Measurement Of Hemoglobin A1c Research Articles

Correlation Between the Glycemia Risk Index and Longitudinal Hemoglobin A1c in Children and Young Adults With Type 1 Diabetes.

The glycemia risk index (GRI) is a composite metric developed and used to estimate quality of glycemia in adults with diabetes who use continuous glucose monitor (CGM) devices. In a cohort of youth with type 1 diabetes (T1D), we examined the utility of the GRI for evaluating quality of glycemia between clinic visits by analyzing correlations between the GRI and longitudinal glycated hemoglobin A1c (HbA1c) measures. Using electronic health records and CGM data, we conducted a retrospective cohort study to analyze the relationship between the GRI and longitudinal HbA1c measures in youth (T1D duration ≥1 year; ≥50% CGM wear time) receiving care from a Midwest pediatric diabetes clinic network (March 2016 to May 2022). Furthermore, we analyzed correlations between HbA1c and the GRI high and low components, which reflect time spent with high/very high and low/very low glucose, respectively. In this cohort of 719 youth (aged = 2.5-18.0 years [median = 13.4; interquartile range [IQR] = 5.2]; 50.5% male; 83.7% non-Hispanic White; 68.0% commercial insurance), baseline GRI scores positively correlated with HbA1c measures at baseline and 3, 6, 9, and 12 months later (r = 0.68, 0.65, 0.60, 0.57, and 0.52, respectively). At all time points, strong positive correlations existed between HbA1c and time spent in hyperglycemia. Substantially weaker, negative correlations existed between HbA1c and time spent in hypoglycemia. In youth with T1D, the GRI may be useful for evaluating quality of glycemia between scheduled clinic visits. Additional CGM-derived metrics are needed to quantify risk for hypoglycemia in this population.

Evaluation of a Lipid Profile in Normoglycemic and Pre-diabetic Saudi Office Employees in Makka Region: A Case-Control Study.

Diabetes mellitus (DM) poses a significant health challenge worldwide. The impact of a sedentary lifestyle in predicting and managing complications of diabetes represents an urgent need for health strategies. The objective of this study was to evaluate the lipid profile among normoglycemic and prediabetic Saudi office workers. The research was a case-control study carried out in Makkah al-Mukarramah (Kingdom of Saudi Arabia, KSA).Seventy-five office worker volunteers between the ages of 19 and 45 years were recruited for the study. The participants were divided into two groups: a control group of non-diabetic normal subjects (NGT) and prediabetic subjects with impaired fasting plasma glucose and/or impaired glucose tolerance (IGT), based on the American Diabetes Association recommendations. Measurements of glucose, hemoglobin A1C (HbA1C), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were performed using standard procedures and commercial kits. Statistical analysis was performed to compare the lipid profile in the two groups, and a P-value of <0.05 was considered statistically significant. A proportion (58.7%) of the office workers are prediabetics; prediabetic office workers had higher total cholesterol compared to the controlgroup (p < 0.05). Triglyceride levels were higher in office workers with prediabetes compared to the normoglycemic group (p < 0.05). LDL levels were elevated in the prediabetic office workerscompared to the control group (p < 0.05). Office employees with prediabetes exhibit elevated levels of cholesterol, triglycerides, and LDL. The disturbance in lipid profile may be linked to impaired glucose tolerance in individuals with a sedentary lifestyle, such as office workers.

(157) Prescribing Ozempic and Wegovy for Weight Loss is Associated with an Increased Risk of Erectile Dysfunction and Hypogonadism in Non-Diabetic Males

Abstract Introduction The use of antidiabetic medications, such as metformin or sulfonylureas, can have diverse effects on sex hormones, potentially influencing erectile function. While both Ozempic and Wegovy (semaglutide) include sexual dysfunction as a side effect of the medication, no study has assessed how frequently men will experience sexual dysfunction with these medications. Recently, semaglutide was approved in June of 2021 for weight loss in non-diabetic patients and has exploded in popularity. Objective Our objective is to assess the risk of developing ED in non-diabetic males after starting semaglutide using a large claims-based database. Methods We queried the TriNetX Research database, a comprehensive insurance claims database. Our study cohort included males aged 18 to 50 who have been prescribed semaglutide after June 1st, 2021. We excluded individuals with a history of pelvic radiation, prostatectomy, pulmonary hypertension, diabetes mellitus, or any hemoglobin A1c measurement ≥7%. Propensity-matching was performed between the cohorts for age, ethnicity, race, BMI, hypertension, sleep apnea, and hyperlipidemia. Our primary outcome was comparing the proportion of men that received an ED diagnosis and/or prescription for phosphodiesterase-5 inhibitors (PDE5i) from one day to any time after the index prescription of semaglutide. The secondary outcome of interest included the risk of developing testosterone deficiency. Risk was reported using relative risk (RR) with 95% confidence intervals (CI). Statistical significance was set using a two-sided alpha at 0.05. Results We found 2,117 non-diabetic males with a prescription of semaglutide, which were compared to an equivalent number of propensity matched controls (Table 1). Compared to matched controls, males with a semaglutide prescription were significantly more likely to be diagnosed with ED and/or prescribed PDE5i (1.4%) when compared to control males who were never prescribed semaglutide (0.14%) (RR: 10.0, 95% CI [3.05 – 32.82]). Similarly, males with a prescription for semaglutide were more likely to receive a subsequent diagnose of testosterone deficiency (3.83%) compared to controls (1.7%), (RR: 2.25, 95% CI [1.53 – 3.32]) from one day to any time after the index prescription. Conclusions In this claims-based analysis, we found that non-diabetic males with a prescription of semaglutide have a significantly higher risk of developing ED and testosterone deficiency. Rates of erectile dysfunction in men prescribed semaglutide are overall low at 1.4% but, we were surprised that these rates were so much higher than those not receiving semaglutide as we expected that weight loss drugs would improve erectile function. Further studies are needed to assess the impact of semaglutide in non-diabetic men to assess how this drug impacts the male hypothalamic-pituitary-gonadal axis. Despite its increasing popularity for weight loss, both clinicians and patients should be aware of potential hormonal effects when discussing and considering the medication. Disclosure No.

The Glucose Management Indicator: Time to Change Course?

Laboratory measurement of hemoglobin A1c (HbA1c) has, for decades, been the standard approach to monitoring glucose control in people with diabetes. Continuous glucose monitoring (CGM) is a revolutionary technology that can also aid in the monitoring of glucose control. However, there is uncertainty in how best to use CGM technology and its resulting data to improve control of glucose and prevent complications of diabetes. The glucose management indicator, or GMI, is an equation used to estimate HbA1c based on CGM mean glucose. GMI was originally proposed to simplify and aid in the interpretation of CGM data and is now provided on all standard summary reports (i.e., average glucose profiles) produced by different CGM manufacturers. This Perspective demonstrates that GMI performs poorly as an estimate of HbA1c and suggests that GMI is a concept that has outlived its usefulness, and it argues that it is preferable to use CGM mean glucose rather than converting glucose to GMI or an estimate of HbA1c. Leaving mean glucose in its raw form is simple and reinforces that glucose and HbA1c are distinct. To reduce patient and provider confusion and optimize glycemic management, mean CGM glucose, not GMI, should be used as a complement to laboratory HbA1c testing in patients using CGM systems.

Uncommon causes of hemoglobin E flags identified during measurement of hemoglobin A1c by ion-exchange high-performance liquid chromatography.

We present 3 cases of discordant results from screening hemoglobin A1c (HbA1c) measured by ion-exchange high-performance liquid chromatography (HPLC) all due to various forms of interference and flagged by the instrument as "suspected hemoglobin E (HbE)." The first case was due to a rare hemoglobin variant, later confirmed to be hemoglobin Hoshida, the second due to "true" heterozygous HbE, and the third a result of analytical artifact causing splitting of the HbA1c peak without an underlying variant hemoglobin. We examine the similarities in these cases along with the laboratory work-up to classify each cause of interference to demonstrate the wide array of potential causes for the suspected HbE flag and why it warrants proper work-up. Because there is no standardized method of reporting out hemoglobin variant interference in HbA1c measurement, we discuss our laboratory's process of investigating discordant HbA1c measurements and reporting results in cases with variant interference as 1 possible model to follow, along with discussing the associated laboratory, ethical, and clinical considerations. We also examine the structure of hemoglobin Hoshida, HbE, and conduct a brief literature review of previous reports.

Two patients with α-chain hemoglobin variant Hb Q-Iran detected by measuring hemoglobin A1c using the variant mode of the HA-8180V HPLC analyzer.

Hemoglobin variants are often discovered when hemoglobin A1c (HbA1c) levels measured with a high-performance liquid chromatography (HPLC) system in fast mode are found to be low. The HA-8180V HPLC analyzer by Arkray offers two measurement modes: fast mode (FM) and variant mode (VM). Two Japanese patients with α-chain variant Hb Q-Iran detected incidentally after analyses with the HA-8180V in VM showed an abnormal peak, are presented. The first patient was a man in his 70s, and the second patient was a man in his 50s. Both were non-diabetic, but their results from HbA1c measurement in VM showed an abnormal peak. The VM-HbA1c, FM-HbA1c, and HbA1c measured by enzymatic assay and glycated albumin levels of the two patients were all within the reference ranges. They were diagnosed as having Hb Q-Iran (α2-75Asp → His) by globin gene analysis. It is difficult to detect α-chain hemoglobin variants based on abnormal FM-HbA1c levels, but measuring HbA1c in VM is useful for efficiently detecting hemoglobin variants.

Changes in Metabolic Parameters of Hemoglobin A1c, Weight, and Blood Pressure During and After COVID-19 Stay-at-Home Orders.

Due to the COVID-19 pandemic, a "state of emergency" was declared in North Carolina on March 10, 2020. Subsequent "stay-at-home" (SAH) orders restricted activities including use of fitness facilities, and teleworking was encouraged. This study investigates metabolic effects of these changes in activity level. This retrospective prepost study included adults diagnosed with type 2 diabetes mellitus and hypertension with hemoglobin A1c (HbA1c), weight, and blood pressure (BP) measurements for 3 time periods: 3/10/2019-9/9/2019 ("pre-SAH"), 3/10/2020-9/9/2020 ("during SAH"), and 3/10/2021-9/9/2021 ("post-SAH"). The primary outcome was change in HbA1c pre-SAH to during SAH and during SAH to post-SAH. Secondary outcomes were changes in weight, systolic BP (SBP), and diastolic BP (DBP) over the same periods. Exploratory outcomes included health care utilization. Paired t test compared outcomes between time periods using Bonferroni-adjusted α of 0.025 for significance. Analysis included 301 participants with an average age of 69.8 years. HbA1c, SBP, and DBP trended up from pre-SAH to during SAH and then decreased post-SAH with a significant change only for DBP from during SAH to post-SAH (74.2 mmHg to 73.6 mmHg, P < .001). Weight trended down across the 3 study periods. In-office visits significantly decreased from pre-SAH to during SAH, and telehealth visits significantly decreased from during SAH to post-SAH (both P < .001). With the exception of DBP, findings reveal consistency in HbA1c, weight, and BP across time periods before, during, and after COVID-19 SAH orders in North Carolina.

High prevalence of retinopathy in young-onset type 2 diabetes and possible sex differences: insights from Norwegian general practice

IntroductionPeople with young-onset type 2 diabetes (YOD), defined as diabetes diagnosis before age 40, have a high lifetime risk of vascular complications. We aimed to estimate the prevalence of YOD...

Commutability and Uncertainty of Blood Hemoglobin A1c Testing Materials.

Hemoglobin A1C (HbA1C) is used to evaluate glycemic control over a three-month period. Blood matrix-based HbA1C materials are needed for quality control and evaluation of HbA1C measurements. This study investigated the commutability of blood materials (BMs) and aimed to upgrade BMs for HbA1C testing for use as proficiency test (PT) material. We measured BMs from a DM blood donor (n = 1), an in vitro glycation procedure (n = 3), and from commercial sources (n = 2) for HbA1C in parallel with fresh unprocessed BMs (n = 3) and clinical blood samples (n = 25). Two NGSP-certified methods, including a turbidimetric and an enzymatic immunoassay, were used for HbA1C determinations. Commutability as investigated according to CLSI EP14-Ed4 guidelines. The commutable BMs exhibited a mean paired difference of 0% to 9% when compared to reference methods, whereas the non-commutable BMs represented a mean paired difference of 3% to 11%. Fresh, unprocessed BMs with a low HbA1C of 6.0% were more commutable than BMs with a high HbA1C. The values of HbA1C in BMs (mean and uncertainty following ISO Guide 35 for RM production) were applied to upgrade the PT material to be used as a reference material. The relative uncertainty of BM-Ndm-1 and BM-Gcb-3 were 1 and 0.4%, respectively. The commutability of hemoglobin in BMs is dependent on the preparation process. Blood materials with a high HbA1C content are usually less commutable versus materials with low HbA1C content when prepared by the same process. Our study showed BMs can be successfully used as quality control or PT materials.

HCC is associated with diabetes and longitudinal blood glucose control in a national cohort with cirrhosis.

Diabetes is associated with HCC; however, the impact of longitudinal blood glucose (BG) control on HCC risk in cirrhosis is not well known. We investigated this knowledge gap in a cohort of United States Veterans with cirrhosis from 2015 to 2021. We used repeated hemoglobin A1c measurements to categorize follow-up time according to BG control (defined as hemoglobin A1c < 7%) state over time: uncontrolled, nonsustained control (≤2 y), or sustained control (>2 y). We performed a sensitivity analysis using hemoglobin A1c < 8% to define BG control. We used Fine and Gray Cox proportional hazards regression with death and transplant as competing events to compare rates of incident HCC. Our study included 81,907 individuals, 56.2% of whom had diabetes at baseline. There were 8,002 incident HCCs. The rate of HCC was 18% higher in diabetes (95% CI: 13% - 24%), and the relative increase in the rate of HCC varied by etiology of cirrhosis from nonsignificant (HCV) to an increase of 120% (HBV). Uncontrolled and nonsustained BG control was associated with 1.80 (95% CI: 1.70-1.91) and 2.34 (95% CI: 2.21-2.48) times the rate of HCC compared to sustained BG control, respectively. Using Hgb A1c < 8% to define BG control, HCC rates in uncontrolled and nonsustained BG control were 2.43 (2.28-2.58) and 2.23 (2.11-2.36) times that observed in sustained BG control. Associations between diabetes and HCC in cirrhosis vary according to the longitudinal BG control state. Inadequate BG control is consistently associated with a higher risk of HCC, and long-term BG control should be considered in comprehensive cirrhosis care.

Markers of Glycemic Control in Adults with Sickle Cell Disease

Background: Approximately 10% of adults with sickle cell disease (SCD) have diabetes mellitus (DM) (PMID 30714090). Glycemic control is challenging to evaluate in the setting of hemoglobinopathies, such as SCD, due to potentially inaccurate hemoglobin A1c (HbA1c) measurements (PMID 30897962). Fructosamine has been proposed as a marker of glycemic control in patients with hemoglobinopathies, although its use remains unvalidated in clinical studies (PMID 27457632). The ideal glycemic monitoring strategy in patients with SCD is unclear. Therefore, the objective of this study was to evaluate the performance of fructosamine and HbA1c in predicting glycemic burden in adults with SCD. Methods: We analyzed 439 patients followed between Jan 2010 and Feb 2023 at the University of Illinois Sickle Cell Center. DM was defined by a diagnostic code in the electronic health record plus either prescription of an outpatient antidiabetic agent or an outpatient random serum glucose &amp;gt;200 mg/dL. Comparisons of clinical and laboratory variables by DM status were performed using the Wilcoxon rank sum, Pearson's chi-squared, and Fisher's exact test. Correlation analyses were conducted to evaluate the association of fructosamine and HbA1c with time-paired mean serum glucose concentrations, and of HbA1c with indirect bilirubin (I Bili), absolute reticulocyte counts (retic), and lactate dehydrogenase (LDH) concentration. Multivariate regression models for HbA1c used mean serum glucose concentration and either I Bili, retic, or LDH as covariates with an interaction term. Results: The median age of the cohort at the time of enrollment was 32 years (interquartile range [IQR] 25-43 years), 57% were female, 76% were hemoglobin SS, and 46% were on hydroxyurea. 41 (9.3%) patients had DM (Table). SCD patients with DM were older, more frequently on angiotensin converting enzyme inhibitors or angiotensin receptor blockers, had higher serum triglyceride concentrations, lower baseline eGFR, and higher baseline urine albumin-to-creatinine ratios compared to those without DM (p ≤ 0.004). In 39 patients with 157 observations, fructosamine concentration correlated poorly with 14-day time-paired mean glucose concentrations ( r s +0.02, p = 0.8; R2 0.01). In 19 patients with 176 observations, HbA1c significantly correlated with 30-day time-paired mean glucose concentrations ( r s +0.36, p &amp;lt; 0.001; R2 0.25). HbA1c progressively increased with higher glucose category (p &amp;lt; 0.001), while there was no association between fructosamine concentrations and glucose category (p = 0.5) (Figure). Increased hemolysis was associated with decreased HbA1c (I Bili r s -0.44, p &amp;lt; 0.001; retic r s -0.33, p = 0.002; LDH r s -0.18, p = 0.2). After adjustment for hemolytic markers with interaction effects, HbA1c continued to predict 30-day time-paired mean glucose concentration (I Bili β HbA1c +20.8, p &amp;lt; 0.001; retic β HbA1c +24.1, p &amp;lt; 0.001; LDH β HbA1c +26.0, p = 0.002). The addition of these hemolytic and interaction terms generally improved the fit of the model (Unadjusted R2 0.24 versus adjusted for I Bili R2 0.42, retic R2 0.22, or LDH R2 0.55). Conclusions: Our findings suggest that fructosamine concentration is a poor glycemic marker in adults with SCD. We observe that increased hemolytic markers are associated with decreased HbA1c, and the addition of a corrective hemolysis interaction term may improve the predictive ability of HbA1c for mean glucose concentration. Further studies are urgently needed to develop and validate glycemic monitoring strategies, such as continuous glucose monitoring, in this group of patients.

SAT135 Prospective Analysis For Improvement For Glycemic Control Using A Patient Portal And Automated Messages

Abstract Disclosure: C.C. Cristancho: None. M. Brandao: None. A. Lema Morocho: None. T. Amorim: None. Background: Type II diabetes is a complex metabolic disorder which is influenced in part by patient dietary choices, medication adherence, and environmental factors. Behavioral health interventions offer an opportunity to potentially affect patient outcomes in a cost-effective manner. Purpose: To study whether automated clinical messaging via the electronic medical chart would be associated with improvement in diabetes-related health measures. Methods: We created an automated clinical messaging system (January 2020) via our electronic medical record. Patients who opted-in for this service received bi-weekly messages which included reminders about diabetes medication adherence as well as exercise and dietary recommendations. We then performed a retrospective longitudinal analysis of patients followed in our diabetes clinic, comparing those who opted-in for messing vs those who did not, and assessed diabetes-related biomarkers including baseline and follow-up hemoglobin A1c, lipid markers, and BMI using linear mixed-effects regression models. Results: 69 patients who had at least 2 measures of hemoglobin A1c were followed longitudinally, of whom 37 (54%) had opted to receive automated messaging. Patients who opted-in were younger (53±12 vs 62±11 years old, p&amp;lt;0.1), but not different in terms of sex (60% F vs 61% F), BMI (31±6 vs 30±7, p=0.84), or A1c (9.4±2.3 vs 8.8±2.7, p=0.34). In the group that received messages, we did not find any significant pre-post differences in A1c, LDL, or BMI over time. In the opt-in group, mean change (over average follow-up of 256 days) in HgbA1c was -0.4 (p=0.42) compared to a change of 0.0 in the non-opt-in group (p=0.99). Discussion: Patients who opted-in to electronic messaging were younger on average. We did not observe any significant longitudinal change in diabetes-related biomarkers within or between groups as related to an automated clinical messaging service, although there was a directional trend toward improvement. Given the cost-effectiveness and ease of this program, consideration should be given toward a trial with a larger sample size and longer follow-up. Presentation: Saturday, June 17, 2023

A New Hemoglobin Variant: Hb Tangshan [HBA1: c.239C > T, CD79(GCG > GTG)(Ala > Val)] Detected by MALDI-TOF MS

In this report we decribed a new α-chain variant found during the measurement of hemoglobin A1c (Hb A1c) using matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS). MALDI-TOF MS analysis detected an α-chain variant with a mass of 15,155 Da. However, this Hb variant was not detected during Hb A1c measurement by cation-exchange high-performance liquid chromatography (HPLC) and capillary electrophoresis (CE) methods. Sanger sequencing validated the presence of a heterozygous missense mutation [HBA1: c.239C > T, CD79(GCG > GTG)(Ala > Val)]. The observed 28 Da mass difference exactly matches the theoretical mass difference (28 Da) resulting from the substitution of alanine (89.079) with valine (117.133). As this represents the initial documentation of the mutation, we named it Hb Tangshan after the proband’s residence.

Effect of Health Literacy Intervention on Glycemic Control and Renal Function Among Thai Older Adults at Risk of Type 2 Diabetes Mellitus.

Diabetes patients with low health literacy often have poor health and clinical outcomes. The study aimed to assess the effectiveness of a health literacy intervention on glycemic control and renal function among Thai older adults at risk of type 2 diabetes mellitus (T2DM). A quasi-experimental study was carried out in rural areas of Phayao Province in northern Thailand. The participants were older adults with T2DM who recorded blood glucose levels ranging from 140 to 180 mg/dL and who were not receiving prescribed medication. The intervention lasted 12 weeks, and data were collected at three points: baseline, post-intervention, and at 3 months' follow-up. The study outcomes included the measurement of fasting blood sugar (FBS), hemoglobin A1C (HbA1c), and glomerular filtration rate (eGFR) levels after the intervention. A linear mixed model and generalized estimating equations model were used to assess the intervention effect for continuous and binary outcomes, respectively. From baseline to post-intervention, FBS and HbA1c decreased more in the intervention group than in the control group by 8.2 mg/dL (p < 0.001) and 0.1% (p = 0.029), respectively, whereas eGFR increased by 8.0 mL/min/1.73m2 (p < 0.001). The absolute effect of the intervention at follow-up was -9.8 units for FBS, -0.4 units for HbA1c, and 14.0 units for eGFR. Abnormal HbA1c level (≥6.5%) of the intervention group was reported as 70.3% at baseline, 31.3% at post-intervention, and 9.4% at follow-up. Compared to baseline levels, the T2DM patients who received the intervention were 0.31 times less likely to have abnormal HbA1c levels than the control subjects at follow-up (p = 0.003) who received no intervention. Our findings suggest that this intervention may potentially improve diabetes self-management and prevention behaviors, thereby reducing the diabetes burden in rural communities in northern Thailand.

Reliability and Validity of Self-Reported Vascular Risk Factors: Hypertension, Diabetes, and Heart Disease, in a Multi-Ethnic Community Based Study of Aging and Dementia.

Queries for the presence of cardiovascular and cerebrovascular risk factors are typically assessed through self-report. However, the reliability and validity of self-reported cardiovascular and cerebrovascular risk factors remain inconsistent in aging research. To determine the reliability and validity of the most frequently self-reported vascular risk factors: hypertension, diabetes, and heart disease. 1,870 individuals aged 65 years or older among African Americans, Caribbean Hispanics, and white non-Hispanic individuals were recruited as part of a community study of aging and dementia. We assessed the reliability, validity, sensitivity, specificity, and percent agreement of self-reported hypertension, diabetes, and heart disease, in comparison with direct measures of blood pressure, hemoglobin A1c (HbA1c), and medication use. The analyses were subsequently stratified by age, sex, education, and ethnic group. Reliability of self-reported hypertension, diabetes, and heart disease was excellent. Agreement between self-reports and clinical measures was moderate for hypertension (kappa: 0.58), good for diabetes (kappa: 0.76-0.79), and moderate for heart disease (kappa: 0.45) differing slightly by age, sex, education, and ethnic group. Sensitivity and specificity for hypertension was 88.6% -78.1%, for diabetes was 87.7% -92.0% (HbA1c ≥6.5%) or 92.7% -92.8% (HbA1c ≥7%), and for heart disease was 85.8% -75.5%. Percent agreement of self-reported was 87.0% for hypertension, 91.6% -92.6% for diabetes, and 77.4% for heart disease. Ascertainment of self-reported histories of hypertension, diabetes, and heart disease are reliable and valid compared to direct measurements or medication use.

Risk of atrial fibrillation in individuals with dysglycemia and diabetes

ObjectiveDiabetes is a risk factor for atrial fibrillation (AF), and increases the risk of thromboembolic events in persons with AF. However, the link between the two conditions is not fully elucidated. Few studies have investigated the association of dysglycemia and incident AF. We investigated the risk of incident AF and prognosis according to diabetes status. Research design and methodsThe Copenhagen Primary Care Laboratory Database was merged with data on medical prescriptions, in- and outpatient contacts and vital status. The risk of AF according to diabetes status was investigated by use of Cox regression models. ResultsOf 354.807 individuals with a hemoglobin A1c (HbA1c) measurement, 28.541 (8 %) had known diabetes, 13.038 (4 %) had new onset diabetes and 27.754 (8 %) had prediabetes (HbA1c 42-47 mmol/mol). Persons with dysglycemia (HbA1c > 42 mmol/mol) and diabetes were older, more were men, they had lower level of education and were more likely to be living alone. We observed a gradual increase in risk of developing AF from HbA1c levels of 40 to 60 mmol/mol. In adjusted analyses we found a stepwise increase in hazard of AF from normoglycemia over prediabetes to persons with diabetes (no diabetes: 1.00 [ref.]; prediabetes: 1.12 [1.08–1.16]; new-onset diabetes: 1.16 [1.10–1.22]; known diabetes: 1.15 [1.11–1.20]). Persons with known diabetes had a significant higher hazard of stroke, cardiovascular and all-cause mortality. ConclusionIncreasing levels of HbA1c were associated with an increased hazard of developing AF. Persons with new onset of diabetes and those with known diabetes had similar hazard of developing AF, however persons with known diabetes had a significant higher hazard of stroke, cardiovascular- and all-cause mortality.

Improving glucose control in patients with type 2 diabetes using retrospective continuous glucose monitoring.

The prevalence and cost of type 2 diabetes mellitus (T2DM) is rising. Diabetes care should be individualized based on patient risk factors and goals. Professional continuous glucose monitoring (CGM) is a tool for primary care providers to assist patients with diabetes management. Nurse practitioners at an outpatient primary care practice began using CGM in patients with T2DM in 2019 to guide treatment due to the high number of patients not reaching glucose targets. There was no policy in place to guide patient selection for CGM. This quality improvement (QI) project, conducted in an outpatient primary care clinic, evaluated the effect of retrospective CGM use in patients with T2DM through a retrospective chart review to create a policy for use. Hemoglobin A1c (HbA1c) measurements pre-CGM and post-CGM use were compared. CGM reports were evaluated for the presence of hypoglycemia. Additionally, number of times a patient used CGM between HbA1c laboratory examinations as well as insulin status were determined by reviewing the electronic health record. Patients using CGM for HbA1c higher than goal (n = 60) noted a 1.01% decrease in HbA1c (p < .01). The decrease was similar regardless of exogenous insulin status. Hypoglycemia was detected in 54.3% of patients (n = 44), including 45% (n = 27) of those with elevated HbA1c levels. Retrospective CGM is a cost-effective tool to individualize management of patients with T2DM in primary care. A policy was created to guide CGM use in patients not reaching glucose goals and those with concern for hypoglycemia.

Development of a portable spectrophotometer using artificial neural networks for non-invasive determination of glycated hemoglobin in blood by Raman spectroscopy

BACKGROUND: Non-invasive diagnosis of diabetes is one of the major problems of contemporary medicine. The system being planned could be a new technology for measuring hemoglobin A1c (HbA1c) accurately and non-invasively. Therefore, a series of studies are to be conducted to assess the efficiency of the method under study and determine its potential for medical diagnosis and monitoring of HbA1c.&#x0D; AIMS:&#x0D; &#x0D; Investigation of the feasibility of Raman spectroscopy for non-invasive measurement of HbA1c.&#x0D; Development and design of a portable analyzer using this technology.&#x0D; Assessment of the efficiency and accuracy of the developed device.&#x0D; &#x0D; METHODS: Neural network creation requires collecting a training sample of measurements for subsequent application of TensorFlow library tools and performing laboratory measurements to calibrate the system for determining HbA1c. The device will use a 785-nm laser to take spectra according to the Raman spectroscopy. The obtained data will be fed to the input of the neural network based on the architecture of convolutional neural networks. Experiments will be conducted to train the model to determine the accuracy and efficiency of the device. A two-step data collection procedure is planned. First, a preliminary test will be done on 50 patients to see how the proposed method handles different age and gender groups and different HbA1c levels. Later, the data will continue to be collected on a larger scale, including patients with different types of diabetes and healthy individuals. Data will be collected using a portable spectrophotometer and monitored by high-performance liquid chromatography. Various metrics will be used to assess the efficiency and accuracy of the device such as accuracy, precision, recall, and F1-score.&#x0D; RESULTS: An analysis of the available literature was conducted and the following conclusions were drawn. In addition, a neural network model was developed using HbA1c measurements. Currently, our model is optimized to improve the accuracy and reliability of the results.&#x0D; CONCLUSIONS: The non-invasive Raman spectroscopy-based method has several advantages in measuring HbA1c levels. The procedure is faster and non-traumatic, and HbA1c levels can be monitored continuously. In particular, the non-invasive method eliminates errors associated with protein leakage outside the bloodstream.

970-P: Effectiveness of Continuous Glucose Monitoring Use for Diabetes Management in an Academic Endocrinology Practice

The achievement of individualized glycemic targets in patients with diabetes is often a significant challenge. Empowering patients with technological tools in the ambulatory setting can pave the way for improved glucose control. We retrospectively examined the records of 94 patients managed in an academic endocrinology practice who were referred for management of diabetes over a 12-month period. Forty-one patients (18 females and 23 males, average age 57.7 years), who had at least two hemoglobin A1c measurements and two 14-day periods of personal continuous glucose monitoring (CGM) data, were included in the analysis. Nine patients had type 1 and 32 patients had type 2 diabetes. Eight patients were not on any insulin therapy, 8 patients were on basal insulin, 18 were using multiple daily insulin injections, and 7 were managed with insulin pump therapy. A multidisciplinary management approach was utilized. The pharmacologic regimen, including both insulin and other medications, was adjusted every 2-4 weeks via in-person visits and remote data upload as necessary. The average A1c was 8.4% at initial visit and 7.1% at the most recent follow-up, a decrease of 1.3% (p=0.0002). Review of CGM data showed that the average time-in-range (70-180 mg/dl) increased from 63.6% at first CGM download to 74.1% at a mean follow-up of 301 days (p=0.0097), while the amount of time in the hyperglycemic range (time-above-range, &amp;gt;180 mg/dl) decreased from 33.5% to 22.1% (p=0.0079). Time-below-range (&amp;lt;70 mg/dl) remained statistically unchanged, signifying no worsening of hypoglycemia. In conclusion, in ambulatory patients with diabetes and suboptimal glucose control, frequent and tailored adjustments in insulin and noninsulin medications aided by CGM use with close follow-up can lead to significant improvement in glycemic control. The latter, if sustained, can translate to fewer complications and greater patient satisfaction in the long-term. Disclosure K.N.Grennan: None. A.A.Rizvi: None. A.Kathuria: None.

Early Identification of Type 2 Diabetes Using Glycated Haemoglobin in Primary Care Medical Offices as a Proof of Feasibility in Austria

Numerous studies have been carried out on determination of glycated haemoglobin to diagnose type 2 diabetes (T2D), among them the manuscript by Selvin et al [1]. They have led the American Diabetes Association (ADA) to recommend haemoglobin A1c (HbA1c) measurements to identify patients having diabetes in their 2010 position statement with a cut off of =6.5 % [2]. Nevertheless, there is some controversial discussion whether HbA1c should be the gold standard for diagnosis of T2D instead of fasting glucose or oral glucose tolerance testing with various arguments in favour of HbA1c [3].