HbA1c Concentration Research Articles

Routine HbA1c screening identifies de novo (pre)diabetes mellitus in 37% of ACS patients which comes with an even higher ischemic risk compared to known diabetes mellitus

Abstract Background Diabetes is a prominent risk factor for coronary artery disease (CAD). By exacerbating the progression of CAD, it puts these patients at increased risk of acute coronary syndrome (ACS) and recurrent ischemic events. It is therefore important to identify hyperglycaemic individuals and to treat them accordingly. However, in daily practice it is seen that a subsequent proportion of people with diabetes is undiagnosed. Purpose The aim of this research is to gain insight in the prevalence of patients with de novo (pre)diabetes, the treatment, and the risk of major adverse cardiac and cerebrovascular events (MACCE) compared to patients with known diabetes in an ACS cohort treated by percutaneous coronary intervention (PCI). Methods The Southeast Netherlands Heart Registry (ZON-HR) is an ongoing, multicentre registry collecting data of patients who underwent a PCI procedure. Of this cohort, patients presenting with ACS and measured HbA1c concentrations (on admission) were selected (N=1507). Patients with diagnosed diabetes are considered well-regulated when HbA1c <53 mmol/mol. Patients undiagnosed with diabetes were divided into three groups: HbA1c concentration <42 mmol/mol (normal), HbA1c 42-47 mmol/mol (pre-diabetes) and HbA1c ≥48 mmol/mol (diabetes). The rates of 30-day repeated myocardial infarction (MI), unplanned revascularisation, ischemic CVA, stent thrombosis, and cardiovascular mortality were determined, separately and combined as MACCE in patients with known diabetes compared to prediabetes and diabetes de novo. Results In the selected population, 28.5% of the patients were previously diagnosed with diabetes, which was well-regulated in only 30.2% of these patients. Of the patients not previously diagnosed, 23.1% and 14.4% had pre-diabetic and diabetic HbA1c concentrations, respectively. In 56.1% of patients with de novo diabetes, no glucose-lowering medication was prescribed at discharge (Table 1). At 30-day follow-up, de novo diabetes patients had increased rates of MACCE compared to patients with known diabetes (HR: 3.51, 95%CI 1.48-8.52) after multivariate analysis which corrected for differences at baseline (Figure 1). In addition, a significant increase in unplanned revascularisation (p=.014) and MI (p=.037) was found between de novo diabetes and known diabetes patients. Conclusions Almost half of the ACS patients in this cohort had either poorly regulated diabetes (305 patients) or was undiagnosed with (pre)diabetes while having an increased HbA1c concentration on admission (401 patients). Despite routine HbA1c screening, a subsequent part of these patients is not adequately treated for (pre)diabetes, especially the de novo diabetes patients. By this group, an even larger rate of MACCE was found, compared to the already established risk of diabetes in ACS. Therefore, active screening and treatment (as recommended in the guidelines) should get more attention to improve outcomes in these high-risk patients.Table 1:ACS population based on HbA1cFigure 1:Survival curves of 30D MACCE

Health Benefits of Yerba Mate Consumption on Cardiovascular Health

Background: Yerba mate is a Paraguayan kind of herbal tea prepared from the dried and roasted leaves of trees called Ilex paraguariensis St. Hill. It is known for high content of polyphenols, methylxanthines and saponins. According to the studies products rich in those nutrients may have a positive influence on the humans cardiovascular health. Materials and methods: We reviewed publications obtained from PubMed and Google Scholar. Articles were selected based on keywords such “yerba mate’’, “Ilex paraguariensis’’, “cardiovascular diseases’’. For the final analysis, qualified articles were published from 2005 to 2024. Results: Confirming positive impact on serum lipid levels individuals using mate tea. Long – term positive influence on blood pressure. Moreover subjects with obesity took advantages of Yerba beverage by decreasing waist-to-hip ratio. Patients with diabetes were observed to have a significant reduction in fasting plasma glucose level and HbA1c concentration. Conclusions: Most of the cited researches support the hypothesis of benefits coming from drinking mate infusions for patients with elevated lipid serum levels, obesity, high blood pressure and type 2 diabetes mellitus. All of mentioned health issues can lead to the cardiovascular problems therefore using mate infusions can prevent CVDs. Taking everything into consideration, medical professionals might recommend Yerba mate tea for their patients especially as a replacement of a coffee.

Effects of Daily Almond Consumption on Glycemia in Adults with Elevated Risk for Diabetes: A Randomized Controlled Trial.

The purpose of this study was to examine the potential for sustained almond consumption to reduce HbA1c concentrations among individuals with elevated values. A 16-week randomized, parallel-arm, controlled trial was conducted. Eighty-one adults with elevated HbA1c concentrations (>5.7%) were randomly assigned to incorporate 2 oz of raw almonds (A: n=39) or energy-matched snacks (C: n=42) into their daily diets. Body weight, body composition, plasma lipids, HbA1c, plasma vitamin E, glycemia (by meal tolerance test and continuous glucose monitoring), dietary intake, and hedonic responses to test foods were measured at stipulated time points. Participants consuming almonds ingested 253 kcal/d more than participants in the control group (P=0.02), but this did not result in a significant difference in body weight. No statistically significant differences were observed in HbA1c concentrations, blood chemistries, body composition, or glycemia over time or between groups. However, Healthy Eating Index scores improved within the almond group as compared to the control group (P<0.001). Additionally, the hedonic rating of almonds within the almond group did not decline as markedly as the control group's reduced liking of the pretzel snack. Alpha-tocopherol increased significantly, and gamma tocopherol tended to decrease in the almond group, indicating compliance with the dietary intervention. Overall, daily ingestion of 2oz of raw almonds in a self-selected diet for 16 weeks did not alter short-term or longer-term glycemia or HbA1c concentrations in adults with elevated HbA1c concentrations, but they were well-tolerated hedonically and improved diet quality without promoting weight gain.

The effect of severe COVID-19 infection on biochemical markers (FBS, HbA1C, FA, INS, C-Pep) in diabetic patients

Background &amp; objective: Several studies have been conducted around the world on the impact of COVID-19 on people with diabetes mellitus (DM). Any acute illness can cause stress and increased inflammatory reactions, which increase sympathetic outflow and produce catecholamines, growth hormones, cortisol, and cytokines, all of which raise the risk and severity of complications from diabetes. Diabetes is a significant risk factor for the severity of COVID-19. We conducted this study to identify whether severe COVID-19 infection has any effect on the biomarkers, including fasting blood sugar (FBS), HbA1C, FA, INS, C-Pep, in individuals with DM. Methodology: This study was simultaneously conducted at Department of Chemistry and Biochemistry, College of Medicine of Al-Nahrain University, and Department of Medicine of Mustansiriyah University College of Medicine, Baghdad, Iraq. During the months of February and March 2022, 50 COVID-19 patients with diabetes and 50 COVID-19 patients without diabetes were included in the study. The control group included 100 healthy, sexually identical people (age 50-80), collected under the supervision of the second supervisor from relatives and students of Mustansiriyah University, College of Medicine. Venous blood samples of 5 mL were taken from all participants and subjected to laboratory tests to detect the levels of the biomarkers. Results: Average FBS level in DM patients was 304.9 mg/dL, (range 132-545.9 mg/dL), which was remarkably higher than in non-DM patient groups (193.3 mg/dL), range (of 66.2–458). The DM patients' group had a significantly higher concentration of HbA1C (median = 6.70 mg/dL, range 5.2-8.1) than the non-DM patient group (median = 5.8, range 4.2–7.6) with a significant difference. Although The group of DM patients had significantly greater FA concentrations than the group of non-DM patients. In contrast, the median and range for insulin and c-peptide Displays non-significant differences for covid-19 patients (DM and non-DM), but it's significant with a control group. Conclusion: According to this study, COVID-19 patients with diabetes had greater biochemical indicator levels than non-diabetic people. Pre- and postprandial hyperglycemia and diabetic ketoacidosis were more common in COVID-19 DM patients than in non-infected DM patients. We found that COVID-19 increased the severity risk for T2DM patients and glucose level is raised and progresses in a vicious cycle exacerbated by insulin resistance (IR) and decreased pancreatic b-cell function. Keywords: COVID-19, Diabetes mellitus, FBS, HbA1C, FA, INS, C-Pep Citation: Yones MS, Al-Wasiti E, Al Qaseer AH, Al-Rubaiawi HK. The effect of severe COVID-19 infection on biochemical markers (FBS, HbA1C, FA, INS, C-Pep) in diabetic patients. Anaesth. pain intensive care 2024;28(5):804−808; DOI: 10.35975/apic.v28i5.2553 Received: June 01, 2024; Reviewed: June 19, 2024; Accepted: June 19, 2024

Plasma glucose, HbA1c, insulin and lipid profile in Sudanese type 2 diabetic patients with cardiovascular disease: a case control study

Background: Type 2 diabetes mellitus (T2DM) and its consequences are a serious global public health issue. By 2030, the number of people with type 2 diabetes is predicted to reach 439 million. The purpose of this study is to evaluate the plasma levels of glucose, HbA1c, insulin, and lipid profile in Sudanese T2DM patients. Methods: This case control study included 165 Sudanese patients with diabetic type 2 and a cardiovascular condition as cases and 165 diabetic type 2 volunteers without a cardiovascular disorder as controls. The concentrations of plasma glucose, HbA1c, and lipid profile were assessed using a Mindray BS-480 auto-chemistry analyzer, and insulin was analyzed using a Cobase 411 auto analyzer. The collected data were analyzed using statistical tools for social science computer programs (SPSS version 21). Results: According to the findings, (59.4%) of patients between the ages of (50-69). Females made up 50.9%. (38.2%) of patients had an illness duration of between (8-15 years). (41.8%) of individuals did not have hypertension. There was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin among diabetics with cardiovascular disease compared to diabetics without cardiovascular disease (p-value = 0.001, 0.000, 0.018, and 0.000). Females had significantly higher blood TC, LDL-C, HDL-C, and BMI than males (p-values = 0.000, 0,001, and 0.000, respectively). There were significant positive correlation between FBS, HBA1c, insulin and duration of disease (r=0.155, p, value=0.005) (r=0.160, p, value=0.004)(r=0.103, p. value=0.061)respectively, while there were significant negative correlation between TC, TG,LDL-C, HDL-C and duration of disease (r=-0.152, p, value= 0.006)(r=-0.023, p, value=0.678)(r=-0.113, p, value= 0.040)(r=-0.145, p, value=0.008)respectively. Conclusion: When comparing diabetics with cardiovascular disease to diabetics without cardiovascular disease, there was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin. FBS, HBA1c, insulin, and illness duration all had a strong positive connection.

8731 Glucose homeostasis remains normal across a range of adiposity in fit men and women

Abstract Disclosure: A.W. Potter: None. G.C. Chin: None. J.I. Jacques: None. L.J. Nindl: None. D.P. Looney: None. W.J. Tharion: None. C.L. Chapman: None. E.N. Halford: None. K.E. Friedl: None. Introduction. Glucose dysregulation is a major obesity-related comorbidity, affecting mental and physical performance. Glycated hemoglobin (HbA1c) is a validated and stable biomarker representing glucose regulation over 2-3 months. Nearly half of American adults (41%) have elevated HbA1c concentrations representing prediabetes (≥5.7%). In a large cross-sectional sampling of the American population, HbA1c becomes elevated in 33% of individuals at &amp;gt;24% body fat (BF) (men) and &amp;gt;38%BF (women). However, daily physical activity is an important moderator of metabolic health and adiposity - the “fit fat” concept. We evaluated this effect in physically active men and women. Methods. Body composition and metabolic health data were obtained from 36,392 adults (18,130 men and 18,262 women) in the National Health and Nutrition Examination Survey (NHANES) from 1999-2018, for comparison of %BF and HbA1c relationships. Body composition and HbA1c data were obtained from 220 healthy and physically fit active-duty military men and women (188 men, mean ± SD (range): age 25.7 ± 5.9 (18-53) years; height 176.3 ± 7.7 (154.0-201.1) cm; body mass 85.3 ± 11.9 (55.7-134.7) kg, maximal oxygen uptake (VO2max) 49.1 ± 11.9 (33.8-62.5) ml/kg/min; 32 women, age 26.5 ± 7.0 (19-45) years; height 161.4 ± 5.9 (147.1-172.8) cm; body mass 63.9 ± 8.3 (46.7-86.6) kg, VO2max 42.5 ± 8.3 (29.1-52.6) ml/kg/min). Body composition was measured using DXA (iDXA, General Electric Healthcare, Madison, WI) and HbA1c was measured from capillary blood samples using a validated point-of-care analyzer (DCA Vantage Analyzer, Siemens Medical Solutions USA, Inc, Malvern, PA). Results. HbA1c remained within the normal range (&amp;lt;5.7%) for 98% (216/220) of a relatively wide range of %BF in a group of men (9-36%) and women (21-46%) who engaged in daily physical activity. This sample included 64 men (34%) and 4 women (12.5%) that exceeded the 24 and 38%BF thresholds where clinically high HbA1c concentrations have been observed in the civilian population. From this subset, none of the assessed women had HbA1c ≥5.7%. Three men had HbA1c 5.7-5.8% and also high measured physical fitness (VO2max, 50.1-62.5 ml/kg/min) and low %BF (15-17%); while one had lower physical fitness (VO2max 43.87 ml/kg/min) and higher body fat (26%) (HbA1c 6%). Conclusion. Glucose homeostasis remains within normal values across a range of adiposity in fit men and women. These data support the importance of daily physical activity in mitigating elevations in HbA1c, even in individuals with increased relative body fat. Physical activity appears to have a protective effect for metabolism. Presentation: 6/3/2024

A-059 Validation of self-collected capillary dried blood spot collection for clinical HbA1c testing

Abstract Background The increased prevalence of diabetes in socially disadvantaged populations requires solutions that are amenable to these communities. Unmanaged diabetes can cause cardiovascular disease, kidney damage, blindness, and limb amputation. Diabetes is traditionally diagnosed using fasting/oral glucose tolerance or hemoglobin A1c (HbA1c) tests; both of which require access to medical and laboratory facilities. Self-collected capillary dried blood spot (DBS) testing for HbA1c could alleviate health disparities by offering access to low cost and minimally invasive remote collection. The objective of this study was to validate self-collected capillary DBS specimens for clinical HbA1c testing. Methods DBS HbA1c was measured using the hemolysate application of the Roche cobas c513 Tina-quant Hemoglobin A1cDx Gen.3 assay. Calibration was performed according to the manufacturer’s package insert. Patient samples were prepared by collecting two 3mm DBS punches. Non-biological standards were prepared by placing two blank 3mm DBS punches into an empty tube and adding 10uL of standard. After 24 hours, samples were resuspended in 750uL of hemolyzing reagent and incubated for 75 minutes at room temperature (RT) while shaking at 800 RPM. Preliminary data showed that non-biological standards spotted onto DBS cards did not behave like real patient samples. A correction factor (CF) was derived (n=134) and challenged (n=20) to account for the systematic bias observed between matched patient DBS and venous specimens. Imprecision was established by running two patient DBS specimens as controls. Accuracy was evaluated using residual College of American Pathologists (CAP) proficiency testing (PT) material (n=32). Linearity was confirmed by running 5 levels of Maine Standards Linearity HbA1c Kit in triplicate. Stability of the DBS specimen and the hemolysate supernatant extracted from the DBS specimen were observed at RT. Results Specimens tested between venous and DBS HbA1c to derive the CF (n=134) had a bias of 0.26% (4.32%) and a linear equation of (y=0.938x +0.631; R=0.996). The resulting CF is: reported HbA1c% = (DBS HbA1c% - 0.631)/0.938. Matched venous and DBS specimens that challenged the CF (n=20) had a bias of -0.10% (-1.83%) and a linear equation of (y=1.06x -0.41; R=0.988). Imprecision was 2.3% and 1.3% for patient DBS control specimens with mean concentrations of 5.3% and 5.9%, respectively. Residual CAP PT samples (n=32) had an average bias of -0.05% (-0.40%). DBS HbA1c concentrations from 4.2-15.5% were linear (y=0.903x +1.15; R=0.999). The DBS specimen is stable for 60 days at RT and the hemolysate supernatant is stable for at least 10 hours at RT. Conclusions Self-collected capillary DBS specimens are acceptable for the clinical measurement of HbA1c, and effectively increase accessibility to diabetes screening and monitoring. Applying a CF to DBS patient samples removes the systematic bias observed between matched venous and DBS samples. Non-biological standards and capillary whole blood do not behave the same on DBS cards. Alternative PT for DBS specimens should be investigated as at-home collection advances.

The prevalence of hyperlipoproteinemia(a) in outpatient cardiology clinic patients of European ancestry: results from a STAR-Lp(a) cross-sectional study.

Elevated lipoprotein(a) [Lp(a)] is independently associated with an increased risk of cardiovascular disease (CVD). Evaluating the levels of Lp(a) among patients of European ancestry referred to outpatient cardiology clinics. We included 2475 consecutive patients referred to outpatient cardiology clinics between March 2022 and January 2024. We excluded all patients with atherosclerotic cardiovascular disease, heart failure, significant valve disease, and aortic aneurysm. The median age of the 2475 study participants (of which 1724 [69.7%] were women) was 66.0 years [53.0-73.0 years]). An Lp(a) level of ≥30 mg/dL (≥75 nmol/L) was recorded in 21.5% and a level of ≥50 mg/dL (≥125 nmol/L) was recorded in 13.5% of patients. In univariable analysis the level of Lp(a) was significantly associated with hypertension, sleep apnea, migraine, polycystic ovary syndrome, physical activity, fasting blood glucose, HbA1c, LDL, and non-HDL cholesterol. Being female (β±SE 0.06±0.02), atrial fibrillation (0.05±0.02), HbA1c (0.14±0.02), and LDL cholesterol (0.09±0.02) were independently related to the level of Lp(a). Atrial fibrillation (odds ratio [OR] 1.80, 95%CI:1.01-3.19), migraine (0.51, 0.32-0.83) and hyperlipidemia (1.56, 1.22-1.99) were related to Lp(a) ≥30 mg/dL (≥75 nmol/L), while being female (1.46, 1.10-1.92), hyperlipidemia (1.49, 1.12-1.97), hypertension (1.42, 1.10-1.84) and HbA1c (0.84, 0.72-0.96) were related to Lp(a) ≥50 mg/dL (≥125 nmol/L). The prevalence of increased Lp(a) concentration among patients of European ancestry consulting with cardiologists is 21.5%. Being female, hypertension, atrial fibrillation, migraine, LDL-C, and HbA1c concentration are independently related to the level of Lp(a) in this population.

Altered oxidant and antioxidant levels are associated with vascular stiffness and diabetic kidney disease in type 1 diabetes after exposure to acute and chronic hyperglycemia

BackgroundHyperglycemia-induced oxidative stress is a well-established pathological mediator of vascular complications in diabetes. We assessed plasma oxidant and antioxidant levels in response to acute and chronic hyperglycemia in relation to vascular stiffness and varying degrees of kidney disease in type 1 diabetes individuals.MethodsThe acute hyperglycemia study included 22 type 1 diabetic individuals with normal albumin excretion rate (AER) and 13 non-diabetic controls. These individuals received an acute glucose challenge during a 120-minute hyperglycemic clamp. The chronic hyperglycemia study included 118 type 1 diabetic individuals with chronically low (n = 60) or high (n = 58) HbA1c concentrations and varying degrees of diabetic kidney disease (DKD) classified as normal, moderate, or severe albuminuria (AER). Levels of malondialdehyde (MDA), reactive oxygen metabolites (ROMs), total antioxidant capacity (TAC), biological antioxidant potential (BAP) and superoxide dismutase (SOD) were measured from plasma or serum samples in the FinnDiane study.ResultsLevels of MDA (p < 0.01) and ROMs (p < 0.01) were elevated in type 1 diabetes individuals compared to non-diabetic controls at baseline. Acute hyperglycemia further increased MDA levels (p < 0.05) and sustained the elevation of ROMs in type 1 diabetes individuals. Acute hyperglycemic challenge impaired TAC in both non-diabetic (p < 0.05) and type 1 diabetes (p < 0.01) individuals compared to baseline whereas BAP was increased (p < 0.05) with no difference observed in non-diabetic controls. There was a positive association between high circulating MDA and AIx (r2 = 0.611, p = 0.05), and between delta ROMs and delta AIx (r2 = 0.955, p = 0.014) in combined analysis of individuals with type 1 diabetes and non-diabetic controls. Type 1 diabetes individuals with varying status of DKD, showed elevated levels of ROMs in those with high HbA1c compared to their counterpart with low HbA1c (p < 0.05). Individuals with severe albuminuria showed elevated ROM levels (p < 0.01) and depressed antioxidant capacity (p < 0.01) compared to those with normal AER of comparable HbA1c concentrations.ConclusionsBiomarkers of oxidative stress are associated with vascular stiffness and DKD following acute and chronic hyperglycemic exposure and may provide added value to HbA1c in understanding disease pathology, predicting risk and assessing the status of secondary complications of type 1 diabetes.

Prediction the Occurrence of Thalassemia With Hematological Phenotype by Diagnosis of Abnormal HbA1c.

The current investigation aims to analyze the occurrence of thalassemia in patients who participated in hemoglobin A1c (HbA1c) testing in clinical laboratory showing high hemoglobin F (HbF) level (≥ 1.5%) or abnormal Hb peak and predict the main influence factors by using different statistical models. The current investigation is a single-center retrospective cohort study. HbA1c concentration was detected by using TOSOH HLC-723G8 glycated hemoglobin analyzer. SNaPshot SNP (Single Nucleotide Polymorphism) typing and AccuCopy technology were employed to detect mutations in thalassemia-related pathogenic genes. A total of 126 patients endured high HbF levels or abnormal Hb peak during HbA1c detection, and 66.7% of subjects (n = 84) showed thalassemia mutations. Three heterozygosity mutations, including c.52A>T (p.K18*), c.-78A>G, and c.126_129delCTTT(p.F42Lfs*19) present in HBB gene, were also identified. --SEA/αα mutation demonstrated the youngest ages (p < 0.001). 17 M (p < 0.001) and 41/42 M (p < 0.01) mutations with β-thalassemia showed higher HbF levels compared with patients without thalassemia mutations. Except for -α3.7, mutations in thalassemia showed lower levels of mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) compared with patients without thalassemia mutations. Patients with thalassemia mutations showed younger age (p < 0.001), lower Hb (p < 0.001), MCV and MCH levels (p < 0.001), higher red blood cell (RBC)count (p < 0.001), and platelet distribution width (PDW) level (p = 0.007) than patients without thalassemia mutations. Three statistical models indicate MCV is the most valuable independent factor for predicting thalassemia and ROC (receiver operating characteristic) curves analysis of AUC (Area Under the Curve) of 0.855 (95% CI [0.787-0.923], p < 0.001) with MCV. High HbF level (≥ 1.5%) or abnormal Hb peak present in HbA1c testing indicated high incident rate of thalassemia. MCV is the most valuable independent predicting factor for subjects having thalassemia.

Heterogeneous effects of Medicaid coverage on cardiovascular risk factors: secondary analysis of randomized controlled trial

ObjectivesTo investigate whether health insurance generated improvements in cardiovascular risk factors (blood pressure and hemoglobin A1c (HbA1c) levels) for identifiable subpopulations, and using machine learning to identify characteristics of people...

Concentric remodeling and the metabolic-associated steatotic liver disease in patients with type 1 diabetes: an exploratory study.

Diabetic cardiomyopathy in young patients with type 1 diabetes (T1D) usually presents as asymptomatic diastolic heart dysfunction with left ventricle (LV) remodeling. Its prevalence seems to be underestimated. One of the factors seemingly influencing LV remodeling is a metabolic-associated steatotic liver disease (MASLD), which was extensively investigated in patients with type 2 diabetes but not with T1D. This study aimed to describe the correlation between MASLD risk and relative wall thickness (RWT) in young patients with T1D without heart failure symptoms or treatment. Study participants were recruited at the inpatient diabetology department, in admission order. Patients underwent a set of laboratory tests and echocardiographic examinations. The risk of MASLD was estimated using fatty liver index (FLI). Acquired data was then statistically analyzed. The study group consisted of 55 patients. 25 participants had RWT > 0.42, suggesting LV remodeling. Study participants did not differ in HbA1c, NT-proBNP, HDL, LDL, non-HDL, and uric acid concentrations. However, patients with RWT > 0.42 had higher FLI (40.97 vs. 13.82, p < 0.01) and BMI (27.3 vs. 22.5, p < 0.01) and differed in transaminase concentrations. Moreover, patients with RWT > 0.42 had significantly higher LV mass index (85.6 vs. 68.2g/m2) and altered mitral ring velocities. In univariable logistic regression, FLI correlated with LV remodeling risk (OR 1.028, p = 0.05). The optimal cutoff point for FLI predicting the RWT > 0.42 was 26.38 (OR 10.6, p = 0.04, sensitivity 0.857, specificity 0.657). FLI correlates with RWT in patients with T1D independently of diabetes metabolic control and hypothetically may support recognizing T1D patients with a higher risk of LV remodeling.

A comparative study to assess Hba1c levels in antenatal non diabetic women with anemia and without anemia

BackgroundGlycosylated hemoglobin (HbA1c) has a glucose residue attached to the terminal NH2 group (valine residue) of one or both HbA beta chains. HbA1c levels are not affected by blood glucose levels alone. HbA1c results are affected by several factors, such as anemia, structural hemoglobinopathies and thalassemia syndromes. HbA1c concentrations are affected by conditions that affect erythrocyte turnover. Iron deficiency anemia is the most common form of anemia. The prevalence of anemia among pregnant women in India is above 50 %. Although many forms of anemia are associated with the lowering of HbA1c, iron deficiency has been shown to shift HbA1c slightly upward. Research on this topic has yielded a variety of findings. In some research, there was no association observed between anemia and HbA1c levels; in other investigations, there was a rise or fall in this number. Iron deficiency anemia and HbA1c′s relationship is therefore still unclear. Therefore, this study aims to determine the correlation between Iron deficiency anemia and HbA1c levels among non diabetic pregnant women with anemia. MethodologyThis prospective observational study was conducted among singleton pregnant women attending antenatal clinic OPD in a private tertiary hospital in Chengalpattu, Kanchipuram district. After the complete review of their obstetric record, blood was collected in 5 ml sterile syringes and transferred equally to the two separate test tubes containing ethylene-diamine-tetra acetic acid (EDTA) anticoagulant for determining RBC indices and HbA1c levels. The difference in mean between two independent samples (between Anemia and Non-anemia) was determined using an independent sample t-test, and the difference between two independent proportions was calculated using a z-test. Bivariate Pearson's correlation analysis was used to adjudicate the relationship between red blood cell indices and HbA1c level, and correlation coefficient (r)was calculated, and the p-value of <0.05* was considered statistically significant. ResultsBivariate Pearson's correlation analysis was done to determine the relationship between HbA1c levels and red blood cells in anemic pregnant women. HbA1c levels negatively correlated with Hemoglobin (r = −0.875, p < 0.01*), PCV (r = −0.732, p =<0.01*) and transferrin saturation (r = 0.224, p < 0.01*) and it was statistically significant. Other indices, such as serum iron concentration and TIBC, demonstrated no correlation with HbA1c level. ConclusionThis study shows that the reliability of Hba1c in diagnosing diabetes among pregnant women with iron deficiency anemia is misguiding and can be considered after treating the condition. Also, more studies are needed to improve our understanding of this topic.

Nephroprotective Effect of Ferula assa-foetida Oleo Gum Resin on Type 2 Diabetic Rats.

Diabetic nephropathy is one of the main causes of kidney failure in the end stage of diabetes worldwide. On the other hand, asafoetida is a gum whose hypoglycemic effects have been proven. The present study was conducted with the aim of using asafoetida to prevent diabetic nephropathy. Diabetes was induced by a high-fat diet (60%) and streptozotocin injection (35 mg/kg) in rats. Diabetic rats were treated with an oral dose of 50 mg/kg of asafoetida for 8 weeks. At the end of the experiment, serum and urine parameters were examined. Antioxidant enzymes and lipid peroxidation levels in the kidney were also determined along with its histological examination. The expression levels of tumor necrosis factor-alpha and Transforming growth factor beta genes were also evaluated. Glucose, cholesterol, triglyceride, and HbA1c concentrations were significantly reduced in the asafoetida 50. On the other hand, in the treatment group, serum creatinine, urea, and albumin levels decreased and increased in urine. Antioxidant enzymes in the kidney improved significantly, and the expression of tumour necrosis factor-alpha and transforming growth factor-beta genes decreased. Histopathological examination also showed that necrosis, epithelial damage, and leukocyte infiltration increased in the diabetic and decreased in the treatment group. The result of biochemical analysis, enzymatic, and histological examinations showed that asafoetida may delay the progression of diabetic nephropathy due to the presence of anti-inflammatory and antioxidant activities.

Isolated and grouped relationships between type 2 diabetes and peripheral arterial disease on skin temperature in the foot plantar region

The aim of the study was to verify relationships between isolated and grouped clinical conditions (Type 2 Diabetes Mellitus [T2DM] and Peripheral Arterial Disease [PAD]) with the skin temperature of the plantar region of the feet (Tskin_Feet). Twenty-four elderly women participated, divided into three groups: GT2DM + PAD (n = 8; 69.6 ± 8.0 years-old; 148 ± 5 cm; 63.8 ± 8.9 kg), GT2DM (n = 8, 69.3 ± 7.8 years-old, 151 ± 6 cm; 66.3 ± 10.8 kg), and control group (CG) (n = 8; 69.3 ± 6.6 years old; 148 ± 6 cm; 58.0 ± 5.3 kg). The T2DM was diagnosed based on HbA1C concentrations, and PAD was assessed using the Ankle-Brachial Index. Thermographic images were captured for both feet using the Flir thermal camera (model T420®) and analyzed using Flir Tools® software. The Inner canthus (IC) measurement was used as an indicator of core body temperature. Five regions of interest (ROIs) were determined for each image. The difference (Δ) between the temperature at the IC (average among right and left side) and of the each of the five ROIs in the plantar region (right foot and left foot) was calculated, where lower values indicated a closer proximity to the core body temperature. The one-way ANOVA was performed to verify differences between groups of clinical conditions. A significance level of 5% was assumed. The GT2DM group exhibited higher Tskin_Feet absolute values than the CG for all ROIs. However, just for ROI4 (hindfoot) of the right foot plantar was significant (p = 0.027). On the other hand, when analyzing the values difference between the average temperature at the IC of the temperature in the five evaluated ROIs on the right and left foot, the GT2DM group showed significantly lower values than the CG for for ROI 2 (forefoot) p = 0.0429 and ROI 4 (hindfoot) p = 0.009 on the right foot and for ROI 1 (forefoot) p = 0.0338; ROI 2 (forefoot) p = 0.0392 and ROI 5 (hindfoot) p = 0.0377 on the left foot. In conclusion, GT2DM presented a Tskin_Feet closer to the core temperature (IC) indicating a higher temperature. The presence of PAD appears to attenuate skin overheating.

The Impact of Thyroid Hormones on Cardiometabolic Risk in Children and Adolescents with Obesity, Overweight and Normal Body Mass Index (BMI): A One-Year Intervention Study.

Thyroid hormones regulate metabolism and have a major impact in maintaining cardiovascular homeostasis. The purpose of our study was to examine the relation of thyrotropin (TSH) and thyroid hormones with cardiometabolic parameters in children and adolescents with obesity, overweight, and normal body mass index (BMI) before and after the implementation of a comprehensive, multidisciplinary, personalized, lifestyle intervention program for 1 year. One thousand three hundred and eleven (n = 1311) children and adolescents aged 2 to 18 years (mean age ± SD: 10.10 ± 2.92 years) were studied prospectively. Patients were categorized as having obesity (n = 727, 55.45%), overweight (n = 384, 29.29%) or normal BMI (n = 200, 15.26%) according to the International Obesity Task Force (IOTF) cutoff points. All patients received personalized guidance on diet, sleep, and physical activity at regular intervals throughout the 1-year period. Detailed clinical evaluation and hematologic, biochemical and endocrinologic investigations were performed at the beginning and the end of the study. Subjects with obesity had a more adverse cardiometabolic risk profile than subjects with overweight and normal BMI on both assessments. At initial evaluation, total T3 concentrations were positively associated with uric acid and HbA1C, and free T4 concentrations were negatively associated with insulin concentrations, while there was no association between TSH concentrations and cardiometabolic risk parameters. Following the 1 year of the multidisciplinary, lifestyle intervention program, the concentrations of lipids, HbA1C, ALT, and γGT improved significantly in all subjects. Changes in TSH concentrations were positively associated with changes in systolic blood pressure (SBP), glucose, triglycerides, and cholesterol concentrations. Changes in free T4 concentrations were negatively associated with changes in cholesterol and insulin concentrations. Furthermore, changes in T3 concentrations were positively associated with changes in HbA1C, glucose, uric acid, and triglyceride concentrations. These findings indicate that in children and adolescents with overweight and obesity, thyroid hormones are associated with indices conferring cardiometabolic risk.

Impact of Probiotics on the Glycemic Control of Pediatric and Adolescent Individuals with Type 1 Diabetes: A Systematic Review and Meta-Analysis.

Human recombinant insulin is currently the only therapy for children and adolescents with type 1 diabetes (T1D), although not always efficient for the glycemic control of these individuals. The interrelation between the gut microbiome and the glycemic control of apparently healthy populations, as well as various populations with diabetes, is undeniable. Probiotics are biotherapeutics that deliver active components to various targets, primarily the gastrointestinal tract. This systematic review and meta-analysis examined the effect of the administration of probiotics on the glycemic control of pediatric and adolescent individuals with T1D. Randomized controlled trials employing the administration of probiotics in children and adolescents with T1D (with ≥10 individuals per treatment arm), written in English, providing parameters of glycemic control, such as mean glucose concentrations and glycosylated hemoglobin (HbA1c), were deemed eligible. The search strategy resulted in six papers with contradictory findings. Ultimately, five studies of acceptable quality, comprising 388 children and adolescents with T1D, were included in the meta-analysis. Employing a random and fixed effects model revealed statistically significant negative effect sizes of probiotics on the glycemic control of those individuals, i.e., higher concentrations of glucose and HbA1c than controls. Children and adolescents with T1D who received probiotics demonstrated worse glycemic control than controls after the intervention. Adequately powered studies, with extended follow-up periods, along with monitoring of compliance and employing the proper strains, are required to unravel the mechanisms of action and the relative effects of probiotics, particularly concerning diabetes-related complications and metabolic outcomes.

Association of glycosylated hemoglobin concentrations with structural and functional brain changes in the normoglycemic population: A systematic review.

Optimal glucose control is crucial for maintaining brain health and preventing metabolic and cognitive disorders in the general population. Glycosylated hemoglobin (HbA1c) serves as a key marker for assessing glucose intolerance and its impact on brain structure and function in healthy individuals. However, existing literature presents conflicting findings, necessitating a systematic review to consolidate current knowledge in this domain. This systematic review examines 26 English-language studies involving participants aged 15 years and above, investigating the relationship between HbA1c levels and brain health. Studies focusing on normal/general populations and utilizing magnetic resonance imaging (MRI) as the imaging modality were included. Exclusion criteria encompassed review articles, abstracts, letters, animal studies, and research involving neuropsychiatric or metabolic diseases. Data were gathered from PubMed, Scopus, and Web of Science databases up to November 2023. Analysis reveals significant associations between HbA1c levels and various brain metrics, including volume, cortical thickness, fractional anisotropy, mean diffusivity, activity, and connectivity. However, findings exhibit inconsistency, likely attributed to disparities in sample characteristics and study sizes. Notably, hippocampal volume, white matter hyperintensity, and ventral attention network connectivity emerge as frequently affected structures and functions, mirroring trends observed in diabetic populations. Despite inconclusive evidence, glucose intolerance appears to exert considerable influence on select brain structures and functions in individuals without diagnosed metabolic disorders. Understanding these associations is critical for mitigating the risk of cognitive decline and dementia in healthy populations. Future investigations should aim to elucidate the intricate relationship between HbA1c concentrations and brain health parameters in normoglycemic individuals.

Effect of Vitamin-D on Glycemic Parameters and Adiponectin in gestational diabetes.

To determine the effect of Vitamin-D-supplementation on glycemic parameters: glucose levels in blood, insulin, HbA1c, HOMA-IR, and adiponectin in women with gestational diabetes. An experimental study was executed at PGMI/LGH of Lahore from June 2020 to June 2021, with 34 Vitamin-D-deficient women who had gestational diabetes (20-26 weeks). All were aged between 21-32 years, randomly and equally divided into controls and cases. Cases received 200,000 IU Vitamin-D-dose. Fasting blood was collected before as well as after treatment from each participant. Spectrophotometry and peroxidase method were used to estimate HbA1c and glucose concentrations respectively. Insulin, adiponectin, and Vitamin-D were assessed by ELISA. To verify data normality, the Shapiro-Wilk test was applied and to prove group comparison Mann-Whitney U, Wilcoxon signed-rank, and Sample-t tests were used via IBM-SPSS version-21. No difference in blood glucose was found between controls and cases before treatment (p=0.858), while post-treatment, significant reduction found in cases (p=0.019). Before treatment, no difference was noticed in insulin levels of both groups (p=0.44), however, post-treatment, a significant decline was expressed in cases (p=0.001). No difference was found in HOMA-IR between controls and cases before treatment (p=0.14) but post-treatment, significant reduction was observed in cases (p=0.001). Non-significant difference was noted in HbA1c before (p=0.664) and after (p=0.169) treatment in both groups. Non-significant upsurge in adiponectin was observed in cases before (p=0.544) and after (p=0.194) treatment. Vitamin-D supplementation significantly improves glycemic control in gestational diabetic women, however, its effect on adiponectin was non-significant.

HbA1c variability associated with dementia risk in people with type 2 diabetes.

Although poor glycemic control is associated with dementia, it is unknown if variability in glycemic control, even in those with optimal glycosylated hemoglobin A1c (HbA1c) levels, increases dementia risk. Among 171,964 people with type 2 diabetes, we evaluated the hazard of dementia association with long-term HbA1c variability using five operationalizations, including standard deviation (SD), adjusting for demographics and comorbidities. The mean baseline age was 61 years (48% women). Greater HbA1c SD was associated with greater dementia hazard (adjusted hazard ratio=1.15 [95% confidence interval: 1.12, 1.17]). In stratified analyses, higher HbA1c SD quintiles were associated with greater dementia hazard among those with a mean HbA1c<6% (P=0.0004) or 6% to 8% (P<0.0001) but not among those with mean HbA1c ≥ 8% (P=0.42). Greater HbA1c variability is associated with greater dementia risk, even among those with HbA1c concentrations at ideal clinical targets. These findings add to the importance and clinical impact of recommendations to minimize glycemic variability. We observed a cohort of 171,964 people with type 2 diabetes (mean age 61 years). This cohort was based in Northern California between 1996 and 2018. We examined the association between glycosylated hemoglobin A1c (HbA1c) variability and dementia risk. Greater HbA1c variability was associated with greater dementia hazard. This was most evident among those with normal-low mean HbA1c concentrations.