HbA1c In Type 2 Diabetes Mellitus Patients Research Articles

The association between serum high-density lipoprotein and hemoglobin A1c in T2DM: Evidence from a nationwide cross-sectional study in diabetic patients

IntroductionThe prevalence of Type 2 Diabetes Mellitus (T2DM) is expected to rise, increasing the risk of cardiovascular disease. This study explores the relationship between high-density lipoprotein cholesterol (HDL) and glycemic control in T2DM patients, measured by hemoglobin A1c (HbA1c). While HDL is known to confer cardiovascular benefits, its impact on glycemic control remains unclear. MethodsThis cross-sectional study analyzed 30,195 Thai adults with T2DM data from the 2018 Thailand DM/HT database. Well-controlled HbA1c was defined as less than 53 mmol/mol (7 %). The study utilized multivariable linear, piecewise linear, and logistic regression analyses to investigate the relationship between HDL levels and glycemic control. ResultsThe impact of HDL on HbA1c levels was nonlinear, showing a U-shaped relationship among the study participants with an HDL inflection point of 59 mg/dl. In females, a U-shaped relationship was also observed at the same inflection point, where increased HDL above this level was associated with a rise in HbA1c (Adjusted β = 0.205, P < 0.001). In contrast, a linear model better explained the consistent negative relationship between HDL and HbA1c in males (Adjusted β = –0.076, P < 0.001). Furthermore, in the poorly controlled HbA1c group, a significant U-shaped pattern was observed with an inflection point at 59 mg/dl. ConclusionThis study found a nonlinear, gender-specific relationship between HDL and HbA1c in T2DM patients. Males with higher HDL are more likely to achieve glycemic control, while a U-shaped relationship is observed in females. Further research is needed to understand the differing correlation between well-controlled and poorly controlled groups.

Correlation Between Thyroid-Related Hormones and Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients with Normal Thyroid Function: A Retrospective Study.

To investigate the correlation between thyroid-related hormones and diabetic retinopathy (DR) in euthyroid patients with type 2 diabetes mellitus (T2DM). Patients with T2DM admitted to our hospital between January 2023 and June 2023 were retrospectively analyzed. The patients were divided into DR and non-diabetic retinopathy (NDR) groups according to whether DR occurred. Thyroid function-related hormones (TSH, FT3, and FT4), blood glucose indices (FBG and HbA1c), and blood lipid indices (HDL-C, LDL-C, TC, and TG) of the two groups were analyzed by univariate and multivariate logistic regression to explore the risk factors for DR. Pearson correlation analysis and multiple stepwise regression analysis were used to investigate the correlation of TSH or FT3 with FBG, HbA1c, and TG in DR patients. Of the 286 patients with T2DM included in this study, 101 (35.31%) developed DR and 185 (64.69%) did not. High TG, FBG, HbA1c, and TSH and low FT3 levels were independent risk factors for DR in T2DM patients. TSH positively correlated with TG, whereas FT3 negatively correlated with TG and HbA1c in T2DM patients with DR. Higher TSH and lower FT3 in T2DM patients with normal thyroid function may affect glucose and lipid metabolism, thereby increasing the risk of DR.

Effect of Total Hemoglobin on Glycated Hemoglobin (HbA1c) in Type 2 Diabetes Mellitus

Background: Glycated hemoglobin (HbA1c) is a pivotal marker in the diagnosis, prognosis, and therapeutic monitoring of diabetes mellitus. Given the involvement of hemoglobin in non-enzymatic glycation reactions, it is hypothesized that total hemoglobin concentration might impact HbA1c levels alongside blood glucose concentrations. Objectives: This study aimed to estimate and compare plasma fasting glucose level and total hemoglobin level in type 2 diabetes mellitus (T2DM) patients with and without anemia. The study also aimed to estimate HbA1C and compare with calculated HbA1C using formula in T2DM patients with and without anemia and to correlate between total hemoglobin levels with directly measured HbA1c in T2DM patients with and without anemia. Methodology: This cross-sectional study, employing purposive sampling, investigated 30 anemic and 30 non-anemic Type 2 Diabetes Mellitus (T2DM) patients at the Central Diagnostic Laboratory. Total Hemoglobin, HbA1C, and Fasting Plasma Glucose were measured for the patients and the data was analyzed. Results: Independent 't' tests revealed significant differences (p &lt; 0.0001) in estimated HbA1c, fasting blood sugar, calculated HbA1c, and Hb levels between the two groups. Subgroup analyses exhibited significant differences in estimated HbA1c for both groups individually (p = 0.003 for T2DM without anemia and p&lt;0.0001 for T2DM with anemia). Pearson's correlation analysis indicated no significant correlation between HbA1c and hemoglobin in either subgroup. Similarly linear regression analysis treating HbA1c as the dependent variable yielded a non-significant p-value, suggesting that hemoglobin levels do not significantly influence HbA1c. Conclusion: In conclusion, regardless of anemia status, our findings suggest that hemoglobin is not a significant predictor of HbA1c levels in T2DM patients, offering valuable insights into factors influencing HbA1c variability in diabetic populations.

Correlation analysis of bone metabolism indices and glycosylated hemoglobin in middle-aged and older adult patients with type 2 diabetes mellitus.

This study aimed to evaluate the association between bone metabolism indices and glycated hemoglobin (HbA1c) levels in middle-aged and older adult patients with type 2 diabetes mellitus (T2DM). We retrospectively analyzed 372 T2DM patients aged > 45 years who had attended the Endocrinology Department at our hospital (males, n = 192; postmenopausal females, n = 180). We collected data concerning patient characteristics, HbA1c levels, and bone metabolism indices (25-hydroxyvitamin D [25(OH)D], β-isomerized C-terminal telopeptides, N-terminal osteocalcin [N-MID], procollagen type 1 N-terminal propeptide [P1NP], bone-specific alkaline phosphatase [BAP], calcium [Ca], and phosphorus [P]). Study patients were divided into 3 groups according to their HbA1c levels: Group A, HbA1c < 7.5%; Group B, HbA1c 7.5 to 8.9%; and Group C, HbA1c ≥ 9.0%. Pearson correlation was used to determine the correlation between HbA1c levels and the bone metabolism indices. Multiple linear regression analysis was performed to identify factors influencing HbA1c in T2DM patients. Among the 3 groups, no differences were observed in 25(OH)D, β-CTx, Ca, or P indices among the 3 groups, whereas a statistically significant difference in N-MID was observed. Pearson correlation analysis showed an inverse correlation between HbA1c levels and N-MID and no correlation with other bone metabolism indices. Multiple linear regression analysis showed that N-MID was a factor influencing HbA1c levels after adjusting for age and body mass index (BMI). Serum N-MID levels negatively correlated with HbA1c levels in middle-aged and older adult men with T2DM. Therefore, high serum N-MID levels may contribute to blood glucose control in T2DM patients.

Association of High sensitivity C-reactive protein (Hs-CRP) with poor Glycaemic control and Coronary Heart Disease in Type 2 Diabetes Mellitus

High sensitivity C-reactive protein (Hs-CRP) is a sensitive marker of subclinical inflammation associated with atherosclerosis. Uncontrolled diabetes mellitus (DM) is one of the important risk factors of coronary heart disease (CHD). The aim of this study was to evaluate the association between Hs-CRP levels and both glycaemic control and CHD in Syrian type 2 diabetes mellitus (T2DM) patients. A random sample of 108 subjects was selected from T2DM and/or CHD patients seen in the National Centre for Diabetes, and the outpatient clinic of cardiology department at Tishreen University Hospital in Latakia. Four groups were formed: Group 1 [T2DM (+) CHD (-), N=29], Group 2 [T2DM (-) CHD (+), N=25], Group 3 [T2DM (+) CHD (+), N=29], and Group 4 (T2DM (-) CHD (-), N=25). Serum Hs-CRP and glycated haemoglobin (HBA1C) were determined. The SPSS 25.0 program was used for the statistical analysis. Probability (P) value less than 0.05 was considered statistically significant. Mean Hs-CRP level was higher in T2DM subjects with (5.23±1.56mg/l) or without (2.29±0.78mg/l) CHD compared to T2DM (-) CHD (-) patients (0.16±0.04mg/l), (p&lt;0.0001 for both). Mean Hs-CRP level in T2DM with CHD was not only higher than T2DM patients without CHD (p&lt;0.0001), but also than non-diabetic subjects with CHD (2.56±0.45mg/l) (p&lt;0.0001). There was a positive correlation between serum Hs-CRP and HBA1C in T2DM patients with CHD (r=0.781, P&lt;0.0001), Similarly, Hs-CRP levels were positively and significantly correlated with HBA1C in T2DM patients without CHD (r=0.800, p&lt;0.0001). We also noticed that for every 1.0% increase in HbA1c there was an 77% increase in the likelihood of having an elevated Hs-CRP. We concluded that Hs-CRP was strongly correlated with glycaemic control in T2DM patients. The highest Hs-CRP level was observed in T2DM with CHD patients. Hs-CRP could predict the incidence of coronary heart disease in T2DM patients.

Leptin and other Biochemical Investigations in the Serum of Type 2 Diabetes Mellitus Patients

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by hyperglycemia and insulin resistance, and serious health consequences can be developed from T2DM such as in the eye (diabetic retinopathy), the renal (diabetic nephropathy), the cardiovascular system (hypertension), etc. Leptin is one of the regulators that released by the adipose tissue, which involved in mediating inflammatory processes, and related to oxidative stress. This article was made to examine the level of leptin in T2DM patients and its association with lipid profile and glycaemia status in T2DM patients. Also, the possibility of using leptin in the prognosis of T2DM was investigated. The study was included 60 T2DM patients and 30 normal glycemic non-diabetic control. The results have shown a significant high levels of serum leptin, glucose, HbA1c, triglycerides, and cholesterol in T2DM patients with significant low level of high-density lipoprotein, when compared to control. Leptin has shown to be involved in the pathophysiology of type 2 diabetes mellitus. The T2DM patients were contained a significant high levels of leptin in their serum compared to the normal glycemic people without T2DM disease. Furthermore, leptin was correlated significantly with the percentage of HbA1c in T2DM patients, which indicates a major part of influence between leptin and insulin resistance development in T2DM patients. Moreover, lipids were altered significantly in T2DM patients, but the results have revealed no significant involvement of leptin with this alteration. Based on these findings, we suggest the use of leptin in the prognosis of risks in T2DM patients.

Correlation of leucocyte and platelet indices in patients with type 2 diabetes mellitus with microvascular complications at a tertiary care hospital in south India - A prospective cross-sectional study.

Objective. The present study was directed to assess the correlation between leukocyte and platelet indices and microvascular complications in patients with type 2 diabetes mellitus (T2DM). Methods. A prospective cross-sectional study was conducted between January 2020 and May 2021 at a tertiary healthcare center. Sixty T2DM patients, who fulfilled the inclusion and exclusion criteria, were included into the study and divided into 2 groups: T2DM patients with microvascular complications and T2DM patients without vascular complications. Clinical history was taken and examinations (routine complete blood count) were done to obtain platelet indices, neutrophillymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) were obtained and tabulated. A correlation was statistically analyzed from the obtained data, p value <0.05 was considered to be statistically significant. Results. From the patients with microvascular complications, 18 cases suffered from retinopathy and nephropathy. Majority of the participants suffered from moderate non-proliferative retinopathy. The creatine median and absolute neutrophil count (ANC) were significantly higher in T2DM patients with microvascular complications (p<0.0001 and p<0.0054, respectively) compared to T2DM patients without vascular complications. No significant correlation was found between platelet indices, NLR, PLR with regard to fasting blood sugar, post prandial blood sugar, HbA1C in T2DM patients. Conclusions. Since no significant correlation was found between the different platelet indices and microvascular complications, it is evident that these markers cannot be used as the predictors of microvascular complications in T2DM patients.

The relationship between the level of exercise and hemoglobin A1c in patients with type 2 diabetes mellitus: a systematic review and meta-analysis.

The aim of the study was to evaluate the relationship between changes in hemoglobin A1c (HbA1c) and exercise levels in type 2 diabetes mellitus (T2DM) patients when performing various types of exercise. The inclusion criteria were randomized controlled trials involving adults with T2DM, intervention involving exercise alone, the overall duration of intervention ≥12 weeks, and reporting HbA1c. Weighted mean difference (WMD) was defined as the mean difference between the intervention group and the control group weighted by the inverse of the squared standard error for each study, and all WMDs were pooled as overall effects. A meta-regression analysis was performed to evaluate the relationship between the exercise level and the WMD in HbA1c. Forty-eight studies (2395 subjects) were analyzed. The pooled WMD in HbA1c decreased significantly (-0.5% [95% confidence intervals: -0.6 to -0.4]) but contained significant heterogeneity (Q = 103.8, P < 0.01; I2 = 36.6%). A meta-regression analysis showed that the intensity (metabolic equivalents [METs]), time (min/session), or frequency (sessions/week) of the exercise was not associated with the HbA1c. However, the overall duration of exercise (weeks) was significantly associated with the WMD in HbA1c (meta-regression coefficient: 0.01 [95% confidence intervals: 0.002-0.016]; R2 = 70.0%), and that result did not contain significant heterogeneity (P > 0.05; I2 = 14.7%). The exercise intervention decreases HbA1c in T2DM patients. In addition, exercise for an extended duration was associated with an increase in HbA1c, so the effects of exercise may be evident early on, but results suggested that exercise for a prolonged period alone may increase HbA1c.

Effects of Liraglutide on Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

IntroductionNonalcoholic fatty liver disease (NAFLD) is a common comorbidity of type 2 diabetes mellitus (T2DM), and no approved therapies are currently available. A meta-analysis was performed to investigate the effects of liraglutide on NAFLD in patients with T2DM.MethodsMedline (via PubMed), Embase (via Elsevier), and the Cochrane Central Register of Controlled Trials (CENTRAL) (via Cochrane Library) from inception to April 2020 were searched. After screening the literature and extracting data, we assessed the risk of bias of the eligible studies. The Cochrane Collaboration's RevMan software program was used for the statistical analysis.ResultsEleven trials involving 535 patients were included for the final analysis. Compared to the placebo or control group, liraglutide decreased liver fat (LF) (insulin: mean difference MD − 2.50, 95% confidence interval [CI] − 4.30 to − 0.70), body mass index (BMI) (placebo: MD − 1.13, 95% CI − 2.03 to − 0.23; pioglitazone: MD − 4.10, 95% CI − 6.27 to − 1.93; metformin: MD − 1.07, 95% CI − 2.06 to − 0.08; insulin: MD − 1.01, 95% CI − 1.60 to − 0.43), lipoproteins, including high-density (insulin: MD − 0.10, 95% CI − 0.15 to − 0.05) and low-density lipoproteins (MD − 0.26, 95% CI − 0.43 to − 0.10), glycated hemoglobin A1c (HbA1c) (placebo: MD − 0.86; 95% CI − 1.22 to − 0.51; insulin: MD − 0.22, 95% CI − 0.41 to − 0.04), total cholesterol (placebo: MD − 0.34, 95% CI − 0.65 to − 0.03; metformin: MD 0.09, 95% CI 0.01–0.18), and triglycerides (placebo: MD − 0.29, 95% CI − 0.57 to − 0.01; insulin: MD − 0.80, 95% CI − 1.03 to − 0.57). Liraglutide may be associated with increased gastrointestinal reactions compared to pioglitazone.ConclusionThese findings revealed that liraglutide decreased LF, BMI, lipids, or HbA1c in T2DM patients complicated with NAFLD, indicating its potential therapeutic efficacy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01072-4.

Model-based Prediction of the Long-term Glucose-Lowering Effects of Ipragliflozin, a Selective Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor, in Patients with Type 2 Diabetes Mellitus.

IntroductionSodium-dependent glucose cotransporter 2 (SGLT2) inhibitors inhibit the reabsorption of glucose from the kidneys and increase urinary glucose excretion (UGE), thereby lowering the blood glucose concentration in people suffering from type 1 and type 2 diabetes mellitus (T2DM). In a previous study, we reported a pharmacokinetics/pharmacodynamics model to estimate individual change in UGE (ΔUGE), which is a direct pharmacological effect of SGLT2 inhibitors. In this study, we report our enhancement of the previous model to predict the long-term effects of ipragliflozin on clinical outcomes in patients with T2DM.MethodsThe time course of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) in patients with T2DM following ipragliflozin treatment that had been observed in earlier clinical trials was modeled using empirical models combined with the maximum drug effect (Emax) model and disease progression model. As a predictive factor of drug effect, estimated ΔUGE was introduced into the Emax model, instead of ipragliflozin exposure. The developed models were used to simulate the time course of FPG and HbA1c following once-daily treatment with placebo or ipragliflozin at doses of 12.5, 25, 50 and 100 mg, and the changes at 52 weeks at the approved dose of 50 mg were summarized by renal function category.ResultsThe developed models that included UGE as a dependent variable of response were found to well describe observed time courses in FPG and HbA1c. Baseline blood glucose level and renal function had significant effects on the glucose-lowering effect of ipragliflozin, and these models enabled quantification of these impacts on clinical outcomes. Simulated median changes in HbA1c in T2DM patients with mild and moderate renal impairment were 25 and 63% lower, respectively, than those in T2DM patients with normal renal function. These results are consistent with the observed clinical data from a previous renal impairment study.ConclusionsEmpirical models established based on the effect of UGE well predicted the renal function-dependent long-term glucose-lowering effects of ipragliflozin in patients with T2DM.Electronic supplementary materialThe online version of this article (10.1007/s13300-020-00785-2) contains supplementary material, which is available to authorized users.

VITAMIN D SUPPLEMENTATION AND HBA1C LEVELS IN TYPE 2 DIABETIC PATIENTS

Introduction: Type 2 diabetes mellitus (T2DM) is a major public health problem, with an estimated 65 million patients in India. Studies shown that low serum 25(OH)D concentrations are associated with an increased risk of type 2 diabetes and shown the beneficial effect of vitamin D supplementation on insulin sensitivity. Vitamin D is formed in humans by subcutaneous photosynthesis from its precursor, 7-dehydrocholesterol by exposing themselves to the sun. older age is associated with a decrease in 7-dehydrocholesterol concentration in the human skin. This lifestyle habit and their natural diet of low vitamin D consumption may cause poor glucose control in diabetic patients. The purpose of this study was to examine the association between serum 25(OH)D and glycosylated hemoglobin (HbA1c) levels.&#x0D; Material and Methods: This was a prospective observational study of T2DM patients aged 18 and above who attended the outpatient clinics of a tertiary center. The following variables were collected from the cases: age, sex, type of diabetes, HbA1c result. Baseline HbA1c and vitamin D levels were recorded prior to supplementation and after a period of 6 months of supplementation with vitamin D, HbA1c and vitamin D levels were recorded once again. &#x0D; Results: A total of 169 patients were included in the study and whose follow up was completed at the end of 6 months. Mean age of the study population was 46.87 ± 15.99. there were 74(43.79%) male and 95(56.21%) female. Mean HbA1c pre-supplementation (%) was 9.58 ± 2.41 while post supplementation was 7.21 ± 1.08. There was a significant reduction of HbA1c of T2DM (P &lt; 0.0001). Vitamin D levels pre-supplementation (nmol/L) (mean ± SD) was 38.54 ± 29.54 while, Vitamin D levels post-supplementation (nmol/L) (mean ± SD) was 38.54 ± 29.54. There was a significant increase of vitamin D levels of T2DM (P &lt; 0.0001).&#x0D; Conclusion: Significant inverse association between vitamin levels D and HbA1c in T2DM patients was observed. Also there was significant reduction in HbA1c as vitamin D levels increased. Regular screening of vitamin levels D and HbA1c in T2DM patients is advised.&#x0D; Keywords: Vitamin D, diabetes, T2DM, 25-hydroxyvitamin D

Longitudinal follow-up study of the retrobulbar and intrarenal hemodynamics in patients with T2DM.

Objective:The primary aim of this study is to examine the hemodynamics of retrobulbar and intrarenal in the changes of early stage of type 2 diabetes mellitus (T2DM) patients from 2000 to 2015 and to assess incidence associated with diabetic kidney disease (DKD) and diabetic retinopathy (DR).Method:Our study contained 60 subjects newly diagnosed of T2DM were divided into 2 groups base on the mean resistive index (RI) (≤0.7 and >0.7) of hemodynamic and to compare between-group differences of the early changes in hemodynamics of retrobulbar and intrarenal and also to conclude the incidences of diabetic kidney disease (DKD) and diabetic retinopathy (DR)subsequently with a long follow-up duration(2000–2015). First, to compare the mean RI of central retinal artery (CRA) between 2 groups. Second, to compare the mean RI of intrarenal hemodynamics in the bilateral interlobular renal arteries, renal function parameters (blood urea nitrogen (BUN), creatinine (Cr), blood glucose parameters (glycosylated hemoglobinA1c (HbA1c), fasting plasma glucose (FBG), and 2-hour postprandial blood glucose (2hPBG)), glomerular filtration rate (GFR), albumin excretion rate (AER), and urine albumin-to-creatinine ratio (UACR) between 2 groups.Results:First part of our follow-up studies was to compare hemodynamic RI index of retrobulbar in years of 2000 and 2015, both renal function and blood glucose parameters were fund significantly enhanced in subject group RIs ≤0.7. Incidence of DKD and DR was notably lower in group RIs ≤0.7 than group RIs > 0.7, difference was statistically significant (P < .05). Incidence of HbA1c ≤7% was higher in group RIs ≤0.7 than group RIs >0.7, but difference was not statistically significant (P > .05). Incidence of proliferative diabetic retinopathy (PDR) was notably lower in group RIs ≤0.7 than group RIs >0.7, but the difference was not statistically significant (P > .05). Second part of our follow-up studies was to compare hemodynamic RI index of interlobular renal in years of 2000 and 2015, both renal function and blood glucose parameters were fund significantly enhanced in subject group RIs ≤0.7. Compared data of various incidences from first part of study were coherent with second part. (Incidence of DKD and DR was notably lower in group RIs ≤0.7 than group RIs >0.7, difference was statistically significant (P < .05). Incidence of HbA1c ≤7% was higher in group RIs ≤0.7 than group RIs >0.7, but difference was not statistically significant (P > .05). Incidence of PDR was notably lower in group RIs ≤0.7 than group RIs >0.7, but the difference was not statistically significant (P > .05).Conclusions:RIs of retrobulbar and interlobular renal which would serve as a good predictors for the hemodynamics changes in retrobulbar and intrarenal would assess incidence of DKD and DR during the preclinical stage in long-term range excluding renal function and HbA1c in T2DM patients.

Positive Relationship of Platelet Volume Indices with HbA1c in Unselected Type-2 Diabetes Mellitus Patients.

The aim of this study is to investigate the relationship of several platelet volume indices with glycated hemoglobin (HbA1c) in a large cohort of type 2 diabetes mellitus (T2DM) patients. This is a retrospective study conducted on 1,729 T2DM patients. The database was based on the laboratory information system of the Department of Clinical Laboratory Medicine of the First Affiliated Hospital of Shaoyang University from May 2017 to February 2018. These patients were divided into two subgroups depending on their platelet volume indices and HbA1c levels. Mean platelet volume (MPV), platelet distribution width (PDW) and platelet-large cell ratio (P-LCR) were positively correlated with HbA1c levels (all p < 0.01), but not the thrombocytocrit (PCT). The platelet, MPV, PDW, P-LCR, and glucose levels were significantly higher in the higher HbA1c subgroup (≥ 6.5%) than that in lower subgroup (< 6.5%) (p < 0.01). The platelet, MPV, P-LCR, PCT, HbA1c, and glucose levels were significantly higher in higher PDW subgroup (≥ 17 fL) than that in lower subgroup (< 17 fL) (p < 0.01). In the higher MPV subgroup (≥ 12 fL), the platelet, PDW, P-LCR, PCT, HbA1c, and glucose levels were significantly higher than that in lower subgroup (< 12 fL) (p < 0.01). These platelet volume indices were positively correlated with HbA1c in T2DM patients, which might provide potential new parameters to monitor glucose control.

PDB8 - HBA1C As A Risk Factor For Cardiovascular Disease in Type 2 Diabetes Mellitus: A Hospital-Based Study in Taiwan

Cardiovascular disease (CVD) is the major cause for death in type 2 diabetes mellitus (T2DM) patients worldwide. Evidence has emerged that HbA1c may increase the risk for CVD and others. This study was to examine the relationship between HbA1c and onset cardiovascular disease, and target HbA1c in T2DM patients in Taiwan. Data in T2DM patients were extracted from Chang Gung Memorial Hospital between 2007 and 2014. CV outcome events were derived post T2DM diagnosed with data in medical charts such as HbA1c until end of the year 2014. A total of 126,079 T2DM patients were enrolled into the analysis. Per 1% unit increase in baseline HbA1c and mean HbA1c, hazard ratio (HR) for CVD were 1.05 (95% CI: 1.04 ~ 1.06, p < 0.001) and 1.31 (1.29 ~ 1.33, p < 0.001) when patients had previous CVD, respectively (p < 0.001). Per 1% unit increase in mean HbA1c, hazard of CVD increased 23% (17% ~ 29%), 21% (19% ~ 29%), and 6% (3% ~ 9%) for other treatment, oral anti-diabetic drug (OAD), and combination of insulin and OAD, respectively (all p < 0.001). Hazard of CVD increased more than 100% when mean HbA1c was higher than 8% compare with mean HbA1c was lower than 7% (p < 0.001). The rate of achieving target HbA1c level were significantly higher in OAD (1.45, 1.37 ~ 1.53) and lower in combination of insulin and OAD group (0.87, 0.82 ~ 0.93) when compared with the other treatment group (all p < 0.001). High HbA1c increases risk for CVD in T2DM patients revealed from large hospital based cohort in Taiwan. Maintenance of HbA1c control needs to be monitored continuously, especially in T2DM patients whose mean HbA1c was higher than 8%, with treatments in combination of insulin and OAD.

Systematic Review of Efficacy and Safety of Newer Antidiabetic Drugs Approved from 2013 to 2017 in Controlling HbA1c in Diabetes Patients

Type 2 Diabetes Mellitus (T2DM) is the most common form of diabetes mellitus and accounts for about 95% of all diabetes cases. Many newer oral as well as parenteral antidiabetic drugs have been introduced in to the market in recent years to control hyperglycemic conditions in diabetes patients and many of these drugs produce potential side effects in diabetes patients. Hence, this systematic review was aimed to analyze and compare the efficacy and safety of oral antidiabetic agents in controlling HbA1c in T2DM patients, that were approved by the United States-Food and Drug Administration (US-FDA) from 2013 to 2017. All randomized controlled, double-blind trials published in English during the search period involving the newer antidiabetic agents were selected. In the outcome assessment comparison, semaglutide demonstrated the highest efficacy in lowering HbA1c, with a 1.6% reduction (p < 0.0001) when given at a dose of 1.0 mg. The safety profile of all the agents as compared to placebo or control were similar, with no or slight increase in the occurrence of adverse events (AEs) but no fatal reaction was reported. The most common AEs of all the antidiabetic agents were gastrointestinal in nature, with several cases of hypoglycemic events. However, among all these agents, semaglutide seems to be the most efficacious drug to improve glycemic control in terms of HbA1c. Alogliptin has the least overall frequency of AEs compared to other treatment groups.

ADHERENCE LEVEL AND BLOOD SUGAR CONTROL OF TYPE 2 DIABETES MELLITUS PATIENTS WHO GETS COUNSELING AND SHORT MESSAGES SERVICE AS REMINDER AND MOTIVATION

Objective: Examines the effects of counseling and short messages service (SMS) as a reminder and motivation toward medication adherence improvement and controlled HbA1c levels of type 2 diabetes mellitus (T2DM) patients.Methods: This study used a quasi-experimental method with prospective data retrieval. The subjects of this study were 40 patients with outpatient T2DM in internal disease polyclinic in West Nusa Tenggara Hospital, Indonesia. Patients who fulfilled the inclusion criteria were divided into two groups: The control group (n=20) receiving only the drug care service and the treatment group (n=20) receiving counseling and SMS reminder and motivation from the pharmacist. Data collecting was conducted using the pill count method, and HbA1c levels were taken from the medical record.Results: The results showed that counseling and SMS as reminder and motivation by a pharmacist can improve treatment adherence significantly (p&lt;0.05) by 11.33 ± 8.47 and can decrease HbA1c level significantly (p&lt;0.05) of 1.32 ± 0.72 in the intervention group. There was a positive correlation between T2DM patient treatment adherence to HbA1c levels (r=0.254, p=0.023).Conclusion: The provision of counseling and SMS as a reminder and motivation by the pharmacist can have a positive effect toward medication adherence and control of HbA1c in T2DM patients.

Association between numbers of decayed teeth and HbA1c in Japanese patients with type 2 diabetes mellitus

Background: Dental caries (DC) are more prevalent in individuals with diabetes than in healthy individuals. However, the association between glycaemic control and DC has not been well characterized in patients with type 2 diabetes mellitus (T2DM). We therefore assessed the association between glycated haemoglobin (HbA1c) serum concentrations and the prevalence of DC in patients with T2DM.Methods: Retrospective analyses of data pertaining to 108 Japanese patients with T2DM hospitalized because of poor or worsened glycaemic control were included. We divided the patients based on HbA1c into two groups: HbA1c level ≥75 mmol/mol (9.0%) as poorly controlled T2DM, and HbA1c level <75 mmol/mol (9.0%) as a control group. We compared the association of lifestyle factors, dental caries, and periodontal health between patients with poorly controlled T2DM and controls. Stepwise multiple regression analyses were performed to evaluate the association between HbA1c, the absolute number of decayed teeth (DT), the sum of decayed, missing, and filled teeth, and the Met Need Index (MNI).Results: DT was higher and MNI was lower in patients with poorly controlled T2DM as compared to that in controls (P = 0.006 and P = 0.004, respectively). Multiple regression analyses revealed a significant association between HbA1c levels and DT (adjusted β = 0.039, 95% confidence interval [CI], 0.005 to 0.072, P = 0.025) and the MNI (adjusted β = −0.216, 95% CI −0.374 to −0.058, P = 0.008).Conclusions: DT and MNI were associated with HbA1c in T2DM patients.

Effectiveness of Ipragliflozin for Reducing Hemoglobin A1c in Patients With a Shorter Type 2 Diabetes Duration: Interim Report of the ASSIGN-K Study.

BackgroundIpragliflozin is a selective sodium glucose co-transporter 2 inhibitor. The ASSIGN-K study is investigating the efficacy and safety of ipragliflozin for type 2 diabetes mellitus (T2DM) in the real-world clinical setting.MethodsJapanese T2DM patients with inadequate glycemic control despite diet and exercise with/without pharmacotherapy were enrolled in an investigator-driven, multicenter, prospective, observational study examining the efficacy and safety of ipragliflozin treatment (50 mg/day for 52 weeks). We performed interim analysis after 24 weeks.ResultsIn 367 patients completing 24-week ipragliflozin therapy, hemoglobin A1c (HbA1c) decreased significantly from 8.07% at baseline to 7.26% in week 24 (P < 0.001). The change in HbA1c from treatment initiation to week 24 was -0.88% in patients < 65 years old versus -0.55% in those ≥ 65 years and -0.92% in men versus -0.70% in women (all P < 0.001). When baseline HbA1c was < 7%, 7% to < 8%, and ≥ 8%, the change was -0.18%, -0.45%, and -1.48%, respectively (P = 0.5352, P < 0.001, and P < 0.001, respectively). When baseline body mass index (BMI) was < 25, 25 to < 30, and ≥ 30, the change was -1.05%, -0.65%, and -0.87%, respectively (all P < 0.001). Multiple regression analysis showed that HbA1c decreased more in patients with a higher baseline HbA1c or shorter duration of diabetes. An HbA1c < 7% was achieved in 33.3% of the patients, and their baseline HbA1c was significantly lower than that of patients failing to achieve it (P < 0.001). Adverse events (AEs) occurred in 106/451 patients (23.5%), including 29.1% of patients aged 65 or older. Common AEs were vulvovaginal candidiasis (3.1%) and genital pruritus (1.8%). Serious AEs included urinary tract infection, unstable angina, and ketosis, which occurred in patients who did not suspend medication during acute illness.ConclusionsIpragliflozin significantly improved HbA1c in T2DM patients with inadequate glycemic control. Improvement in HbA1c was significant irrespective of age, sex, baseline HbA1c, or BMI, but efficacy was greater with a higher baseline HbA1c and shorter duration of diabetes. For safe continuation of treatment, patients should be advised to suspend medication during acute illness.

Serum Uric Acid Levels were Dynamically Coupled with Hemoglobin A1c in the Development of Type 2 Diabetes.

The aim of the study was to decipher the relationship between serum uric acid (SUA) and glycated hemoglobin A1c (HbA1c) or fasting plasma glucose (FPG) in both type 2 diabetes mellitus (T2DM) patients and normal subjects. A total of 2,250 unrelated T2DM patients and 4,420 Han Chinese subjects from a physical examination population were recruited for this study. In T2DM patients SUA levels were negatively correlated with HbA1c (rs = −0.109, P = 0.000) and 2 h plasma glucose levels (rs = −0.178, P = 0.000). In the physical examination population, SUA levels were inversely correlated with HbA1c (rs = −0.175, P = 0.000) and FPG (rs = −0.131, P = 0.009) in T2DM patients but positively correlated with HbA1c (rs = 0.040, P = 0.012) and FPG (rs = 0.084, P = 0.000) in normal-glucose subjects. Multivariate analyses showed that HbA1c was significantly negatively associated with HUA both in T2DM patients (OR = 0.872, 95% CI: 0.790~0.963) and in the physical examination T2DM patients (OR = 0.722, 95% CI: 0.539~0.968). Genetic association studies in T2DM patients showed that alleles of two glucose-uric acid transporter genes, ABCG2 and SLC2A9 were significantly associated with SUA levels (P < 0.05). SUA level is inversely correlated with HbA1c in T2DM patients but positively correlated with HbA1c in normal-glucose subjects. The reverse transporting of uric acid and glucose in renal tubules might be accounted for these associations.

Oxidative DNA damage and oxidized low density lipoprotein in Type II diabetes mellitus among patients with Helicobacter pylori infection.

BackgroundHelicobacter pylori (H. pylori) infection is reported to be associated with various extragastrointestinal conditions such as insulin resistance, diabetes mellitus and metabolic syndrome. H. pylori infection and type 2 diabetes mellitus (T2DM) are associated with oxidative stress, this cross-relation between H. pylori induced infection in T2DM and oxidative damage is still debated. Thus, the question arises whether an increase in the serum level of 8-OHdG and Ox-LDL will occurs in patients with T2DM infected H. pylori; this will be through determination and compare frequency of H. pylori infection in T2DM and non-diabetic patients.Methods100 patients presented with history of epigastric discomfort for more than 1 month; 50 patients with T2DM and 50 non-diabetics. Anti-H. pylori IgG using ELISA, fasting and postprandial glucose level, glycated hemoglobin (HbA1c) and body mass index (BMI) was calculated. Serum 8-OHdG and Ox-LDL was measured using ELISA for the 100 patients and 50 control subject.ResultsRates of H. pylori infection of T2DM and non-diabetic were 66 and 58 %, respectively, (p = 0.001). H. pylori IgG antibody was not correlated with HbA1c either in T2DM (p = 0.06) or non-diabetic (p = 0.25). Serum 8-OHdG level in T2DM with positive H. pylori infection showed a significant difference compared to non-diabetics with positive H. pylori infection (p = 0.001) and higher than that in T2DM with negative H. pylori. A correlation between 8-OHdG concentration and HbA1c in T2DM patients infected with H. pylori was observed (r = 0.39, p = 0.02). Serum Ox-LDL level in T2DM with positive H. pylori infection showed a significant difference compared to diabetics with both negative H. pylori infection and in non-diabetics with positive H. pylori infection (p = 0.001).ConclusionsIncreased levels of oxidative DNA damage (8-OHdG) and Ox-LDL suggest the mechanistic link between H. pylori infection combined with diabetes and increased generation of ROS and could play as an important image for high risk to atherosclerosis.