 countries met inclusion criteria. Though not always clinically significant, results indicated that nurse-led care had beneficial impacts on glycated haemoglobinvalues, with reductions from 0.03% to 2.0%. This was evident when nurses received formal training, used treatment algorithms, had limited medical support, utilized technology and offered defined culturally sensitive and appropriate diabetes care. Findings support nurse-led Type 1 and 2 diabetes care. Although further research is required, changes may necessitate increased recognition of nurse-led care and funding. Nurse-led care models should differ according to health-care settings.

Abstract WP13: Value Of Stress Hyperglycemia Ratio In Predicting The Prognosis Of Patients With Acute Ischemic Stroke:a Subgroup Analysis Of The Rescue Bt Clinical Trial

Objective: This study aimed to evaluate the correlation between the stress hyperglycemia and clinical outcomes after large vessel occlusion stroke (LVO) at 90 days. Methods: The RESCUE BT trial was a multicenter, randomized, double-blind, placebo-controlled clinical trial, consisting of 948 patients from 55 centers in China. In this subgroup study, 542 consecutive stroke patients with glucose or glycated hemoglobin values were included. Stress hyperglycemia was evaluated both as a tri-categorical variable (≤1.07 vs 1.08-1.29 vs ≥1.30) and a continuous variable. The primary outcome was favorable functional outcome (modified Rankin Scale [mRS] ≤ 2) at 90 days. The secondary outcome contained excellent functional outcome (modified Rankin Scale [mRS] ≤ 1) and safety outcomes such as 90-day mortality and intracranial hemorrhage. Results: 542 patients were included. Compared to patients with the lowest tertiles of stress hyperglycemia, calculated as glucose/GA ratio, the highest tertiles of stress hyperglycemia was obviously associated with a higher rate of poor functional outcome at 90-day (modified Rankin Scale [mRS] score 3-6) after adjusted for potential covariates (adjusted hazard ratio, 0.44; 95% confidence interval, 0.28-0.69, P &lt; 0.001). This result was also consistent in the excellent clinical outcome of 90-day mRS score 2-6 (adjusted hazard ratio, 0.48; 95% confidence interval, 0.29-0.79, P =0.004). Conclusion: In patients with acute ischemic stroke, lower stress hyperglycemia, as measured by glucose/GA ratio, was more likely to have favorable outcome at 90-day. Trial registration Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167, December 27, 2017.

ODP169 Challenges with use of HbA1C for Evaluation of Blood Glucose Control

Abstract Background Glycated hemoglobin (A1C) is widely used to diagnose diabetes mellitus and monitor glucose control. It represents a measurement of a proportion of glycated hemoglobin which reflects average glycemia over the lifespan of a red blood cell. Genetic factors that affect A1C values have been extensively studied and there is a growing knowledge of some variants that lead to abnormal fasting glucose-A1C ratio. Still, in some patients, delayed diagnosis or suboptimal treatment of diabetes mellitus remains an existing problem when glycated hemoglobin is underestimating blood glucose levels. Case 69-year-old man was seen in endocrine clinic following a hospital admission for newly diagnosed type 2 DM with hyperglycemic hyperosmolar state and a complicated urinary infection. Prior to admission the patient presented to primary care physician with symptoms of urinary infection and was found to have glucose &amp;gt;500mg/dL on point-of-care test and A1C of 9.5% without known history of diabetes mellitus. After a short hospital course the patient was discharged to home on low dose basal insulin and metformin. His morning glucose in the week after hospital stay was ranging between 140-182mg/dL. At the time of first visit in endocrinology he endorsed symptoms suggestive of peripheral neuropathy and had long standing polyuria, normal BMI and no other medical history or complaints. He was educated about the new diagnosis, diabetic diet, treatment and monitoring and no medication change was made at that time. On the next follow up he reported home glucose readings of 134-191mg/dL and repeated A1C was 5.1%. Urine test was remarkable for microalbuminuria and blood test showed low Hb of 8.7g/dL. Work up for anemia revealed alpha talassemia minor, hemoglobin SC disease and G6PD deficiency. During the following year regular clinic follow up visits were conducted, insulin was discontinued and the patient remained on metformin and empagliflozin over the next 4 years to date. When goal glucose control was achieved with fasting glucose of 90-130mg/dL A1C was 3.8% without any hypoglycemia. Hemoglobin at that time was 9.1g/dL. Over the next 4 years and to date his A1C was still checked 1-2 times a year and remained between 4-4.6%. On review of this patient's chart prior to hospital admission his HbA1C was 5.7% so diabetes mellitus was not suspected before the patient developed diabetic emergency that carries high mortality Discussion: There are known genetic and non-genetic factors that affect HbA1C value. It is very likely that this patient as well as many others have significant delay in diagnosis of diabetes mellitus if only HbA1C is used as screening test. A possibility of genetic variant that affects A1C values, especially in patients of African descent should always be considered when there is a discrepancy between fasting glucose and glycated hemoglobin value. Presentation: No date and time listed

SGLT2-inhibitors are effective and safe in the elderly: The SOLD study

Background and aimsSodium-glucose co-transporter-2 inhibitors (SGLT2i) may have important benefits for the elderly with type 2 diabetes (T2D), however some safety concerns still limit their use in patients over 70 years of age. The SOLD study (SGLT2i in Older Diabetic patients) is a multicenter study, aimed to evaluate the effectiveness and safety of SGLT2i in the older diabetic patients in a real-life setting. Materials and methodsWe analyzed a population of 739 adults (mean age 75.4 ± 3.9 years, M/F 420/319) with T2D, which started a SGLT2i-based treatment after the age of 70, with at least one year of follow-up. Data were collected at baseline, at 6 and 12 months of follow-up. ResultsSGLT2i (37.5% Empagliflozin, 35.7% Dapagliflozin, 26.1% Canagliflozin, 0.7% Ertugliflozin) were an add-on therapy to Metformin in 88.6%, to basal insulin in 36.1% and to other antidiabetic drugs in 29.6% of cases. 565 subjects completed the follow up, while 174 (23.5%) discontinued treatment due to adverse events which were SGLT2i related. A statistically significant reduction of glycated hemoglobin (baseline vs 12 months: 7.8 ± 1.1 vs 7.1 ± 0.8%, p < 0.001) and body mass index values (baseline vs 12 months: 29.2 ± 4.7 vs 28.1 ± 4.5 kg/m2, p < 0.001) were evident during follow-up. Overall, estimated glomerular filtration rate remained stable over time, with significant reduction of urinary albumin excretion. In the subgroup of patients which were ≥ 80 years, a significant improvement in glycated hemoglobin values without renal function alterations was evident. Overall discontinuation rate during the follow-up period was different across age groups, being urinary tract infections and worsening of renal function the most common cause. ConclusionSGLT2i are well-tolerated and safe in the elderly and appear as an effective therapeutic option, though some caution is also suggested, especially in more fragile subjects.

Safety and Efficacy of Eucaloric Very Low-Carb Diet (EVLCD) in Type 1 Diabetes: A One-Year Real-Life Retrospective Experience.

A eucaloric very low carbohydrate diet (EVLCD) is a diet with a daily caloric intake equal to the total daily energy expenditure (TDEE) with a carbohydrate content of <50 g/day. The literature on very low carbohydrate diets (VLCD) in type 1 diabetes (DM 1) is limited, although recently published scientific studies have highlighted their safety and efficacy in managing DM 1. In this retrospective analysis, we report the clinical data of 33 patients affected by DM 1 carrying out insulin therapy who switched voluntarily from their usual diet (high carb, low fat) to an EVLCD. Our aim is to evaluate the glycemic control, the amount of insulin needed in order to maintain glycemic control and safety of EVLCD. The switch improved glycemic control (mean glycated hemoglobin decreased from 8.3% to 6.8% (p < 0.01). The number of patients who reached a glycated hemoglobin value of <7% increased statistically from 12% to 57% (p < 0.01), and there was a statistically significant decrease (p < 0.01) in the units of daily insulin (from 36.7± 14.9 IU to 28.9 ±9.1 IU) A reduction from 54% to 24% in clinical level 2 hypoglycemia episodes was reported. No cases of severe hypoglycemia or ketoacidosis were observed. The results of the study support that EVLCD in DM 1 seems safe and effective when adopted under tight medical supervision.

Persistent hyperlactatemia in decompensated type I diabetes with hepatic glycogenosis and hepatomegaly: Mauriac syndrome: a case report

BackgroundWe describe a case of Mauriac syndrome, which is a rare complication of poorly controlled type I diabetes that combines glycogenosis, hepatomegaly, growth retardation with a Cushingoid appearance that is most often present in children but also in young adults. Here we also describe another finding with this syndrome, which is hyperlactatemia.Case presentationThe case is of a 16-year-old female of North African ethnicity with history of poorly controlled type I diabetes who was brought to the emergency department for dyspnea and tachycardia, treated initially for diabetic ketoacidosis. Her persistent hyperlactatemia helped to reveal a more subtle condition known as Mauriac syndrome after multiple examinations and follow-up.ConclusionsThis case reports shows that Mauriac syndrome is a rare condition that should be considered in a setting of poorly controlled type I diabetes, hepatomegaly, Cushingoid appearance, and hyperlactatemia. The current treatment of this condition is a strict control of blood glucose levels with an attempt to achieve an acceptable glycated hemoglobin value.

FACTORS AFFECTING THE LEVEL OF GLYCATED HEMOGLOBIN IN HOSPITALIZED TYPE 2 DIABETES MELLITUS PATIENTS

Today type 2 diabetes mellitus is a socially significant disease with a high growth rate in the number of patients and the risk micro- and macrovascular complications. Modern diabetology considers the level of glycated hemoglobin to be the most important tool for diagnosing type 2 diabetes mellitus. The efficacy of therapy is assessed by the target values of this very indicator.&#x0D; The aim of the study was to analyze the correlation between the level of glycated hemoglobin in type 2 diabetes mellitus patients, hospitalized to a specialized endocrinology department, and a number of clinical and epidemiological characteristics that are mandatory for describing the patient’s status.&#x0D; Materials and Methods. The authors conducted a retrospective analysis of case histories of type 2 diabetes mellitus patients hospitalized to the endocrinology department of Ulyanovsk Regional Clinical Hospital in 2020. Continuous sampling method was used. Results on the correlation between the diagnosis and the glycated hemoglobin value were obtained. Statistica 13 (StatSoft) was used for data processing. The level of glycated hemoglobin was assessed once, when the patient was hospitalized, by high performance liquid chromatography on a Bio Rad analyzer.&#x0D; Results. When conducting multivariate regression analysis, negative correlations close to linear were found in the pairs “glycated hemoglobin - duration of type 2 diabetes mellitus anamnesis” and “glycated hemoglobin - number of concomitant diagnoses not associated with type 2 diabetes mellitus”. Such patterns may be explained by the fact that a longer duration of the disease and a wider range of comorbid pathologies increase patients’ adherence to treatment and physician’s recommendations.&#x0D; Conclusion. The work conducted allows us to clarify the mechanisms of influence on the patient's compliance in type 2 diabetes mellitus treatment.

Atherosclerosis in the primary health care setting: A real-word data study

Introduction and ObjectivesTo characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. MethodsA cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. ResultsA total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001). ConclusionsAbout one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.

Machine-Learning-Based Noninvasive In Vivo Estimation of HbA1c Using Photoplethysmography Signals.

Glycated hemoglobin (HbA1c) is an important factor in monitoring diabetes. Since the glycated hemoglobin value reflects the average blood glucose level over 3 months, it is not affected by exercise or food intake immediately prior to measurement. Thus, it is used as the most basic measure of evaluating blood-glucose control over a certain period and predicting the occurrence of long-term complications due to diabetes. However, as the existing measurement methods are invasive, there is a burden on the measurement subject who has to endure increased blood gathering and exposure to the risk of secondary infections. To overcome this problem, we propose a machine-learning-based noninvasive estimation method in this study using photoplethysmography (PPG) signals. First, the development of the device used to acquire the PPG signals is described in detail. Thereafter, discriminative and effective features are extracted from the acquired PPG signals using the device, and a machine-learning algorithm is used to estimate the glycated hemoglobin value from the extracted features. Finally, the performance of the proposed method is evaluated by comparison with existing model-based methods.