HbA1c Levels In Diabetic Patients Research Articles

Cross-Sectional Study to Compare Preoperative Fasting Volume of Gastric Contents by Using Ultrasonography in Non-Diabetic and Diabetic Patients Posted for Elective Surgery

Background: Diabetic patients are known to have gastroparesis and consequent delayed gastric emptying which predisposes them to an increased risk of aspiration as compared to the general population. This study compares the gastric volumes in diabetic and non-diabetic patients using point-of-care ultrasound and correlates it with the HbA1c levels in diabetic patients.
 Methods: This cross-sectional study included 180 patients, 90 diabetic (>5 years) and 90 nondiabetic, aged >40 years, American Society of Anaesthesiologists' physical status I–II kept fasting for 8 hours. Before induction, gastric ultrasound was performed to measure craniocaudal (CC) and anteroposterior (AP) diameters followed by calculation of antral cross-sectional area (CSA) and gastric volume (GV) in right lateral decubitus (RLD) position using curved array probe. In diabetic patients, the gastric volumes were correlated with HbA1c values.
 Results: In the RLD, the mean CC and AP diameters were higher in diabetic Group. The calculated CSA in RLD in diabetics (8.014 ± 2.412 cm2) were significantly higher than non-diabetic (6.314± 2.894 cm2) (p < 0.0001). The calculated GV of 71.501 ± 35.937 ml in the diabetic group was significantly higher than 48.0022± 41.587 ml in the non-diabetic group (p < 0.0001). In diabetics, the gastric volumes showed significant correlation with HbA1c.
 Conclusion: Diabetic patients show higher residual gastric volume as compared to non-diabetic patients indicating gastroparesis. The gastric volumes are further increased in those with poorly controlled disease with high HbA1C levels. Ultrasound is an effective tool in assessing the risk of aspiration and altering anaesthetic management accordingly.

Restriction of Rice Portion and Pre-Meal Fruit with HbA1c Levels and Abdominal Fat for Diabetics in Malang City

Background: Glycemic control is the basic for managing diabetes to prevent chronic complications in diabetes. HbaA1c levels reaching <= 7% is one indicator of achieving good glycemic control. The 3 J principles (right type, amount, and schedule) in the pillars of meal management are not easy to apply, causing diabetes to have difficulty achieving glycemic targets.
 Objectives: Analyzing rice restriction portion and pre-meal fruit with HbA1c levels and abdominal fat in people with diabetes in Malang City
 Methods: Experimental study type 'randomized controlled trial' with pre-posttest control group design involved 16 people with diabetes who were active in Prolanis activities at the Malang city health center. Respondents were randomly divided into 2 groups. HbA1c levels were taken 2 times, before and after the intervention. The t test and paired t test with a p value <0.05 were used to test the effect of the intervention on HbA1c levels, abdominal fat and abdominal circumference in people with diabetes for 3 months.
 Results: Both forms of intervention can reduce HbA1c levels in diabetic patients. Limiting the portion of rice significantly reduced HbA1c levels (p=0.003) and visceral fat levels. However, determining the amount of rice with added pre-meal fruit did not considerably decrease visceral fat and abdominal circumference (p>0.05).
 Conclusions: Limiting the portion of rice eaten by itself or combining it with pre-meal fruit may help diabetics lower their HbA1c levels. Many fruit varieties can be defined as being suitable for diabetics to eat before meals based on their physiological properties and glycemic index.
 Keywords: HbA1c Level, Pre-meal fruit, , Rice Portion Restriction

Comparison of proportional macular thinning in normal and diabetic patients without diabetic retinopathy in tertiary hospital, Bhavnagar – An observational comparative study

Patients with diabetes mellitus are found to exhibit decreasing thickness in the macula with progression of disease severity and consistent elevation in the HbA1C levels. The study compares the thinning of macula in diabetic patients without retinopathy and non-diabetic patients using Optical Coherence Tomography (OCT).This observational cross-sectional design was conducted on 200 eyes of 100 patients, who reported to the tertiary care centre OPD in Bhavnagar. The study group included 50 diabetic individuals without retinopathy and 50 were non diabetic patients as controls. The macular thickness between groups was assessed using OCT. The correlation of CMT values with HbA1C levels were also evaluated in patients with diabetes.The macula thickness in patients with diabetes was found to be thinner when compared to non-diabetic patients (P<0.05), and the thickness of macula increased with a consistent increase in the HbA1C levels in diabetic patients without diabetic retinopathy (P<0.05). OCT remains a promising diagnostic imaging tool in evaluating accurately the thickness of macula in patients with diabetes. According to the study's findings, diabetic individuals without retinopathy at a tertiary care facility in Bhavnagar had thinner macula.

Comparison of Atherosclerotic Plaque Compositions in Diabetic and Non-diabetic Patients.

Diabetes mellitus is one of the major risk factors for coronary artery disease. Intravascular ultrasound(IVUS)imaging has an important role in the evaluation of atherosclerotic coronary artery disease. The aim of the study was to investigate the potential link between diabetes mellitus and plaque vulnerability in patients with coronary artery disease. In total, 26 patients with acute coronary syndrome (eight with diabetes mellitus) and 34 with stable angina pectoris (16 with diabetes mellitus) constituted the study population. Patients underwent IVUS ultrasound and virtual histology (VH)-IVUS imaging during routine diagnostic catheterization procedures. A total of 70 plaques in 60 patients were examined. Patients with diabetes mellitus had a significantly greater percentage of fibrofatty components in the minimal lumen area (MLA) (17± 12 in diabetics; 12± 6 in non-diabetics; p=0.06). Thin-cap fibroatheromaswere more frequent in patients with diabetes mellitus (72% versus 45%; p=0.012). There was a positive correlation between the presence of attenuated plaque and hemoglobin A1C (HbA1c) levels as well (7.09 ± 1.66 versus 6.02 ± 1.00; p=0.011). Patients with HbA1C ≥7.5% also had the highest prevalence of attenuated plaque. As shown by VH-IVUS, the prevalence of vulnerable plaques in patients with diabetes mellitus was much higher than that in non-diabetic patients. The presence of attenuated plaque detected in grayscale intravascular ultrasonography was associated with high HbA1C levels in diabetic patients. Diabetes mellitus may cause cardiovascular vulnerability by changing the plaque morphology.

Association of Glycemic Index Using HbA1c and Sensorineural Hearing Loss in Diabetes Mellitus Type 2 Patients: A Systematic Review and Meta-Analysis

ABSTRACT
 Objective: To systematically review the available evidence on the association of HBA1c levels and development of sensorineural hearing loss and to quantitatively analyze the available data on HBA1c levels in patients with type 2 diabetes mellitus and sensorineural hearing loss to determine an HbA1c level that may be associated with the risk of having sensorineural hearing loss.
 Methods:
 Design: Systematic Review and Meta-analysis Eligibility Criteria: Cross-sectional studies, or cohort studies which were limited to English language that investigated the correlation of glycemic index using HBA1c and sensorineural hearing loss among adult type 2 diabetic patients which were done from January 2010 to December 2021. Studies with no published outcome, incomplete data or that were ongoing as of August 1, 2022 were also excluded.
 Information Sources: MEDLINE (through PubMed), Cochrane Library, Scopus, Embase (through OVID@journal), Directory of Open Access Journals (DOAJ), Google Scholar and HERDIN Plus
 Risk of Bias: Risk of Bias was assessed using the Guidelines for Cochrane Collaboration Synthesis of Results: Results were presented using forest plots for representation.Results: A total of 8 studies were reviewed with 2,103 participants in all. Six articles compared hearing loss incidence between diabetic and non-diabetic patients. Overall, there were a total of 881 diabetic patients and 1222 non-diabetic patients. There was a significantly lower incidence of sensorineural hearing loss in non-diabetic patients with a risk ratio of 1.89, 95% CI [1.65, 2.16]. Three articles compared the HbA1c levels of diabetic patients with or without sensorineural hearing loss. Diabetic patients without sensorineural hearing loss had significantly lower HbA1c levels compared to those with sensorineural hearing loss with mean difference of 1.04, 95%CI [0.82, 1.25].Conclusion: In conclusion, this meta-analysis showed a higher prevalence rate of sensorineural hearing loss among patients with diabetes mellitus compared to non-diabetic patients. Moreover, poor glycemic control among diabetic patients with a glycemic index based on HbA1c of more than 8.3 (6.97-9.6) is associated with sensorineural hearing loss.

HOST FACTORS AND RISK OF PIN SITE INFECTION IN EXTERNAL FIXATION: A LITERATURE REVIEW EXAMINING AGE, BODY MASS INDEX, SMOKING, AND COMORBIDITIES INCLUDING DIABETES

An international Consensus Group has by a Delphi approach identified the topic of host factors affecting pin site infection to be one of the top 10 priorities in external fixator management. The aim of this study was to report the frequency of studies reporting on specific host factors as a significant association with pin site infection. Host factors to be assessed was: age, smoking, BMI and any comorbidity, diabetes, in particular. The intention was an ethological review, data was extracted if feasible, however no meta-analysis was performed.A systematic literature search was performed according to the PRISMA-guidelines. The protocol was registered before data extraction in PROSPERO. The search string was based on the PICO criterias. A logic grid with key concept and index terms was made. A search string was built assisted by a librarian. The literature search was executed in three electronic bibliographic databases, including Embase MEDLINE (1111 hits) and CINAHL (2066 hits) via Ovid and Cochrane Library CENTRAL (387 hits). Inclusion criteria: external fixation, >1 pin site infection, host factor of interest, peer-reviewed journal. Exclusion criteria: Not written in English, German, Danish, Swedish, or Norwegian, animal or cadaveric studies, location on head, neck, spine, cranium or thorax, editorials or conference abstract. The screening process was done using Covidence.A total of 3564 titles found. 3162 excluded by title and abstract screening. 140 assessed for full text eligibility. 11 studies included for data extraction. The included studies all had a retrospective design. Three identified as case-control studies. Generally the included studies was assessed to have a high risk of bias. A significant associations between pin site infection for following host factors: a) increased HbA1C level in diabetic patients; b) congestive heart failure in diabetic patients; c) less co-morbidity; d) preoperative osteomyelitis was found individually.This systematic literature search identified a surprisingly low number of studies examining for risk of pin site infection and host factors. Thus, this review most of all serves to demonstrate a gap of evidence about correlation between host factors and risk of pin site infection, and further studies are warranted.

Is There a Relationship between Optic Nerve and Chiasm Measurements with HbA1c Levels in Diabetic Patients?

Objectives We investigated the optic nerve (ON) and chiasm (OC) in magnetic resonance (MR) in diabetic patients by comparing them with hemoglobin A1c (HbA1c) levels. Methods In this retrospective study, cranial MRIs of 42 adults (19 males and 23 females) with diabetes mellitus (DM) (group1) and 40 healthy controls (19 males and 21 females) (group 2) were included. In both groups, bilateral ON widths and OC area, width, and height were measured. In the DM group, HbA1c values were also obtained at the time of MRI or within the same month. Results In the DM group, the mean of the HbA1c values was 8.31 ± 2.51%. There were no significant differences between ON diameter; and OC area, width and height of the DM and control groups ( p > 0.05). In each of the DM and control groups, ON diameter was not different between the right and left sides ( p > 0.05). In DM groups, correlation tests showed that there were positive correlations between right and left ON diameters, OC area and OC width, and OC height ( p < 0.05). In males, ON diameters were higher than those in females bilaterally ( p < 0.05). In patients with higher HbA1c values, OC width was smaller ( p < 0.05). Conclusion A significant correlation of OC width and HbA1c levels suggests that uncontrolled DM causes ON atrophy. Our study represents a thorough assessment of OC measures using standard brain MRI to evaluate optic degeneration in DM patients and shows that the OC width measurement is suitable and reliable. This simple method can be obtained from clinically available scans.

Incidence of Superficial and Deep Surgical Site Infections in Post Cardiac Surgery Patients with Pre-Operative HBA1C ≥ 7 % Compared to Those Having Pre-Operative HBAIC &lt; 7%

Objectives: The main objective of the study is to find the Incidence of superficial and deep surgical site infections in post cardiac surgery patients with pre-op HBA1C ≥ 7 % compared to those having pre-op HBAIC &lt; 7%. Material and methods: This cross-sectional study was conducted in Armed forces institute of cardiology AFIC /NIHD Rawalpindi during 1st October 2022 to 30 November 2022. Data was collected with the permission of ethical committee of hospital. All the patients who met the inclusion and exclusion criteria were selected for the study. As a routine practice at the cardiac surgery outpatient clinic of our hospital, HbA1c levels of diabetic patients are examined along with other routine examinations approximately 7–10 days before the surgery. Results: The data was collected from 354 patients of age range was 58.98 ± 4.56 years. According to analysis that was performed to investigate the mortality predictivity, age, gender, input ejection fraction, HbA1c levels and preoperative albumin levels were found to be associated with mortality. In the group with HbA1c≥7, the ejection fraction was lower (p=0.027) and mortality was higher (p=0.008). Practical Implications: Increased level of HbA1c&gt;7 in cardiac surgery patients is considered to be the increased incidence of SSI. Conclusion: Increased level of HbA1c&gt;7 in cardiac surgery is considered to be the increased incidence of SSI. We also found that good peri-operative control of RBS associated with decreased rate of SSI after cardiac surgery. Keywords: Cardiac, HbA1c, Diabetic, Surgery, Ejection fraction

Vitamin B12, folic acid, vitamin D, iron, ferritin, magnesium, and HbA1c levels in patients with diabetes mellitus and dental prosthesis.

Diabetic patients may have vitamin deficiencies, which are important in the follow-up and complications of diabetes for various reasons. It may be beneficial to include the use of dental prosthesis among the parameters that should be investigated as a cause of vitamin deficiency during the management and follow-up of diabetes mellitus. We aimed to investigate the association between serum vitamin B12, folic acid, 25-hydroxyvitamin D, ferritin, iron, magnesium, and HbA1c levels in diabetic patients with and without removable dental prosthesis and in non-diabetic patients with prosthesis. This study is a single-center case-control study. Participants were classified into the following groups: 1) Diabetic patients (n = 528) with prosthesis, 2) non-diabetic patients with prosthesis (n = 121) and 3) diabetic patients without prosthesis (n = 100). Vitamin B12, 25-hydroxyvitamin D, folic acid, ferritin, iron, magnesium, and HbA1c levels were measured and compared across the groups. A significant difference was observed between the groups with respect to the above parameters. Vitamin B12 levels were determined to be higher in the diabetic group without prosthesis. 25-hydroxyvitamin D levels were found to be significantly higher in the non-diabetic group with a prosthesis than in the other two groups. There was no statistical difference in the iron levels between the groups. Ferritin levels were observed to be significantly higher in the diabetic group with prosthesis compared to the other two groups. Magnesium levels were significantly different between all the three groups. The highest magnesium levels were found in the non-diabetic group with prosthesis. HbA1c levels were found to be higher in the diabetic group with prosthesis. Magnesium levels were correlated with 25-hydroxyvitamin D levels, but a negative correlation was observed between these and HbA1c. Serum vitamin B12 levels were lower in the diabetic and non-diabetic groups with prosthesis compared to the diabetic group without prosthesis. 25-hydroxyvitamin D levels were lower and ferritin was higher in the diabetic groups with and without prosthesis. Magnesium levels were significantly lower in the diabetic group with a prosthesis than in the other two groups. The mean HbA1c level was higher in the diabetic group with prosthesis. The comparison of diabetic patients receiving metformin revealed a higher pronounced vitamin B12 deficiency in the diabetic group with prosthesis. These findings show that those diabetic patients with prosthesis should be evaluated for vitamin B12, 25-hydroxyvitamin D, and magnesium deficiency.

Efektivitas Edukasi Obat untuk Pasien Diabetes Mellitus pada Masa Pandemi Covid-19 di Puskesmas Kecamatan Cempaka Putih, Jakarta Pusat

Diabetes mellitus is a chronic disease requires continuous therapy by professional health workers and self-care management from the patients. To support this, diabetic patient who seek treatment at the primary healthcare facilities is recommended to join The Chronic Disease Management Program (Prolanis). During the Covid-19 pandemic, the frequency of diabetic-related prolanis activities became less monitored, especially regarding the accuracy of using antidiabetic oral (ADO). A quasi-experimental study was conducted through drug education by pharmacists to determine the effect of such education on clinical outcomes, namely the patient's glycosylated hemoglobin (HbA1c) levels. The results showed that there was a decrease in HbA1c levels (1.31%) in the intervention group (n=7) and an increase in HbA1c (0.51%) in the control group (n=17; p=0.078). Eventhough it was not statistically significant due to limited research subjects, education on the proper use of ADO can reduce HbA1c levels in diabetic patients.

Correlation between HbA1c and carotid artery intima-media thickening(cIMT) in diabetic patients

Introduction: Correlation between carotid artery intima-media thickening and HbA1c levels in diabetic patients as a non invasive marker of progressive atherosclerosis. Objectives: The aim of this study is to study the role of two non invasive markers, carotid intima media thickening and HbA1c in diabetic patients and establish the usefulness of both the parameters in evaluating early risk factor assessment. Material and methods: 100 patients meeting the required criteria were taken coming to OPD/IPD bases to Dhiraj hospital in the age group of 35-70 years.HbA1c levels were used according to American diabetes association. Carotid intima media thickening was measures on B mode ultrasonography in radiology department. Results: among the 100 patients, 68 patients were female and 32 patients were male. The mean of HbA1c values were 8.0 ± 2.2%. The mean cIMT values were 0.78 ± 0.3 cm. Conclusion: HbA1c and carotid artery intimal thickness is useful as a diagnostic marker and early risk factor analysis for atherosclerotic changes in diabetic patients.

Host factors and risk of pin site infection in external fixation: A systematic review examining age, body mass index, smoking, and comorbidities including diabetes

Introduction: Host factors affecting pin site infections were selected by The Pin site Consensus Group, using a modified Delphi approach, to be one of the top 10 priorities to investigate how to reduce rates of pin site infections, improve clinical management, and inform research. The aim of this study was to perform a systematic literature review of the association between host factors and pin site infection, focused on age, smoking, body mass index, and comorbidities, in particular diabetes. Materials and Methods: The literature search strategy was developed as advised in the Cochrane Handbook for Systematic Reviews of Interventions following the PRISMA guidelines with the help from a scientific librarian. The protocol was registered in the International Register of Systematic Reviews, PROSPERO (ID: CRD42021273305). The literature search was executed in three electronic bibliographic databases, including Embase MEDLINE (1111 hits) and CINAHL (2066 hits) through Ovid and Cochrane Library CENTRAL (387 hits). Results: A total of 3564 titles were found. 3162 records were excluded by title and abstract screening. 140 studies were assessed for full-text eligibility. All excluded studies were not reporting specific numbers of patients with pin site infection and the associations of interest. 11 studies were included for data extraction. The included studies were all designed retrospective, and the risk of bias assessment was done using Joanna Briggs Institute risk appraisal tool. The extracted data are presented as results in tabular summaries. This review reveals an increased risk of pin site infection associated with increased HbA1C level in diabetic patients and congestive heart failure in diabetic patients. An increased risk of pin site infection was associated with a lower ASA score. None of the included studies found any association between pin site infection and smoking, age, or body mass index. Conclusion: This systematic literature search identified a surprisingly low number of studies examining the association between pin site infection and the specific host factors. Thus, this review most of all serves to demonstrate a gap of evidence about the correlation between host factors and risk of pin site infection, and further studies are warranted.

Effectiveness of Non-Surgical and Surgical Periodontal Therapy in Lowering HbA1c in Diabetic Patients

Diabetes is global pandemic disease, a metabolic disorder of multiple etiology that is characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Periodontitis is a chronic inflammatory disease that is initiated by the accumulation of dental plaque biofilm, within which microbial dysbiosis leads to a chronic, non-resolving and destructive inflammatory response. In the last decades, many studies investigated the impact of periodontal treatment on glycemic control in people with diabetes. The aim of this dissertation is to conduct a review of the published literature to understand the association between periodontal therapy and glycated hemoglobin (HbA1c) values. A search was conducted in PUBMED and of the 277 articles found, only 21 were considered for being more relevant. As has been recognized for some time, the results show a correlation between the two diseases and their link lies in the inflammatory process. In the diabetic patient, this results in higher HbA1c values and a situation that is difficult to control. Being able to control the inflammatory state of the periodontium through oral hygiene protocols and periodontal therapy has several benefits in a complicated clinical picture in situations of poor glycemic control. Non-surgical periodontal therapy proves effective in significantly lowering HbA1c levels in diabetic patients.

COVID-19, Diabetes and Steroids: The Demonic Trident for Mucormycosis.

Coronavirus disease 2019 (COVID-19) has been found to be associated with mucormycosis in few parts of the world, especially India. It is important to look for reasons for this upsurge of cases so that other countries may take proper steps to prevent it. A prospective clinico-demographic study was conducted in SMS Medical College, Jaipur, India from April to May 2021. All patients (235) with COVID associated mucormycosis (CAM) were studied in detail with reference to their diabetic status and steroid intake during treatment of COVID-19. Steroid usage was in 84.3% of patients with methylprednisolone being the most commonly used steroid (66.8%). Majority of the patients had taken steroids for 7–14 days. Diabetes was found in 204 patients and 42.1% of patients were newly diagnosed during/after COVID-19 treatment. The HbA1c levels of diabetic patients ranged from 6.0% to 16.3%. This is perhaps the biggest study in the world shows that the triad of COVID-19, diabetes and steroid usage is a major contributing factor towards mucormycosis. Proper steps should be taken to prevent CAM.

The impact of COVID-19 pandemic on glycemic control in patients with diabetes mellitus in Turkey: a multi-center study from Kocaeli

AimsThe aim of this study is to determine the impact of the COVID-19 pandemic on the management and disease control of the patients with diabetes mellitus in Kocaeli.MethodsThis study was carried out in six leading central hospitals in five major districts of Kocaeli. The study was conducted between June 2020 and November 2020. The patients who had previous admissions to these clinics within 6 months prior to the pandemic were enrolled in the study.ResultsA total of 283 patients were enrolled in the study, among them 151 (53%) patients were female, 268 (95%) had type 2 DM and remaining 5% had type 1 DM. The median weight of the patients was similar between the previous and last visits (84 kg vs 83 kg, p = 0,88). Laboratory parameters of previous and current visits revealed that mean fasting plasma glucose (FPG) and HbA1c levels were not significantly changed. The number of the patients who had controlled blood pressure was significantly decreased. The number of those who had neuropathic complains and the severity of dyslipidemia significantly increased during pandemic period.ConclusionOur study demonstrated that despite decreased compliance with diet and exercise, and difficulty in accessing medication, there was no significant change in weight, FPG and HbA1c levels in diabetic patients. Since cultural differences, education level and socioeconomic opportunities differ between societies, national and international studies will be more accurate to evaluate the effects of epidemics on the course of chronic diseases.

Glycosylated hemoglobin levels and the risk for contrast-induced nephropathy in diabetic patients undergoing coronary arteriography/percutaneous coronary intervention

BackgroundsDiabetes mellitus is an independent risk factor for Contrast-induced nephropathy (CIN) in patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI). Glycosylated hemoglobin (HbA1c) is the gold standard to measure blood glucose control, which has important clinical significance for evaluating blood glucose control in diabetic patients in the past 3 months. This study aimed to assess whether preoperative HbA1c levels in diabetic patients who received CAG/PCI impacted the occurrence of postoperative CIN.MethodsWe reviewed the incidence of preoperative HbA1c and postoperative CIN in 670 patients with CAG/PCI from January 1, 2020 to October 30, 2020 and divided the preoperative HbA1c levels into 5 groups. Blood samples were collected at admission, 48 h and 72 h after operation to measure the Scr value of patients. Categorical variables were compared using a chi-square test, and continuous variables were compared using an analysis of variance. Fisher’s exact test was used to compare the percentages when the expected frequency was less than 5. Univariable and multivariable logistic regression analysis was used to exclude the influence of confounding factors, and P for trend was used to analyze the trend between HbA1c levels and the increased risk of CIN.ResultsPatients with elevated HbA1c had higher BMI, FBG, and LDL-C, and they were more often on therapy with hypoglycemic agents, Insulin and PCI. They also had higher basal, 48 h and 72 h Scr. The incidence of CIN in the 5 groups of patients were: 9.8, 11.9, 15.2, 25.3, 48.1%. (p < 0.0001) The multivariate analysis confirmed that in the main high-risk subgroup, patients with elevated HbA1C levels (≥8.8%) had a higher risk of CIN disease. Trend test showed the change of OR (1.000,1.248,1.553,2.625,5.829).ConclusionsStudies have shown that in diabetic patients undergoing CAG/PCI, elevated HbA1c is independently associated with the risk of CIN, and when HbA1c > 9.5%, the incidence of CIN trends increase. Therefore, we should attach great importance to patients with elevated HbA1c at admission and take more active measures to prevent CIN.

Effect of Empowerment Program with and without Telenursing on Self-efficacy and Glycosylated Hemoglobin Index of Patients with Type-2 Diabetes: A Randomized Clinical Trial.

Introduction: Developing new training methods for improving the health of diabetic patients has always been a concern for nurses. The present study aims to investigate the effects of empowerment-based interventions with or without telenursing on self-efficacy and HbA1c level in diabetic patients.Methods: In this randomized clinical trial, 156 patients with type-2 diabetes were randomly assigned into two intervention groups (empowerment with/without telenursing) and one control group. All subjects in the intervention groups participated in two sessions of the empowerment program. However, only the group of empowerment with telenursing received telephone counseling for 12 weeks. The patients in the control group did not receive any intervention programs. Self-efficacy was measured by diabetes-specific self-efficacy scale. The HbA1c level was measured using Bionic kit. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, Ill., USA).Results: After 14 weeks, while the changes in self-efficacy scores of the control group were not statistically significant, they were significant in the two intervention groups. Comparison of the two intervention groups showed that self-efficacy was higher in the group of empowerment with telenursing. It was only in the empowerment with telenursing group that the reduction of HbA1 c was significant.Conclusion: Training based on empowerment models and emphasis on the strengths of clients in solving their own problems can play a major role in increasing self-efficacy and reduction of HbA1c level. In addition, a continuous training program, along with telephone follow-ups can result in higher self-efficacy and lower HbA1c level.

L-Citrulline Supplementation Increases Plasma Nitric Oxide Levels and Reduces Arginase Activity in Patients With Type 2 Diabetes.

Type 2 diabetes mellitus (T2DM) is becoming a major contributor to cardiovascular disease. One of the early signs of T2DM associated cardiovascular events is the development of vascular dysfunction. This dysfunction has been implicated in increasing the morbidity and mortality of T2DM patients. One of the important characteristics of vascular dysfunction is the impaired ability of endothelial cells to produce nitric oxide (NO). Additionally, decreases in the availability of NO is also a major contributor of this pathology. NO is produced by the activity of endothelial NO synthase (eNOS) on its substrate, L-arginine. Reduced availability of L-arginine to eNOS has been implicated in vascular dysfunction in diabetes. Arginase, which metabolizes L-arginine to urea and ornithine, competes directly with NOS for L-arginine. Hence, increases in arginase activity can decrease arginine levels, reducing its availability to eNOS and decreasing NO production. Diabetes has been linked to elevated arginase and associated vascular endothelial dysfunction. We aimed to determine levels of plasma NO and arginase activity in (T2DM) patients and the effects of L-citrulline supplementation, a natural arginase inhibitor, on inhibiting arginase activity in these patients. Levels of arginase correlated with HbA1c levels in diabetic patients. Twenty-five patients received L-citrulline supplements (2000 mg/day) for 1 month. Arginase activity decreased by 21% in T2DM patients after taking L-citrulline supplements. Additionally, plasma NO levels increased by 38%. There was a modest improvement on H1Ac levels in these patients, though not statistically significant. The effect of L-citrulline on arginase activity was also studied in bovine aortic endothelial cells (BAECs) grown in high glucose (HG) conditions. HG (25 mM, 72 h) caused a 2-fold increase in arginase activity in BAECs and decreased NO production by 30%. L-citrulline (2.5 mM) completely prevented the increase in arginase activity and restored NO production levels. These data indicate that L-citrulline can have therapeutic benefits in diabetic patients through increasing NO levels and thus maintaining vascular function possibly through an arginase inhibition related pathway.

The effect of ginger on blood sugar and urine protein in patients with type 2 diabetes mellitus; a clinical trial

Introduction: The prevalence of diabetes mellitus has been increasing exponentially and its complications are a major cause of morbidity and mortality. Ginger is one of the herbal remedies which has preventive effects on nephropathy in animal models in some studies. Objectives: We aimed to investigate the effect of ginger on urine protein analysis and blood glucose levels in diabetic patients. Patients and Methods: In a clinical trial, 98 patients with type 2 diabetes were randomly divided into two groups; the intervention group received 500 mg of Zingiber as capsule, daily in addition to routine therapies, since control group received only conventional treatments for diabetes. Before and after intervention, blood glucose, urine microalbumin and hemoglobin A1c (HbA1c) were measured. Results: The findings showed that Zingiber decreased HbA1c levels in diabetic patients (P=0.006), however, it did not have a significant effect on fasting blood glucose (P=0.179), 2 hours post-prandial glucose levels (P= 0.272), and the microalbuminuria quantity in urine (P=0.109). Conclusion: In our study, the hypoglycemic short-term effects of ginger observed as a reduction of HbA1c, however its effect on reducing blood glucose levels [FBS and 2 hours postprandial glucose (2hpp)] was not significant, therefore ginger can be considered as a supplementary agent in the treatment of diabetes. However it is recommended to conduct more studies to obtain results with more reliability. Trial registration: The trial protocol was approved by the Iranian Registry of Clinical Trial (identifier: IRCT2017103025732N27; https://www.irct.ir/trial/21503, ethical code; IR.SEMUMS.REC.1395.207).

Association between iron deficiency anemia and HBA1C level in diabetic patients with controlled plasma glucose levels.

Objectives: To determine association of iron deficiency anemia on hba1c level in diabetic patients. Study Design: Cross Sectional Analytical study. Setting: Department of Pathology PIMS Hospital. Period: From June 2018 to December 2018 (6 months duration). Material &amp; Methods: A total of 117 diagnosed cases of diabetes mellitus were included in the study. Pregnant women, patients with end-stage renal disease, hypothyroidism, +hemoglobinopathies, hemolytic anemia, chronic liver disease and malignancy, participants with poorly controlled diabetes, and patient from the northern areas were excluded from the study. Patients were divided according to their fasting plasma glucose (FPG) level. FPG of 126mg/dl was used as a cut-off point for dividing the study population into two groups, i.e controlled sugar level (FPG between 100 and 126 mg/d L) and well controlled sugar level (FPG less than 100 mg/d L). Variables such as Hemoglobin, serum ferritin, serum Hba1c level etc. Results: Mean age of study population in the present study was 56.97±7.29 years. Out of 117 cases, about 45(38.5%) cases were female and 72 (38.5%) were male. Male to female ratio was 1: 1.6.Mean FPG level was 103.3±7.6 in our study population. The mean hba1c levels in the sample was 6.42±0.70 %. Mean Hb levels were recorded as 11.5±2.7 and 10.9±3.03 g/dl, respectively in female and male. From a total of 117 cases, only 66 were identified as having iron deficiency anemia. Only 54 patients had plasma glucose greater than 100 mg/dl. Odds ratio for hba1c&gt;6.5% in iron deficient was 3.90(p=0.001). Conclusion: Iron deficiency can cause elevated serum hba1c level. Health care providers, including physicians, must consider the iron status before prescribing diabetics treatment on the basis of serum hba1c level.