HbA1c Screening Research Articles

Diabetes Screening and Monitoring Among Older Mexican-Origin Populations in the U.S.

The purpose of the study is to examine diabetes screening and monitoring among Latino individuals as compared with non-Latino White individuals and to better understand how we can use neighborhood data to address diabetes care inequities. This is a retrospective observational study linked with neighborhood-level Latino subgroup data obtained from the American Community Survey. We used generalized estimating equation negative binomial and logistic regression models adjusted for patient-level covariates to compare annual rates of glycated hemoglobin (HbA1c) monitoring for those with diabetes and odds of HbA1c screening for those without diabetes by ethnicity and among Latinos living in neighborhoods with low (0.0-22.0%), medium (22.0-55.7%), and high (55.7-98.0%) population percent of Mexican origin. Latino individuals with diabetes had 18% higher rates of HbA1c testing than non-Latino White individuals with diabetes (adjusted rate ratio [aRR] 1.18 [95% CI 1.07-1.29]), and Latinos without diabetes had 25% higher odds of screening (adjusted odds ratio 1.25 [95% CI 1.15-1.36]) than non-Latino White individuals without diabetes. In the analyses in which neighborhood-level percent Mexican population was the main independent variable, all Latinos without diabetes had higher odds of HbA1c screening compared with non-Latino White individuals, yet only those living in low percent Mexican-origin neighborhoods had increased monitoring rates (aRR 1.31 [95% CI 1.15-1.49]). These findings reveal novel variation in health care utilization according to Latino subgroup neighborhood characteristics and could inform the delivery of diabetes care for a growing and increasingly diverse Latino patient population. Clinicians and researchers whose work focuses on diabetes care should take steps to improve equity in diabetes and prevent inequity in treatment.

IDF21-0179 Efficacy and Safety of Gla-100 vs premix insulin after SIT in Chinese T2D: BEYOND V sub-analysis by Screening HbA1c

Background: The randomized, open-label, parallel-group BEYOND V (NCT03359837) study demonstrated that compared with insulin aspart 70/30 (Asp 30), insulin glargine 100 U/ml (Gla-100) demonstrated similar glycemic control at a lower hypoglycemia risk in Chinese type 2 Diabetes (T2D) individuals who had undergone short-term intensive insulin treatment (SIT).

HbA1c and Infection in Diabetic Elective Hand Surgery: A Veterans Affair Medical Center Experience 2012-2018.

Hemoglobin A1c (HbA1c) is an indicator of glucose control over a 3-month period. The plastic surgery service began screening HbA1c levels prior to surgery when a trend in infectious complications was noted in diabetics. We made a cutoff value of < 8% for elective hand surgery. The institutional review board approved a 7-year retrospective chart review (#201900402) 2012 through 2018 of our elective diabetic hand surgery cases. Data collected included: surgery, HbA1c levels within 3 months before surgery, glucose finger sticks day of surgery, and infectious complications up to 30 days after surgery. A Fisher exact test using a P value of < .05 and a logistic regression analysis using a P value of < .05 were used to determine statistical significance between infectious complications and screening. In all, 848 cases were recorded in the data base. Infection complication rates before and after screening were not statistically significant (P = .44). All major complications (3) requiring a return to the operating room involved surgery within the flexor sheath before screening was enforced. This was not statistically significant (P = .25). The relative risk of an infectious complication involving the flexor sheath in unscreened patients was 3.66. A logistic regression analysis found no correlation with infectious complications based on the 3 variables of screening time (P = .99), preoperative finger stick values (P = .12), or HbA1c levels (P = .29). The data did not support our guidelines for enforcing HbA1c cutoff levels prior to elective hand surgery. Consider enforcing levels < 8% when the flexor sheath may be violated.

Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: a multicentre 6-month randomised controlled trial

Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population. In a multicentre, multinational, parallel randomised controlled trial, participants aged 6-18 years using insulin pump therapy were recruited at seven UK and five US paediatric diabetes centres. Key inclusion criteria were diagnosis of type 1 diabetes for at least 12 months, insulin pump therapy for at least 3 months, and screening HbA1c levels between 53 and 86 mmol/mol (7·0-10·0%). Using block randomisation and central randomisation software, we randomly assigned participants to either closed-loop insulin delivery (closed-loop group) or to usual care with insulin pump therapy (control group) for 6 months. Randomisation was stratified at each centre by local baseline HbA1c. The Cambridge closed-loop algorithm running on a smartphone was used with either (1) a modified Medtronic 640G pump, Medtronic Guardian 3 sensor, and Medtronic prototype phone enclosure (FlorenceM configuration), or (2) a Sooil Dana RS pump and Dexcom G6 sensor (CamAPS FX configuration). The primary endpoint was change in HbA1c at 6 months combining data from both configurations. The primary analysis was done in all randomised patients (intention to treat). Trial registration ClinicalTrials.gov, NCT02925299. Of 147 people initially screened, 133 participants (mean age 13·0 years [SD 2·8]; 57% female, 43% male) were randomly assigned to either the closed-loop group (n=65) or the control group (n=68). Mean baseline HbA1c was 8·2% (SD 0·7) in the closed-loop group and 8·3% (0·7) in the control group. At 6 months, HbA1c was lower in the closed-loop group than in the control group (between-group difference -3·5 mmol/mol (95% CI -6·5 to -0·5 [-0·32 percentage points, -0·59 to -0·04]; p=0·023). Closed-loop usage was low with FlorenceM due to failing phone enclosures (median 40% [IQR 26-53]), but consistently high with CamAPS FX (93% [88-96]), impacting efficacy. A total of 155 adverse events occurred after randomisation (67 in the closed-loop group, 88 in the control group), including seven severe hypoglycaemia events (four in the closed-loop group, three in the control group), two diabetic ketoacidosis events (both in the closed-loop group), and two non-treatment-related serious adverse events. There were 23 reportable hyperglycaemia events (11 in the closed-loop group, 12 in the control group), which did not meet criteria for diabetic ketoacidosis. The Cambridge hybrid closed-loop algorithm had an acceptable safety profile, and improved glycaemic control in children and adolescents with type 1 diabetes. To ensure optimal efficacy of the closed-loop system, usage needs to be consistently high, as demonstrated with CamAPS FX. National Institute of Diabetes and Digestive and Kidney Diseases.

Early screening biomarker HbA1c and Hematocrit for gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a metabolic disturbance in pregnancy, traditionally defined as glucose intolerance with onset or first recognition during pregnancy with the outcome of perinatal and offspring complications. The common diagnostic criteria of oral glucose tolerance test in the second or third trimester of pregnant women help to detect the later complications of GDM. Early detection is lacking and highly essential to prevent GDM. We aim to assess the role of glycated hemoglobin and hematocrit for the early screening of GDM.We recruited 403 study participants, collected demographic profiles and medical histories. The levels of glucose, hemoglobin (Hb), glycated hemoglobin (HbA1c), hematocrit (PCV), and thyroid-stimulating hormone (TSH) were measured in the serum samples of study participants. The ROC curve was plotted, cut-off, an area under the curve, specificity, and sensitivity of glycated hemoglobin and hematocrit was calculated using statistical software.In our study, we observed there is a significant difference in the levels of Hb, PCV, and HbA1c between non-GDM and GDM patients. We found the prevalence of GDM 20.88% in our study population. An HbA1c cut of at 5.25% and PCV 34.5%, the sensitivity and specificity of HbA1c as 64.4% and 36.1%, the sensitivity and specificity of PCV as 58.6% and 43.1% respectively. The combined HbA1c & PCV screening results had shown the sensitivity of 36.8% and specificity of 85.4% using the ROC curve.In conclusion, the cut-off values, specificity, and sensitivity of HbA1c and Haematocrit and its combined calculation in the first trimester of pregnant women will be more specific and sensitive early screening tools for GDM.

Chairside Diabetes Screening: A Survey of Dental Providers at the Largest Municipal Healthcare System in the United States.

To assess the knowledge and attitudes of dentists at the largest municipal healthcare system in the United States with regard to point-of-care chairside diabetes testing in the dental clinic. A 29-item survey was designed in a web-based platform (Survey Monkey) and distributed in November 2020 to 264 dental providers (attending dentists and residents) within eleven dental departments of the New York City Health + Hospitals municipal healthcare system. The questionnaire included sections on demographics, current practices, level of diabetes training, scope of practice, and attitudes regarding chairside diabetes testing. Descriptive statistics, bivariate analyses, and logistic regression analyses were performed, with statistical significance set at 0.05. Dentists' willingness to provide chairside HbA1c screening was positively associated with their agreement that this was part of their role (OR = 7.2, p = 0.001) and that screening has an impact on diabetes control (OR = 4.3, p = 0.04). The two most commonly reported barriers to willingness to provide chairside HbA1c screening were amount of time required to obtain and discuss a patient's test results (82.3%) and lack of reimbursement (70.6%). Among the largest municipal healthcare systems in the US, there is very limited integration of diabetes screening and management in the dental setting. Given the epidemic of diabetes among the vulnerable population that these hospitals serve, the dental setting is a critical but underutilized site for diabetes screening and medical referral. Increased efforts should be directed towards implementing workflows that incorporate auxiliary dental staff in order to address barriers to chairside screening.

Pitfalls of Single Measurement Screening for Diabetes and Hypertension in Community-Based Settings.

Background:Cross-sectional screening programs are used to detect and refer individuals with non-communicable diseases to healthcare services. We evaluated the positive predictive value of cross-sectional measurements for Diabetes Mellitus (DM) and hypertension (HTN) as part of a community-based disease screening study, ‘Vukuzazi’ in rural South Africa.Methods:We conducted community-based screening for HTN and DM using the World Health Organization STEPS protocol and glycated haemoglobin A1c (HbA1c) testing, respectively. Nurses conducted follow-up home visits for confirmatory diagnostic testing among individuals with a screening BP above 140/90 mmHg and/or HbA1c above 6.5% at the initial screen, and without a prior diagnosis. We assessed the positive predictive value of the initial screening, compared to the follow up measure. We also sought to identify a screening threshold for HTN and DM with greater than 90% positive predictive value.Results:Of 18,027 participants enrolled, 10.2% (1,831) had a screening BP over 140/90 mmHg. Of those without a prior diagnosis, 871 (47.6%) received follow-up measurements. Only 51.2% (451) of those with completed follow-up measurements had a repeat BP>140/90 mmHg at the home visit and were referred to care. To achieve a 90% correct referral rate, a systolic BP threshold of 192 was needed at first screening. For DM screening, 1,615 (9.0%) individuals had an HbA1c > 6.5%, and of those without a prior diagnosis, 1,151 (71.2%) received a follow-up blood glucose. Of these, only 34.1% (395) met criteria for referral for DM. To ensure a 90% positive predictive value i.e. a screening HbA1c of >16.6% was needed.Conclusions:A second home-based screening visit to confirm a diagnosis of DM and HTN reduced health system referrals by 48% and 66%, respectively. Two-day screening programmes for DM and HTN screening might save individual and healthcare resources and should be evaluated carefully in future cost effectiveness evaluations.

The Role of HbA1c as a Positive Perioperative Predictor of Surgical Site and Other Postoperative Infections: An Explorative Analysis in Patients Undergoing Minor to Major Surgery

BackgroundPatients with diabetes mellitus type 2 (DM2) inhere impaired peripheral insulin action leading to higher perioperative morbidity and mortality rates, with hospital-acquired infections being one important complication. This post hoc, observational study aimed to analyze the impact of surgical and metabolic stress as defined by the surrogate marker hemoglobin A1c (HbA1c), in relation to self-reported DM2, on perioperative infection rates in a subcohort of the Surgical Site Infection (SSI) Trial population.MethodsAll patients of the SSI study were screened for HbA1c levels measured perioperatively for elective or emergency surgery and classified according to the American Diabetes Association HbA1c cutoff values. SSI and nosocomial infections, self-reported state of DM2 and type of surgery (minor, major) were assessed.ResultsHbA1c levels were measured in 139 of 5175 patients (2.7%) of the complete SSI study group. Seventy patients (50.4%) self-reported DM2, while 69 (49.6%) self-reported to be non-diabetic. HbA1c levels indicating pre-diabetes were found in 48 patients (34.5%) and diabetic state in 64 patients (46%). Forty-five patients of the group self-reporting no diabetes (65.2%) were previously unaware of their metabolic derangement (35 pre-diabetic and 10 diabetic). Eighteen infections were detected. Most infections (17 of 18 events) were found in patients with HbA1c levels indicating pre-/diabetic state. The odds for an infection was 3.9-fold (95% CI 1.4 to 11.3) higher for patients undergoing major compared to minor interventions. The highest percentage of infections (38.5%) was found in the group of patients with an undiagnosed pre-/diabetic state undergoing major surgery.ConclusionsThese results encourage investment in further studies evaluating a more generous and specific use of HbA1c screening in patients without self-reported diabetes undergoing major surgery.Trial registration Clinicaltrials.gov identifier: NCT 01790529

Analysis of the relationship between the HbA1c screening results and the development and worsening of diabetes among adults aged over 40\u2009years: a 4-year follow-up study of 140,000 people in Japan \u2013 the Shizuoka study

BackgroundHemoglobin A1c (HbA1c) levels are routinely measured during health check-ups and are used as an indicator of glycemic control in Japan. However, only a few studies have followed up individuals to assess the risk of diabetes development and worsening based on HbA1c screening results. This study evaluated the relationship between HbA1c screening results and the risk of diabetes development and worsening.MethodsData were collected from the Shizuoka Kokuho Database, a Japanese administrative claims database of insured individuals aged > 40 years. We included individuals available for follow-up from April 2012 to March 2018 who had not received any diabetes treatment before March 2014. HbA1c screening results were categorized into 4 groups based on the HbA1c levels at the 2012 and 2013 health check-ups: group A, those whose HbA1c levels were < 6.5% in 2012 and 2013; group B, those whose HbA1c levels > 6.5% in 2012 but < 6.5% in 2013; group C, those whose HbA1c levels were > 6.5% in 2012 and 2013; and group D, those whose HbA1c levels were < 6.5% in 2012 and > 6.5% in 2013. Logistic regression models were used to analyze diabetes development and worsening, defined as the initiation of diabetes treatment by March 2018 and the use of injection drugs by participants who initiated diabetes treatment by March 2018.ResultsOverall, 137,852 individuals were analyzed. After adjusting for covariates, compared with group A, group B was more likely to initiate treatment within 4 years (odds ratio: 22.64; 95% confidence interval: 14.66–34.99). In patients who initiated diabetes treatment by March 2018, injection drugs were less likely used by group D than by group A (odds ratio: 0.28; 95% confidence interval: 0.12–0.61).ConclusionsOur study suggests that although HbA1c levels measured during health check-ups were correlated with the risk of diabetes development and worsening, HbA1c levels in a single year may not necessarily provide sufficient information to consider these future risks.

Annual trends in diabetes screening and management in Australia: A secondary analysis of Medicare Benefits Schedule data.

The increasing incidence of type 2 diabetes (T2D) is a major Australian andworldwide health concern. The aim of this study was to examine trends in T2D pathology testing by Australian doctors, with a focus on screening and early identification. A secondary analysis was conducted of publicly available data for eight pathology tests, accessed from the nationally funded Medicare Benefits Schedule (MBS). Descriptive statistics were used to analyse the annual trends, according to age and sex, for the calendar years 2010-19. Over the 10 years, screening rates for T2D had doubled while glycated haemoglobin (HbA1c) tests for management remained constant. At the end of 2014, the MBS introduced HbA1c screening tests. By 2019, the HbA1c screening rates were three times higher than glucose tolerance tests, which had halved. A strong adoption of the national screening guidelines introduced in 2015-16 was identified. Limitations in MBS data categorisation, such as no item number specific to fasting glucose or insulin, prevented detailed analysis of other potentially relevant tests that might be used to screen for prediabetes and diabetes.

HbA1c Screening for Diabetes in Patients with Acute Coronary Syndrome: A Worthwhile Test or a Pitfall?

Background: Diagnostic concordance between HbA1c and other glucose-based tests is imperfect, and data on this problem in acute coronary syndrome (ACS) are still lacking. The aim of this study was to identify undiagnosed glucose abnormalities in ACS patients, and to compare the effectiveness and consistency of the diagnostic screening based on HbA1c to the oral glucose tolerance test (OGTT). Methods: The study group consisted of 121 ACS patients, mean age 62.3 ± 11.6 years, without known glucose abnormalities. HbA1c, admission and fasting plasma glucose in the first days of hospitalization were assessed and referred to the results of OGTT performed two weeks after discharge. Results: OGTT identified normoglycemia in 45%, pre-diabetes in 39.4%, and diabetes in 15.6%, while HbA1c revealed these categories in 39.7%, 51.2%, and 9.1%, respectively. With an HbA1c cut-off ≥6.5% (48 mmol/mol) diagnostic for diabetes, the sensitivity of the method was 41%, while specificity was 98%, compared to the OGTT. The optimal HbA1c cut-off value at the crossing of sensitivity and specificity curves was 5.9%. The HbA1c value recommended for the diagnosis of pre-diabetes and optimal cut-off point were the same (5.7%). Conclusions: Using HbA1c without OGTT in an early but stable phase of ACS may result in a significant underdiagnosis of diabetes.

First trimester glycosylated hemoglobin for gestational diabetes mellitus screening

ObjectiveOur aim in this study is to evaluate the efficacy of HbA1c in screening for GDM during the first trimester of pregnancy. Materials and methodsIn this retrospective cohort study, we evaluated the first trimester HbA1c (ft-HbA1c) levels of 195 pregnant women who attended our university hospital's obstetrics clinic. Blood samples were drawn from patients during 11–14 weeks of gestation. After that, all patients were screened using standardized one-step 75gr OGTT between 24 and 28 weeks of pregnancy. ResultsIn this study, 195 pregnant women were included. Thirty-two (16.4%) of the women included in this study were diagnosed with GDM. The mean ft-HbA1c level was 5.52% in those who developed GDM and 5.21% in those who did not develop GDM (p = 0.000). Only seven (3.6%) of the women included in this study had an ft-HbA1c level above the prediabetes limit of 5.7%. All these women with prediabetes developed GDM. The cut-off value for ft-HbA1c to distinguish GDM was 5,33%. For this cut-off value, the sensitivity was 71.9%, and the specificity was 82.8%. ConclusionThe findings suggest that ft-HbA1c level is a promising biomarker for GDM screening. Especially, patients with ft-HbA1c level ≥5.33% are at increased risk for developing GDM.

Mind and body: physical health monitoring in clozapine treatment

AimsTo evaluate physical health monitoring standards in patients on Clozapine in the community.StandardsNICE and BNF guidelines for patients on established clozapine treatment advise annual monitoring of weight, waist circumference, pulse, blood pressure, fasting blood glucose, HbA1c, blood lipids and overall physical health assessment. Full blood count is monitored 1-4 weekly.BackgroundIn the management of schizophrenia, antipsychotic medication remains the cornerstone of treatment. Patients affected carry a significant physical health burden with a reduced life expectancy of 10-25 years. Factors that contribute include sedentary lifestyles, consequent obesity and cardiovascular disease, disengagement from health services, a higher incidence of suicide and the physical side effects of antipsychotic medication. For these reasons, comprehensive routine physical assessment of patients on antipsychotic treatment is of central importance.MethodThis audit is a retrospective study of patients known to South Kensington &amp; Chelsea Community Mental Health Team (CMHT). Patients (n = 48) were audited from the Clozapine clinic SystemOne database over a one year period (October 2018-2019) to assess annual monitoring of full blood count (FBC), urea and electrolytes (U&amp;Es), lipid profile, liver function tests (LFTs), HbA1C, thyroid function tests (TFTs), clozapine levels, ECG, and general physical and mental health review.ResultOf the 48 patients, one was transferred to a different service so was excluded (n = 47 total).All (100.0%) of the patients had annual FBC tests. All but one (97.9%) of the patients had a physical health review including blood pressure, pulse, weight and BMI measurement. Three quarters (74.5%) received annual U&amp;Es and LFTs. Almost two thirds of patients had annual lipid and HBA1c screening (63.8%) and over half the cohort had annual TFTs (61.7%). Regarding annual multidisciplinary mental health review, this was performed for the majority of the patients (70.2%).Contrastingly, only a quarter of the patients received annual screening of glucose and Clozapine levels (27.7% for both). Only 12 patients had annual ECG (25.5%).ConclusionFollowing review it is clear that most parameters were monitored annually in a majority of patients. However, shortcomings were detected, specifically annual ECG and waist circumference monitoring.In order to ensure comprehensive monitoring of mental and physical health of patients on Clozapine, flow charts of tests and reviews needed for each patient were written up clearly and will be included in the management pathway for every patient on Clozapine. This was agreed to minimise missing any step, particularly annual ECGs.

Universal HbA1c screening and gestational diabetes: a comparison with clinical risk factors

Background Screening strategies for gestational diabetes mellitus (GDM), particularly early GDM, have traditionally relied upon the use of clinical risk factors (CRFs). Although commonly used in nonpregnant patients, HbA1c screening is not widely used despite reports of abnormal HbA1c values being predictive of GDM development. The aims of this study are to assess the utility of universal HbA1c screening in predicting GDM and to compare universal screening to targeted CRF-based screening for the diagnosis of GDM. Study design This is a retrospective cohort study of patients undergoing universal HbA1c screening at ≤16 completed weeks gestation with a singleton pregnancy between December 2016 and April 2018 at a single urban tertiary care center. Patients with preexisting diabetes (HbA1c ≥6.5%) or patients who did not have glucose tolerance testing were excluded. Patients with HbA1c 5.7–6.4% underwent early two-step GDM screening. Positive screens were diagnosed with early GDM. Normal early screeners underwent repeat 3rd trimester screening. Clinical risk factors for early GDM screening at our institution prior to universal screening were history of GDM, body mass index (BMI) ≥40 kg/m2, prior macrosomia (birth weight ≥4000 g) or stillbirth, and polycystic ovary syndrome. Multivariable regression was performed to assess the relationship between HbA1c and GDM. The predictive ability of universal HbA1c screening compared to that of CRFs was evaluated by testing for differences in the area under the curve (AUC) of receiver operating curves (ROCs). Results One thousand nine hundred and fifteen patients met inclusion criteria. Two hundred and thirty-one (12.1%) patients had an elevated HbA1c ≥5.7%. Patients with elevated HbA1c were more likely to be older, Black, or obese compared with patients with normal HbA1c values. After adjusting for Black race, BMI, age, and public insurance, the odds of GDM development are 3.50 (95%CI 2.26–5.39) times higher among patients with HbA1c ≥5.7% compared to those with a normal HbA1c. Clinical risk factors for early glucose screening were present in 33% of patients with an elevated HbA1c. The AUC of CRF screening and HbA1c ≥5.7% was 0.72 and 0.75, respectively (p= .07), after controlling for Black race, BMI, maternal age, and insurance. Conclusions An elevated HbA1c is associated with an increased risk of GDM. Universal HbA1c screening performs as favorably as CRF based screening for the prediction of GDM.

Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics.

Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments.Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored.Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures.Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients.

Abstract 061: Comparison Of Diagnostic Methods For Diabetes Diagnosis In Patients With Heart Failure: A National Health And Nutrition Examination Survey Analysis

Introduction: The use of hemoglobin A1c (HbA1c) to screen for diabetes in patients with cardiovascular disease has shown low sensitivity, and the currently recommended cutoff point may leave many patients undiagnosed. The objective of the study was to examine the degree of agreement among current diagnostic methods for diabetes, including HbA1c, fasting plasma glucose (FPG), and two-hour plasma glucose (2hPG) after oral glucose tolerance test (OGTT) among community-dwelling heart failure (HF) patients. Methods: We included 237 HF participants (20+ years) without history of diabetes or diabetes medication use, using data from the 2005-2016 National Health and Nutrition Examination Survey cycles. Diagnostic criteria for diabetes were based on the American Diabetes Association (ADA) guidelines: (1) HbA1c ≥ 6.5%, (2) FPG ≥ 126 mg/dL, and (3) 2hPG after OGTT ≥ 200 mg/dL. The sensitivity, specificity, and Receiver Operating Characteristic (ROC) curve for HbA1c and FPG were examined against the OGTT (FPG ≥ 126 mg/dL and/or 2hPG ≥ 200 mg/dL) as the reference method. Results: Included participants had a mean age of 65±1 (SE) years, 45.5% were female, and 12.5% were non-Hispanic black. Among included participants, 50 patients were newly diagnosed with diabetes based on ADA guidelines. Hemoglobin A1c alone identified only 27.0% of patients, whereas the OGTT identified 90.1% of patients. The area under the ROC curve, assessing HbA1c performance for the diagnosis of diabetes defined by OGTT, was 0.76 (95% CI, 0.67-0.84). Sensitivity and specificity using the HbA1c cutoff at ≥ 6.5% were 19.1% and 97.5%, respectively. The Youden’s J statistic for HbA1c was maximized at 5.8-5.9% (69.9-64.3% sensitivity and 63.9-70.1% specificity). Conclusion: Our data show that identification of diabetes among HF patients was inadequate on the basis of HbA1c screening alone. Our findings suggest diabetes screening on the basis of the OGTT or an HbA1c cutoff point of 5.8-5.9%.

Switching to iGlarLixi versus continuation of a daily or weekly glucagon-like peptide-1 receptor agonist (GLP-1 RA) in insufficiently controlled type 2 diabetes: A LixiLan-G trial subgroup analysis by HbA1c and GLP-1 RA use at screening.

AimIn people with type 2 diabetes (T2D) requiring intensification beyond glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) and oral antihyperglycaemic drugs (OADs), switching to iGlarLixi was shown to be efficacious and well‐tolerated in the LixiLan‐G trial. This exploratory analysis of LixiLan‐G assessed the efficacy and safety of switching to iGlarLixi versus continuing GLP‐1 RA therapy, stratified by screening HbA1c level (≥7.0 to ≤7.5 %; >7.5 to ≤8.0 %; >8.0 to ≤9.0 % [≥53 to ≤58 mmol/mol; >58 to ≤64 mmol/mol; >64 to ≤75 mmol/mol]) and previous GLP‐1 RA regimen at screening (once/twice daily or once weekly).Materials and MethodsEndpoints for all subgroups included: change in HbA1c, achievement of HbA1c <7 % and hypoglycaemia events. Adverse events and changes in fasting plasma glucose (FPG), 2‐hour postprandial plasma glucose (PPG), 2‐hour PPG excursion and weight were analysed according to previous GLP‐1 RA regimen.ResultsSwitching to iGlarLixi in all subgroups resulted in significantly greater reductions in HbA1c and proportions of participants reaching HbA1c <7 % (including with no documented hypoglycaemia) at Week 26 compared with continued GLP‐1 RA treatment. Switching to iGlarLixi also led to significantly greater reductions in FPG, 2‐hour PPG, and 2‐hour PPG excursion, irrespective of previous GLP‐1 RA regimen. Rates of hypoglycaemia were low, but slightly higher in those who switched to iGlarLixi for all subgroups. Modest weight gain was seen with iGlarLixi, irrespective of previous GLP‐1 RA regimen.ConclusionsSwitching to iGlarLixi improved glycaemic control, regardless of screening HbA1c or previous GLP‐1 RA type, offering a simple, efficacious and well‐tolerated treatment intensification option for people with T2D inadequately controlled by GLP‐1 RAs and OADs.

165 Elevated hemoglobin A1c and postpartum weight retention

To determine the association of an elevated Hemoglobin A1c (HbA1c) at start of pregnancy and postpartum (PP) weight retention in the absence of a diagnosis of diabetes. This is a retrospective cohort study of women undergoing universal HbA1c screening with initial prenatal labs (≤16 weeks) over a 2-year period (2016-2018) at a single tertiary care center. All women who delivered ≥32 weeks with documented weights at first prenatal visit, delivery, and PP visit were included. Women with preexisting or gestational diabetes, multiple gestation, or no glucose tolerance screening were excluded. Body mass index (BMI) was calculated and gestational weight gain assessed by IOM guidelines. The primary outcome was PP weight retention among women with normal versus elevated HbA1c. 889 women met inclusion criteria, of whom 753 (84.7%) had normal HbA1c and 136 (15.2%) had elevated HgbA1c. Overall, 19 (2.1%) were underweight, 406 (45.7%) normal weight, 207 (23.3%) overweight, and 257 (28.9%) obese at start of pregnancy. Compared to women with normal HbA1c, women with elevated HbA1c were more likely Black, multiparous, obese, and publicly insured (Table 1). Women with an elevated HbA1c gained less weight during pregnancy. Both groups had excessive weight gain. Women with an elevated HbA1c had significantly less PP weight retention (4.5kg vs. 3.1kg, p=0.003). More women in the elevated HbA1c group returned to their pre-pregnancy weight or less by the PP visit (Table 2). When comparing the groups by IOM guidelines, there were no differences in PP weight retention among women who met or exceeded the recommended weight. After adjusting for race, parity, insurance status and pre-pregnancy BMI, the association between elevated HbA1c and PP weight retention was no longer significant (aOR=-1.74 95% CI=-2.9, -0.4). In nondiabetic women, elevated HbA1c in early pregnancy is not associated with PP weight retention, after controlling for confounders. Further efforts to educate these women regarding weight gain during pregnancy and PP weight loss is warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

THE ASSOCIATION OF PERIODONTAL DISEASES WITH TYPE 2 DIABETES MELLITUS AND DIABETES LINKED DYSLIPIDEMIA IN PAKISTANI POPULATION

Objective: To determine the development of dyslipidemia in type 2 diabetics with and without periodontaldiseases.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Fauji Foundation Hospital and Pak Emirates Military Hospital, Rawalpindi,Pakistan, from Jan 2018 to Jan 2019.&#x0D; Methodology: Total number of participated subjects (males and females) was 75, with age ranging from 23 to 72 years. Their tests included blood sugar, lipid profile, HbA1c and hepatitis screening. Oral health parameters were divided into two categories; type 2 diabetes mellitus with and without periodontitis.&#x0D; Results: Out of 75 patients, males and females were 19 (25.3%) and 56 (74.7%). Females with periodontitis 20(74.1%) and without periodontitis 36 (75%) possessed larger numbers. Mean ages [56.33 ± 10.88 years] hada higher incline, along with significantly altered total cholesterol [5.41 ± 1.70 mmol/l], triglycerides [2.55 ± 1.46mmol/l], low and high density lipoproteins [3.01 ± 1.22 mmol/l, 0.97 ± 0.48 mmol/l] in type 2 diabetes mellituswith periodontitis. Patients of diabetes without periodontitis showed mild derangements for triglycerides [1.88 ± 1.22 mmol/l]. Patients of diabetes with dyslipidemia and periodontitis 16 (59.3%) were documented highest innumber, compared to other type 2 diabetes mellitus groups.&#x0D; Conclusion: There was an overall significant association between type 2 diabetes mellitus related dyslipidemiaand periodontitis. Also, significant difference in age and gender of study subjects was noted that affected middle aged females more often than middle to late aged males.

Sugar Sickness in Aboriginal & Torres Strait Islander Cardiology Patients—Hitting the Sweet Spot

We aimed to evaluate improvement in diabetes screening, medication use, and GP clinical handover in Indigenous Australian cardiology patients at Princess Alexandra Hospital. Following the initial audit, the multifaceted interventions in 2018 were increased pathology testing of HbA1c from 6 to 7 days a week, targeted staff education, systematic HbA1c screening for patients under the care of Better Cardiac Care (BCC), Coronary Care Unit, and Cardiac Rehabilitation Team.