Blood HbA1c Research Articles

Cardiovascular diseases across OSA phenotypes: A retrospective cohort study

BackgroundDespite the considerable knowledge of Obstructive Sleep Apnea (OSA) implications for cardiac diseases, the evidence regarding cardiovascular complications across OSA phenotypes including Rapid Eye Movement OSA (REM-OSA) and Positional OSA (POSA) is limited. In this study, we aimed to evaluate the risk of cardiovascular diseases development and progression among patients with REM-OSA and POSA. MethodsBased on a retrospective cohort analysis, we included polysomnography studies done in the sleep lab at the Jordan University Hospital. Regarding cardiovascular diseases, primary outcomes were Heart Failure, and 1-years Major Adverse Cardiac Events while secondary outcomes were atrial fibrillation, pulmonary hypertension, other arrhythmia, metabolic profile, and echocardiographic measurements of the heart. ResultsThe total number of the included patients was 1,026 patients. POSA group had significantly lower percentage of patients with hypertension (P-value = 0.004). Additionally, systolic blood pressure and HbA1c were significantly lower among patients with POSA compared to the NPOSA group (P-value<0.050). Left ventricular end diastolic dimension was significantly higher among patients with POSA while ejection fraction was significantly lower (P-value<0.050). Patients with diabetes and mean HbA1c were significantly lower among patients with REM-OSA compared to patients with NREM-OSA (P-value = 0.015, P-value = 0.046). Multivariate regression analysis revealed that after adjusting for age, gender and preexisting comorbidities, POSA was significantly associated with lower ejection fraction and higher left ventricular diastolic diameter. ConclusionIn conclusion, our findings indicate that POSA might be associated with huge and clinically significant heart strain and poor cardiac functions, yet it might not have a clinically significant atherogenic effect. This study should guide clinicians to identify OSA phenotypes to imply the best treatment plan to reduce its detrimental impact on cardiac muscle.

25-hydroxy vitamin D concentrations negatively correlated with HbA1c in type 2 diabetes mellitus patients: a cross-sectional study in Mampang, South Jakarta

&#x0D; &#x0D; &#x0D; INTRODUCTION: Insulin resistance plays a central role in type 2 diabetes mellitus (T2DM). Another possible cause of T2DM is a deficiency o f 25-hydroxy vitamin D [ 25(OH)D], although the underlying mechanism is not yet clearly understood. The most frequently used laboratory parameters for monitoring T2DM are fasting blood glucose (FBG) and HbA1c. Determining any association of vitamin D with HbA1c and FBG in T2DM.&#x0D; METHODS: A cross-sectional study involving 100 T2DM patients with the following characteristics: 18-year and older persons of both genders, not having kidney and liver disease, not on insulin therapy, not pregnant or lactating, a nd n ot consuming vitamin D i n t he last three months. Spearman’s correlation coefficient was use d to test any association of 25(OH)D with HbA1 c and fasting blood glucose (FBG) (p&lt;0.05).&#x0D; RESULTS: Subjects comprised 74 females and 26 males with a median age of 56 years. Median HbA1c, 25(OH)D, and FBG were 8.05%, 11.2 ng/mL, and 127 mg/dL, respectively. The Spearman correlation coefficient for vitamin D and HbA1c was r=-0.217 (p=0.03), and for vitamin D and FBG,it was r =-0.153 (p=0.128).&#x0D; CONCLUSION: There was a significant negative correlation of vitamin D with HbA1c but not with FBG. Administration of vitamin D should be considered for additional treatment of T2DM.&#x0D; &#x0D; &#x0D;

Prediabetic HbA1c and Cortical Atrophy: Underlying Neurobiology.

To investigate the relationship between blood glycated hemoglobin (HbA1c) and cerebral cortical thickness (CT) and identify potential cellular mechanisms involved. A cohort of 30,579 adults age 45 to 81 (mean ± SD: 64 ± 7.5) years with available data on brain MRI and blood HbA1c levels was analyzed. The relationship between HbA1c and CT was probed using independent spatial profiles of cell-specific gene expression. Lastly, a genome-wide association study was conducted on the shared variance between HbA1c and CT. The HbA1c-CT association was noncontinuous, emerging negatively within the prediabetic range (39.6 mmol/mol). This association was strongest in brain regions with higher expression of genes specific to excitatory neurons and lower expression of genes specific to astrocytes and microglia. A significant locus implicated mitochondrial maintenance and ATP generation. Effective glycemia control at prediabetic levels is warranted to preserve brain health and prevent prediabetes-related neurobiologic perturbations.

The preconception health status of nongravid women aged 18 to 45 years in Arima, Trinidad: a cross-sectional study

BackgroundPreconception care (PCC) is the term used for activities and interventions designed to address and prevent problems related to pregnancy, the neonatal period and childhood. This study assessed maternal health status prior to conception in Trinidad by means of a screening tool, physical measurements, and laboratory samples.MethodsA cross-sectional study was conducted among women aged 18–45 years at a primary care centre in Arima, Trinidad. A de novo PCC screening tool was used to assess 13 domains of high-risk pregnancy in participants. These domains included dietary details, gynaecological and obstetric histories, and genetic and vaccination histories, among others. Blood pressure, weight, height, and waist circumference were recorded, and a capillary blood sample was used to determine random blood glucose and HbA1c levels. All data were coded and entered into SPSS ver. 21.ResultsA total of 400 nongravid participants were recruited, of whom 366 were included in the final analysis. Most (96.7%) had one or more risk factors for adverse pregnancy outcomes. These included overweight (27%), obesity (35%), central obesity (69.4%), and impaired glucose tolerance/diabetes mellitus (IGT/DM) (26.2%). Additionally, a sedentary lifestyle and diet high in processed food/fats were self-reported by 74.9% and 88.8% of participants, respectively. Only 13.1% had planned to conceive, and of those who had no immediate plans to conceive, 76.4% were currently sexually active, and many (60.7%) did not use birth control techniques. More than half (57.1%) had never had a pap smear. On the other hand, 86.3% knew their HIV status. Self-reported percentages for vaccination were as follows: MMR (100%), tetanus (17.5%), hepatitis B (11.5%) and influenza (2.7%). The majority (82.8%) of participants had not visited the dentist in the past year, with 35.9% of these individuals reporting symptoms of periodontitis. Segments of the population had multiple risk factors; for example, 23.7% of participants were overweight or obese and had an elevated HbA1c level.ConclusionsUnexpectedly, most participants had a risk factor for an adverse pregnancy outcome, and many had multiple risk factors. There is a strong case for enhanced preconception care for women in Trinidad.

Effect of Barley Grass on Antioxidant Capacity and DNA Damage in Diabetic Rats

Objective: Worldwide, phytotherapy methods acquire great importance, and studies in this field are increasing their importance each day. This study, it was aimed to examine total antioxidant, oxidant status, oxidative DNA damage, glucose and hemoglobin A1c levels and the effects of barley grass juice on these parameters in rats with diabetes mellitus.&#x0D; Material and Method: Four groups were formed for the study and 6 male rats weighing 250-350 g were used in each group. Control Group; physiological saline was injected via intraperitoneal., Diabetic Group; created using streptozotocin, Barley Grass Group; Barley grass juice (3 ml/rat/day) was given orally for 4 weeks, Diabetic and Barley Grass Group; was injected streptozotocin and barley grass juice was given by oral for 4 weeks.&#x0D; Results: It was determined that barley grass juice decreased blood sugar, glucose, hemoglobin A1c, total oxidative status and oxidative stress index values, increased total anti-oxidative status value, and body weights in streptozotocin-induced diabetes. In addition, it was determined that the addition of barley grass juice provided a significant protective effect and improvement in these parameters.&#x0D; Conclusion: Based on these findings, we can say that barley grass juice has an antidiabetic-antioxidant effect and weight gain in diabetes mellitus

Daily consumption of γ-oryzanol-fortified canola oil, compared with unfortified canola and sunflower oils, resulted in a better improvement of certain cardiometabolic biomarkers of adult subjects with type 2 diabetes: a randomized controlled clinical trial

BackgroundThis study was undertaken to examine the effects of daily consumption of γ-oryzanol (ORZ)-fortified canola oil, as compared with plain canola and sunflower oils, on certain cardiometabolic indicators.MethodsNinety-two adult subjects from both sexes with T2D were randomly assigned to one of the three groups to receive: (a) ORZ-fortified canola oil (Group 1; n1 = 30); (b) unfortified canola oil (Group 2; n2 = 32); or (c) sunflower oil (Group 3; n3 = 30) for 12 weeks. The participants were instructed to use only the given oils for all cooking (but frying) purposes. Anthropometric, dietary and biochemical assessments were done initially and finally.ResultsThough body mass index (BMI) significantly decreased in all three groups, only in Groups 1 and 2 waist circumference (WC) showed a significant decrement (-2.6 ± 0.1 and -2.2 ± 0.1 cm in Groups 1 and 2 respectively, p < 0.001 for both) which was accompanied by a significant reduction of blood pressure just in Group 1. Fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) showed a significant decrease only in ORZ-fortified canola oil group (−7.7 ± 0.4 mg/dL, p = 0.039 and −0.7 ± 0.1%, p < 0.001, respectively). However, insulin resistance, as judged by HOMA-IR, did not change significantly. In addition, serum triglyceride (TG) concentrations decreased in all three groups but only in ORZ-fortified canola oil was this decrement statistically significant (-17.9 ± 2.1 mg/dL, p = 0.005). Other components of serum lipid profile did not change significantly in either group.ConclusionsConsumption of either sunflower or canola oils for 12 weeks improved certain studied biomarkers. However, only ORZ-fortified canola oil resulted in a significant decrease of blood pressure, WC, FBG, HbA1c and TG. These findings can help both clinicians and public health authorities for dietary recommendations to subjects with T2D and presumably the whole community.Trial registration: number at clinicaltrials.gov (NCT05271045).

Harnessing Code Interpreters for Enhanced Predictive Modeling: A Case Study on High-Density Lipoprotein Level Estimation in Romanian Diabetic Patients.

Diabetes is a condition accompanied by the alteration of body parameters, including those related to lipids like triglyceride (TG), low-density lipoproteins (LDLs), and high-density lipoproteins (HDLs). The latter are grouped under the term dyslipidemia and are considered a risk factor for cardiovascular events. In the present work, we analyzed the complex relationships between twelve parameters (disease status, age, sex, body mass index, systolic blood pressure, diastolic blood pressure, TG, HDL, LDL, glucose, HbA1c levels, and disease onset) of patients with diabetes from Romania. An initial prospective analysis showed that HDL is inversely correlated with most of the parameters; therefore, we further analyzed the dependence of HDLs on the other factors. The analysis was conducted with the Code Interpreter plugin of ChatGPT, which was used to build several models from which Random Forest performed best. The principal predictors of HDLs were TG, LDL, and HbA1c levels. Random Forest models were used to model all parameters, showing that blood pressure and HbA1c can be predicted based on the other parameters with the least error, while the less predictable parameters were TG and LDL levels. By conducting the present study using the ChatGPT Code Interpreter, we show that elaborate analysis methods are at hand and easy to apply by researchers with limited computational resources. The insight that can be gained from such an approach, such as what we obtained on HDL level predictors in diabetes, could be relevant for deriving novel management strategies and therapeutic approaches.

Relationships between circulating irisin levels, cardiorespiratory fitness, and cardiometabolic risk: a cross-sectional study in Japanese adults.

High cardiorespiratory fitness levels achieved through regular aerobic exercise are associated with reduced cardiometabolic risk. The exercise-induced myokine irisin possibly mediates these associations, but these relationships are unclear. This study aimed to clarify the relationships between circulating irisin levels, cardiorespiratory fitness levels, and cardiometabolic risk factors adjusted for sex and age. This cross-sectional study included 328 Japanese participants aged between 18 and 88 yr. We measured serum irisin levels and peak oxygen uptake (V̇o2peak) as cardiorespiratory fitness indicators, and body fat percentage, blood pressure, fasting blood glucose, hemoglobin A1c (HbA1c), high-density lipoprotein (HDL) cholesterol, and triglycerides as cardiometabolic risk factors. Cardiometabolic risk scores were calculated from the z-scores of the cardiometabolic risk factors. Quintiles based on V̇o2peak or irisin values, categorized by sex, showed a gradual increase in HDL cholesterol and a gradual decrease in other cardiometabolic risk factors with an increase in cardiorespiratory fitness levels or irisin. Serum irisin levels were negatively correlated with body fat percentage, blood pressure, fasting blood glucose, HbA1c, triglyceride levels, and cardiometabolic risk score and positively correlated with HDL cholesterol levels and V̇o2peak in both sexes and young, and middle-aged and older adults. The same relationship was observed in all participants after adjusting for sex and age. These results suggest that circulating irisin levels may be involved in the association between cardiorespiratory fitness and cardiometabolic risk factors, regardless of sex and age.NEW & NOTEWORTHY Circulating irisin levels gradually increased, and cardiometabolic risks gradually decreased with increasing cardiorespiratory fitness levels. The fitness levels required to increase irisin levels were moderate for young adults and lower than moderate for middle-aged and older adults. Moreover, circulating irisin levels are correlated with a reduction in cardiometabolic risk and an increase in cardiorespiratory fitness. These data suggest that circulating irisin levels are involved in the association between cardiorespiratory fitness and cardiometabolic risk.

THU150 The Association Between Glycated Albumin And HbA1c In Pediatric Acute Leukemia Patients

Abstract Disclosure: S. Sim: None. M. Ahn: None. B. Suh: None. Introduction: Traditionally, HbA1c has been used as a preferred glycemic index in diabetes patients. However, as many acute leukemia patients often present with anemia and/or pancytopenia, HbA1c may not accurately represent blood glucose level in this group. Glycated albumin represents the average level of blood glucose in recent 2-3 weeks, independent of red blood cell life. In this study, we aim to evaluate the usefulness of glycated albumin as glycemic monitoring index in pediatric patients diagnosed with acute leukemia. Methods: We performed retrospective analysis of a total of 206 pediatric patients from The Seoul St. Mary’s hospital, Catholic university of Korea. Medical records of 25 patients diagnosed with type 2 DM and 66 patients with acute leukemia were investigated for serum glycated albumin, HbA1c, fasting blood glucose level, and demographic data such as sex, age, height, weight and BMI z-scores. 115 children and adolescents who visited our outpatient center for routine child health examination were enrolled as the control group. Results: The median serum glycated albumin levels were 12.4%, 19.1% for acute leukemia and T2DM patients. HbA1c and fasting blood glucose levels, 5.3% and 7.6%, 92mg/dl and 129mg/dl respectively, also differed in the two groups. All glycated albumin, HbA1c and fasting blood glucose level did not appear different in between the control and acute leukemia group. In type 2 DM patients, glycated albumin and HbA1c showed positive correlations (r=0.926, p&amp;lt;0.01). Fasting blood glucose level was also positively correlated to glycated albumin (r=0.821, p&amp;lt;0.001) and HbA1c (r=0.773, p&amp;lt;0.001). While glycated albumin did not appear related to HbA1c in the normal control group (r=-0.02, p=0.824), patients with acute leukemia also revealed a positive correlation between glycated albumin and HbA1c (r=0.253, p=0.04). Glycated albumin was negatively related to BMI z-scores in the control group (r=0.554, p&amp;lt;0.001); however, the level showed no correlation to BMI z-scores in acute leukemia group and in T2DM patients (r=-0.133, p=0.286 and r=-0.292, p=0.156). HbA1c level was positively related to BMI z-scores in the control group (r=0.241, p=0.01) and showed no relations in the other two groups. Regression analysis found glycated albumin to be positively correlated to HbA1c both in acute leukemia pediatric patients and T2DM patients even when adjusted for age, sex and BMI z-score (p=0.039, p=0.007). Conclusion: In acute leukemia patients, glycated albumin may be a complementary parameter of glycemic status as in diabetic patients. Presentation: Thursday, June 15, 2023

FRI652 Type 2 Diabetes Management: More GLP1 Agonists And Less Metformin?

Abstract Disclosure: F.J. Lopez Maldonado: None. R.A. Cota: None. Case presentation: A 41-year-old male patient with family history of T2DM in both parents and brother, personal history of mild alcohol consumption and a sedentary job (public accountant), and obesity since age 30 presented to the endocrinology clinic due to failure to lose weight after 1 year of treatment with a nutritionist. During his first visit, the was asymptomatic and had acanthosis nigricans, his blood pressure was measured at 142/92 mmHg, weight was 100.8 kg, waist circumference was 128 cm, and serum glucose was at 280 mg/dL with an HbA1c of 11.9%. Further laboratory tests showed elevated levels of triglycerides (310 mg/dL), LDL (139 mg/dL), AST (96 U/L), and ALT (65 U/L). Two days later, glucose and HbA1c were repeated with similar results. A liver ultrasound was ordered which revealed diffuse hyperechogenicity of the liver and severe fatty liver disease. The ASCVD risk score was 5.4%. The patient was diagnosed with T2DM, obesity, mixed dyslipidemia, and fatty liver disease. The patient received education, nutrition support, exercise, and pharmacotherapy management with stepped-dose oral semaglutide without metformin. The dose was increased monthly starting at 3 mg and reaching the target dose of 14 mg QD. After three months, the patient demonstrated significant improvements in various parameters such as blood pressure (−10/−8 mmHg), weight (−9.8 kg), waist circumference (−25 cm), serum glucose (−179 mg/dL), HbA1C (−5.7%), triglycerides (−154 mg/dL), LDL (−18 mg/dL), AST (−60 U/L), and ALT (−38 U/L), along with an increase in HDL (+6 mg/dL). After approximately 4 months on the target dose the patient showed further improvements in several parameters including ASCVD risk score (2.1%), blood pressure (−20/12 mmHg), weight (−14.8 kg), waist circumference (−30 cm), serum glucose (−183 mg/dL), HbA1C (−6%), LDL (−25 mg/dL), AST (−63 U/L), and ALT (−40 U/L), and HDL (+10 mg/dL), except for triglyceride levels (−130 mg/dL). Follow-up liver ultrasound showed significant improvement in fatty liver disease. Real-world experiences with newly introduced drugs should be reported, as they may have beneficial effects beyond the ones studied. Oral semaglutide, the first oral GLP-1 analog, has been shown to be non-inferior to other subcutaneous GLP-1 analogs. In this case, improvements were observed in glycemic control, weight loss, lipid levels, and a reduction in cardiovascular risk, as well as an improvement in fatty liver disease. Presentation: Friday, June 16, 2023

THU330 No Calm After The Storm : Is Blood Glucose Level At Patient Presentation Related To The Stage And Outcome Of Mucormycosis In COVID- 19 Pandemic?

Abstract Disclosure: V. Sharma: None. K. Kriplani: None. I. Tuli: None. S. Sharma: None. Mucormycosis is one of the most aggressive opportunistic fungalinfections. Although conventionally limited to the demographics of severelyimmunocompromised and those with uncontrolled hyperglycemia and/orketoacidosis, in recent times, has propelled to the frontline in investigationsof COVID-19 complications. It can present in 4 stages, with progressiveinvolvement of the nasal mucosa, the paranasal sinuses, the orbit and thebrain. The stage of Mucormycosis at presentation critically influences academicdialogue on its clinical outcome and treatment options. However, prior researchhas failed to evaluate an association of patient factors especially HbA1clevels and Random Blood sugar(RBS) at presentation with the Stage and patientoutcome of Mucormycosis. A total of 75 patients with laboratory confirmedMucormycosis were enrolled in the study. Mean age of the participants was 45.17years of which 85.33% were survivors . Although there was no statisticallysignificant difference between the survivors and non-survivors concerning meanHbA1C and RBS levels, there was a statistically significant association betweenthe Stage of Mucormycosis and the level of HbA1c and RBS at presentation forStages 2b, 2c, 2d,3a, 3b, 3c, 4a, 4b, and 4c. This leads to the understandingthat clinicians must order blood sugar and HbA1c level at presentation as cuesto a better understanding of disease severity. The most common comorbidcondition was diabetes mellitus, however, only coronary artery disease in thepatient was found to be significantly correlated with mortality, while othersincluding diabetes mellitus, hypertension, chronic steroids use,immunocompromised status, and history of COVID-19 had no significantassociation. The patients with a history a COVID reported a statisticallysignificant higher RBS level than those without. Development or worsening ofdiabetes mellitus is on the long list of COVID-19 complications. Prior studiesreported an increased incidence of Mucormycosis cases in COVID-19 patients -both with diabetes (80%) and/or DKA(14.9%)(1). The binding of SARS-CoV-2 toACE2 receptors resulting in beta cell apoptosis and an ensuing cascade ofvirion, redox and cytokine storms are the simplified mechanisms of type 1 and 2diabetes development respectively, in COVID patients(2). Previous literaturesuggests a statistically significant association between stage of Mucormycosisat presentation and serum lipid profile(3), and serum iron and inflammatorymarkers levels(4). According to the data available from various sources, nosuch study compared the levels of RBS and HbA1C with the stageof Mucormycosis. Reference: (1)Hill et al, Metabolism: clinical andexperimental. 2020 Jun;107:154217 (2) Handayani et al, Obes Med. 2021May;23:100333. (3) Vijay et al, J Assoc Physicians India. 2022 Apr;70(4):11-12(4) Rao et al, J Assoc Physicians India. 2022 Apr;70(4):11-12. Presentation: Thursday, June 15, 2023

FRI099 Advanced Lipoprotein Analysis In Patients With Cushing’s Syndrome

Abstract Disclosure: R.T. Varghese: None. R. McGlotten: None. M. Sampson: None. A. Prakash: None. R. Shamburek: None. A.T. Remaley: None. R. Muniyappa: None. L.K. Nieman: None. Introduction: Cushing syndrome (CS) patients have a higher mortality rate due to increased cardiovascular disease (CVD). Analysis of lipoprotein particles with nuclear magnetic resonance (NMR) spectroscopy provides additional insights into CVD risk beyond the standard lipid panel. The goal of the study was to better characterize the lipid abnormalities in patients with CS by using high-resolution separation of lipoprotein particles. Methods: We measured plasma lipids (Cholesterol, TC; calculated low density lipoprotein, LDL; triglycerides, TG; high density lipoprotein, HDL) by the traditional enzymatic assay and lipoprotein particles by NMR spectroscopy. Measures of inflammation and insulin resistance were also derived from NMR spectra. Values are shown as mean ± SEM or median [IQR]. Results: After initial evaluation, 42 subjects (mean age 47.4 ± 2.5 years; 28 females; weight 85.0 ± 3.1 kg) had Cushing's disease (n=23), ectopic ACTH secretion (n=17), or adrenal adenoma (n=2). Ten patients were on chronic statin therapy, and 14 subjects had type 2 diabetes mellitus (T2DM). The control group comprised 45 subjects without T2DM [mean age 45.4 ± 2.1 years and weight (83.5 ± 2.7) kg]. None in the control group were on statin therapy. Compared to controls, CS patients had significantly higher systolic (135 ±2 vs. 119 ±2 mm Hg, p&amp;lt;0.001) and diastolic blood pressure (79 ±2 vs. 71 ±1 mm Hg, p&amp;lt;0.001), HbA1c (6.1 [5.4-7.5] vs. 5.4 [5.0-5.7], p&amp;lt;0.001), plasma glucose (103 [90-137] vs 94 [89-100] mg/dL, p=0.003), and insulin (17[12-26] vs 11[7-15] uU/mL, p=0.01) levels. Compared to controls, patients with CS had significantly higher triglyceride concentration (116 [84 -146] vs 87 [62-120] mg/dL, p=0.02) and lower LDL concentration (90 [69 -113] vs 108 [90 -125] mg/dL, p=0.04). However, total cholesterol and HDL cholesterol concentrations were not different. LDL particle size in CS was smaller (20.5[20.0-21.0] vs 21.0 [20.7-21.2] nm, p=0.01) and VLDL particle size was larger (49.8 ± 0.9 vs 45.7 ± 1.0 nm, p=0.002) than in controls. No difference was noted between groups in HDL particle number or size or in LDL and VLDL particle number. In the group with CS, a marker of inflammation, GlycA (Glycan N-acetylglucosamine) (494.5 ± 18.2 vs. 382.5 ± 9.0 µmol/L, p&amp;lt;0.001) and Lipoprotein Insulin Resistance score (LPIR) (46.4 ± 3.1 vs. 36.2 ± 3.1, p=0.02) were significantly higher. There were no group differences in branch-chained amino acids (BCCA) levels. These differences remained even when patients with type 2 diabetes and those on statin therapy were excluded. Conclusions: These data suggest that the higher inflammatory and insulin resistance state, dysglycemia, hypertension, and altered lipoprotein profiles may contribute to the increased CV risk in patients with Cushing’s syndrome. Early detection and treatment for these abnormalities may attenuate CV risk. Presentation: Friday, June 16, 2023

THU259 Alpelisib-induced Diabetic Ketoacidosis: Call For A Multidisciplinary Approach

Abstract Disclosure: N. Kalara: None. P. Rios: None. F. Vendrame: None. Introduction: Alpelisib is a p110a subunit phosphatidylinositol-3kinase inhibitor (PI3K) approved for treating hormone receptor-positive, human epidermal growth factor receptor 2-negative, PIK3CA mutated, advanced or metastatic breast cancer. PI3K signaling is essential for the metabolic action of insulin and the inhibition of p110a subunit is associated with hyperinsulinemia and hyperglycemia. In the combination (Alpelisib-Fulvestrant) arm of phase III SOLAR-1 study the all-grade incidence of hyperglycemia was 63%, but diabetic ketoacidosis (DKA) was also observed and reported in 0.7% of patients. To the best of our knowledge, less than 10 cases of Alpelisib-induced DKA have been reported in the literature. Here we describe an additional case. Case Description: A 62-year-old female with a history of metastatic breast cancer, hypertension, and prediabetes, presented with 3 days of nausea, vomiting, abdominal pain, weakness, polyuria, and polydipsia. Fifteen days prior to the presentation the HbA1c was 6.1% for which she was started on metformin 500 mg daily. Alpelisib 150 mg PO BID and Fluvestrant (Estrogen receptor antagonist) were also started the same day. The patient was told to stop the PIK3 inhibitor if the blood glucose increased above 200 mg/dL. The review of system was positive for fatigue, decreased appetite, malaise, 5 lbs weight loss during the previous week, and headache. She had no family history of any endocrinologic disease. The physical exam was unremarkable with no signs of insulin resistance. Laboratory tests revealed pH 7.31 (7.35-7.45), HCO3 10 mmol/L (22-26), PCO2 21 mmHg (35-45), glucose 884 mg/dL (74-106), sodium 120 mmol/L (136-145), K 5.2 mmol/L (3.5-5.1), Cl 93 mmol/L (98-107), CO2 7 mmol/L (21-32), anion gap 22 mmol/L (5-15), GFR 30 mL/min/1.73m2 (&amp;gt;60), Cr 1.80 mg/dL (0.5-1.02), BUN 43 mg/dL (7-18), beta-hydroxybutyrate 3 mmol/L (0.4-0.5), HbA1c 9.2% (4.2-5.6). Additional testing revealed C-peptide 2.3 ng/ml (1.1-4.4) with glucose 397 mg/dL. Results suggested a combined DKA and hyperosmolar hyperglycemic state (HHS). Alpelisib was discontinued and the patient was managed with insulin drip, fluids, electrolyte replacement, and eventually transitioned to a basal-bolus regimen (0.5U/kg). The patient was discharged on metformin and Insulin glargine with the recommendation to follow up with endocrinology and oncology. Conclusion: Our case highlights the importance of blood glucose and HbA1c screening before starting Alpelisib with emphasis on a multidisciplinary approach to monitor blood glucose levels to prevent DKA. Reference: 1. Farah SJ, Masri N, Ghanem H, Azar M. Diabetic ketoacidosis associated with alpelisib treatment of metastatic breast cancer. AACE Clin Case Rep. 2020;6(6):e349-e351. doi: 10.4158/ACCR-2020-0452 Presentation: Thursday, June 15, 2023

THU328 Appropriate Initial Insulin Dosage For Management Of Steroid-induced Hyperglycemia In Hospitalized COVID-19 Patients

Abstract Disclosure: N. Ketaroonrut: None. S. Kiertiburanakul: None. C. Sriphrapradang: None. Introduction: Steroid was recommended for the treatment of severe COVID-19 infection. There are limited studies on the management of steroid-associated hyperglycemia in hospitalized COVID-19 patients. We aimed to determine the appropriate initial insulin dosage to control hyperglycemia in hospitalized COVID-19 patients who received steroid therapy. Methods: We conducted a retrospective single-center analysis of electronic medical records of COVID-19 patients with steroid-induced hyperglycemia who had been treated with insulin. We divided the patients into 4 groups according to the total daily dose (TDD) of subcutaneous insulin therapy at the initiation of dexamethasone ≥6 mg/day or an equivalent dose of glucocorticoid. Glycemic outcomes were compared between groups. Results: A total of 156 patients [age 64±14 years; 50% men; body mass index 26.9±6.9 kg/m2; initial TDD of insulin (units/kg/day): group A, &amp;lt;0.29 (n=79); group B, 0.3-0.49 (n=33); group C, 0.5-0.69 (n=27); group D, &amp;gt;0.7 (n=17)] were included. Most patients (62%) had pre-existing type 2 diabetes. Mean admission blood glucose (BG) and HbA1c were 233±112 mg/dL and 7.8±2.3%, respectively. HbA1c was lowest in group A (6.7±1.2%) and highest in group D (9.8±2.5%). The average daily dexamethasone dosage or equivalent was 49.49±45.4 mg and there were no significant differences between the groups in the dexamethasone dose. The proportion of treatment failure (mean BG &amp;gt;280 mg/dL after the first day of insulin therapy or BG &amp;gt;400 mg/dL for at least 1 time/day) was lowest in group A. Among patients who received TDD &amp;gt;0.3 units/kg/day, group D had the lowest in both the percentage of treatment failure (B (52%) vs C (37%) vs D (29.4%), p=0.006) and mean BG during the 3 days of insulin therapy (B (246.0± 56.7 mg/dL) vs C (246.9±59.0 mg/dL) vs D (228.5±64.4 mg/dL), p=0.21). Three patients had severe hypoglycemia (BG &amp;lt;54 mg/dL) in this study (A: n=1 vs B: n=1 vs C: n=0 vs D: n=1, p=0.51). Conclusions: In the patients who require TDD &amp;gt;0.3 units/kg/day, the treatment failure of hyperglycemia was lowest in the patients who received TDD &amp;gt;0.7 units/kg/day without increasing severe hypoglycemia. This initial insulin dosage may guide physicians to achieve better glycemic control among hospitalized COVID-19 patients who received steroid therapy. Presentation: Thursday, June 15, 2023

Comparative analysis of glycated haemoglobin, fasting blood glucose and haematological parameters in Type-2 diabetes patients

ObjectiveDiabetes remains a major health problem, and Glycated hemoglobin (HBA1c) and fasting blood glucose (FBG) levels play important roles in its management. Also, chronic hyperglycemia coupled with high HBA1c levels impact inflammation and may alter haematological parameters in diabetes. Hence, the need to assess and correlate HBA1c and FBG levels with selected haematological parameters in patients with type-2 diabetes mellitus as the main objective of this study. The study was cross-sectional involving 384 participants. Five milliliters of blood was collected from each participant and analyzed for HBA1c, FBG levels and full blood count which were correlated statistically.ResultsFrom the data obtained and analyzed, there were statistically significant correlations between HBA1c and neutrophil count (p < 0.013), plateletcrit (p < 0.036), mean platelet volume (p < 0.019) and platelet distribution width (p < 0.002). There were also significant differences in FBG (p < 0.014), neutrophil count (p < 0.029), red cell distribution width (p < 0.046), mean platelet volume (p < 0.032) and platelet distribution width (p < 0.013) between diabetes patients with HBA1c less than 7.0% and HBA1c more than or equal to 7.0%. The outcome of the study indicates significant correlation of HBA1c with selected haematological parameters. This could make routine haematological parameters a cost-effective means of predicting poor glucose control in diabetes mellitus patients.

Association of Serum Homocysteine Level with Acute Ischaemic Stroke among Young Adult Patients: Experience at a Largest Medical College Hospital in Bangladesh

Background: Hyperhomocysteinemia is emerging as a possible risk factor for stroke, possibly because of accelerated atherosclerosis. Objectives: This study was conducted to evaluate the association between the serum homocysteine level and ischemic stroke in young Bangladeshi patients. Methodology: This cross-sectional study was carried out among patients 18 to 40 years of either gender with sign and symptoms of acute focal neurological deficit, in the Department of Medicine of Dhaka Medical College Hospital, Dhaka, from January 2015 to December 2015. History taking and physical examination were done in a predesigned data collection sheet. Then required investigations like CT-scan of brain, fasting serum homocysteine, fasting blood sugar, 2 hours ABF blood glucose, HbA1c and fasting lipid profile were done. Results: Out of 96 patients after completing brain imaging 61(65.0%) patients were found suffering from ischemic stroke. Among the patients 74 had normal homocysteine level, 17 patients had moderate hyperhomocysteinemia and 5 patients had intermediate hyperhomocysteinemia. Mean levels of fasting serum homocysteine were significantly higher in patients those had ischemic stroke (16.02 μmol/L, 95% CI: 12.87 to 19.87) compared with those who did not have ischemic stroke (10.47 μmol/L, 95% CI: 9.16 to 11.95, P&lt;0.001). Logistic regression showed fasting homocysteine as an important independent risk factor, with an adjusted OR of 1.1 (95% CI: 1.1 to 1.2; p=0.04966) for every 1 μmol/L increase in homocysteine. Conclusion: The relationship between increasing homocysteine and ischemic stroke risk is strong, graded, and significant. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):24-29

Serum anti-phospholipase A2 receptor antibody in pathological diagnosis of type 2 diabetes mellitus patients with proteinuria

Patients with diabetes mellitus complicated with proteinuria can be diabetic nephropathy (DN), diabetic complicated with non-diabetic kidney disease (NDKD), or DN with NDKD. Among these membranous nephropathy accounted for a large proportion of DN with NDRD. At present, serum anti-phospholipase A2 receptor (PLA2R) antibody is widely used in the diagnosis and evaluation of therapy in idiopathic membranous nephropathy, our study aimed to investigate the diagnostic significance of anti-PLA2R antibody in type 2 diabetes mellitus (T2DM) patients with proteinuria, providing a method for patients with contraindications of kidney biopsy. Eighty-seven T2DM patients with proteinuria who went on kidney biopsy were divided into the DN group, idiopathic membranous nephropathy (IMN) group, and others group according to their pathological results. In our study, 52.87% and 28.74% of patients were found to have IMN and diabetic nephropathy respectively. The levels of anti-PLA2R antibody, total cholesterol, triglyceride, and estimated glomerular filtration rate (eGFR) were higher in the IMN group, while the prevalence of diabetic retinopathy (DR), systolic blood pressure (SBP) and HbA1c were higher in the DN group. For T2DM patients with proteinuria, anti-PLA2R antibody (AUC = 0.904, 95%CI 0.838–0.970) has a high diagnostic value for IMN. The duration of diabetes (OR = 0.798, P = 0.030), eGFR level (OR = 1.030, P = 0.024), and positive anti-PLA2R antibody (OR = 72.727, P < 0.001) favor the diagnosis of IMN, while DR (OR = 50.234, P < 0.001), SBP (OR = 1.041, P = 0.030), and negative anti-PLA2R antibody (OR = 0.008, P = 0.001) is beneficial to the diagnosis of DN. Our study found that NDKD is not uncommon in patients with T2DM and proteinuria, and IMN was the main pathological type. Positive anti-PLA2R antibody has a strong accuracy in the diagnosis of IMN in patients with T2DM and proteinuria.

Pulmonary Aspergilloma Co-Existing with Pulmonary Tuberculosis: A Case Report in Type 1 Diabetes Mellitus (T1DM) Patient

Introduction: Pulmonary aspergilloma is a disease frequently found in immunocompromised patients. In Indonesia, around 18% of diabetes mellitus (DM) patients suffer from chronic pulmonary aspergilloma. However, data on type 1 DM (T1DM) are still limited. Case: We presented the case of a 22-year-old male admitted to the emergency room due to hemoptysis of approximately 200 ml within six hours before admission, nonspecific chest pain during cough, fever, night sweats, and weight loss of 3 kg over the last months. The patient had a history of T1DM and no prior history of respiratory diseases. Physical examination showed tachycardia, tachypnoea, subfebrile, normal body mass index, and rhonchi on the left thorax. Routine laboratory tests revealed increased blood sugar level (503 mg/dL) and HbA1c 16.4%. Chest X-ray and high-resolution computed tomography (HRCT) showed a cavity with an opaque lesion, crescent sign, consolidation, and reticulonodular infiltrate on the left lung. Rapid molecular tests, tuberculosis (TB), and serum galactomannan (GM) were negative. The patient was diagnosed with pulmonary aspergilloma, T1DM, and clinical TB. He was treated with fluconazole, insulin, and a fixed-dose combination of anti-TB. The patient refused the surgery procedure. Immediately, the hemoptysis stopped, blood glucose level was normal, and concomitant with weight gain. Conclusion: Due to innate and acquired immunity impairment, T1DM is a risk factor for pulmonary infections, including TB and pulmonary aspergilloma. Chest HRCT may help diagnose fungal balls. Though the patient refused to undergo surgery, administering antifungal, anti-TB drugs, and glucose control as initial treatment presented a good prognosis in the patient.

Observational study between level of vitamin D, anthropometric status and metabolic profiles in patients with type 2 diabetes mellitus

Introduction. Type 2 diabetes mellitus (T2DM) is currently an important global health disease. At the same time vitamin D deficiency is considered the other public health problem around the world. Some studies suggest involving insufficient or deficiency of vitamin Din the etiopathogenesis of T2DM. Materials and methods. 58 patients, 33 women (56.89%) and 25 men (43.10%) were included in the observational study. Demographics (age, gender), personal anamnestic data (duration of diabetes, micro-and macrovascular complications, therapy with vitamin D supplements), anthropometric and biochemical parameters were assessed. The anthropometric measurement included height (meters), weight (kg) and body mass index (BMI) defined as a ratio of weight to the square of height (kg/m2). Biochemical parameters included the fasting blood glucose, glycated hemoglobin (HbA1c), serum total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, very-low density lipoprotein (VLDL) cholesterol, triglycerides (TG), as well the level 25(OH)D. We followed the correlation between vitamin D levels and the duration of diabetes, BMI, blood glucose levels, HbA1c, TC, LDL-cholesterol, HDL-cholesterol, VLDL-cholesterol, TG. Results. The average values recorded were 11.72 years for the duration of T2DM, 31.77 kg/m2 for BMI, 169.00 mg/dL for blood glucose levels, 8.01% for HbA1c, 200.40 mg/dL for TC, 129.04 mg/dL for LDL-cholesterol, 47.67 mg/dL for HDL-cholesterol, 26.69 mg/dL for VLDL-cholesterol and 160.34 mg/dL for TG. Conclusion. Following statistical analysis, the observational study highlight statistically negative correlation recorded between the level of vitamin D and BMI, glycemic balance (highlighted by the level of fasting blood glucose and HbA1c). The results found nonsignificant correlation between the levels of vitamin D: duration of diabetes and lipid profile.

Association of cardio-renal biomarkers and mortality in the U.S.: a prospective cohort study

ObjectiveDiabetes poses a significant threat to human health. There is a lack of large-scale cohort studies to explore the association between mortality risk and indicators beyond blood glucose monitoring in diabetic populations.MethodsMultivariable Cox proportional hazards regression models were performed to investigate the association of 13 blood biomarkers with mortality risk in the National Health and Nutrition Examination Survey (NHANES) and biomarker levels were log-transformed and correlated with mortality.ResultsDuring a median follow-up of 7.42 years, 1783 diabetic patients were enrolled. Compared to traditional risk factors, the addition of hs-cTnT, hs-cTnI, NT-proBNP, creatinine, cystatin C, and β-2 microglobulin biomarkers increased the predictive ability for all-cause mortality by 56.4%, 29.5%, 38.1%, 18.8%, 35.7%, and 41.3%, respectively. However, the inclusion of blood glucose monitoring had no impact on the prediction of all-cause mortality. Compared with the 1st quartiles of creatinine and Cystatin C, the risk of diabetes mortality were higher in the highest quartiles (HR: 5.16, 95% CI: 1.87–14.22; HR: 10.06, 95% CI: 4.20-24.13).ConclusionsIn the diabetic population, elevated plasma levels of hs-cTnT, hs-cTnI, NT-proBNP, creatinine, cystatin C, and β-2 microglobulin serve as robust and straightforward predictors of long-term mortality compared to blood glucose levels and HbA1c values. Creatinine and cystatin C stand out as more precise markers for predicting diabetes mortality prior to blood glucose monitoring.