HbA1c Values Research Articles

The effect of HbA1c variability on the efficacy of intensive blood pressure control in patients with type 2 diabetes.

The efficacy of intensive blood pressure (BP) control remains controversial, and the variability of HbA1c was a risk factor for macrovascular events in patients with type 2 diabetes. We investigated whether the HbA1c variability modifies the efficacy of intensive BP control. Data from the Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD-BP) trial was utilized. K-means clustering was used to cluster patients into three groups based on the HbA1c variability score and baseline HbA1c values. Cox proportional hazard models and generalized linear models were used to measure the subgroup differences in intensive BP control treatment effects. The primary outcome was a composite of nonfatal myocardial infarction (MI), stroke, or death from cardiovascular causes. In patients with low HbA1c variability rather than medium or high HbA1c variability, intensive BP control reduced the risk of the primary outcome on a relative scale (HR 0.60, 95%CI 0.40-0.90, p interaction was 0.03), non-fatal MI (HR 0.61, 95% CI 0.37-1.00, p interaction was 0.04) and stroke (HR 0.19, 95%CI 0.05-0.64, p interaction was 0.02) or absolute scale. Regardless of the variability group, intensive BP control did not reduce the risk of cardiovascular or all-cause mortality (p interaction >0.05) both on relative and absolute risk scales. HbA1c variability had effect on the efficacy of intensive BP control and intensive BP control brought a significant macrovascular benefit in patients with type 2 diabetes and low HbA1c variability.

Safety and Effectiveness of Glargine 300 U/ml After Switching from Basal Insulins in Patients with Type1 Diabetes: COMET-T Study.

Appropriate glycemic control is paramount for people with type 1 diabetes (PwT1D) by the effective delivery of exogenous insulin. However, glycemic variability and the risk of severe hypoglycemia must be reliably controlled. COMET-T is a prospective, multicenter, observational study conducted in Germany, Austria, and Switzerland during 2021-2022 to assess the effectiveness and safety of insulin glargine 300 U/ml (Gla-300) after switching from other basal insulins. Out of 135 PwT1D, data of 94 patients were analyzed. The primary endpoint was the change in time in range (TIR) approximately 12 and 24 weeks after switching to Gla-300. Secondary endpoints were: change in HbA1c, fasting plasma glucose (FPG), coefficient of variation (CV%) of plasma glucose, body weight (BW) and insulin dose. Patients had mean age of 48.6 ± 16.5 years, included 39.4% males and had 18.2 ± 15.5 years T1D duration. From baseline (54.3%), TIR changed at week 12 (mean change 0.3% [± 14.3]; p = 0.8383) and at week 24 (+ 4.5% [± 14.9], p = 0.078). At week 24, TIR significantly increased in patients with body mass index > 30kg/m2 (8.4% [± 12.8] p = 0.0057) and patients who previously received insulin detemir (10.5%; [± 12.93]; p = 0.0005). At week 24, there was a significant reduction in the HbA1c value (8.1 ± 0.6% vs. 7.7 ± 0.9%; p < 0.001), a reduction in the CV% of plasma glucose (36.1 ± 12.4% vs. 32.8 ± 9.6%, p = 0.056), and increase in bolus insulin dose (26.5 ± 16.3 vs. 27.9 ± 16.6 U/day; p = 0.042). FPG, BW, and basal insulin doses were not significantly changed. Although switching to Gla-300 in poorly controlled PwT1D did not significantly reduce TIR, it significantly decreased HbA1c values and glycemic variability without changes in BW and basal insulin dose.

The Associations of Dental and Periodontal Lesions with the Microvascular Complications in Patients with Type 2 Diabetes Mellitus: A Case–Control Study

Background: Diabetes mellitus is closely related to periodontal disease and dental lesions, disorders which through dental infection and metabolic imbalance become negatively potentiated and cause a vicious circle that is almost impossible to break. The aim of this research was to study if the severity of dental and periodontal lesions is related to the presence of microvascular complications and glycemic control in patients with type 2 diabetes mellitus (T2DM). Methods: In total, 112 subjects with T2DM that underwent a dental evaluation were enrolled in this case–control study. The study group included 56 patients with complicated lesions, whereas the control group included 56 patients whose gender and age matched the study group and that presented superficial lesions. The statistical analysis was carried out using SPSS 26.0, with the result being considered statistically significant if the p values were &lt;0.05. Results: Statistically significant differences were recorded between the two groups regarding the value of blood glucose, HbA1c and fibrinogen, as well as kidney function. Statistically significant differences were also recorded between the two groups when analyzing the presence of microvascular complications, as well as individually analyzed, in the case of diabetic peripheral sensory-motor neuropathy (p &lt; 0.001), but also of diabetic retinopathy (p &lt; 0.05). This study developed a score with a predictive value for the presence of complicated dental and periodontal lesions, including blood glucose, fibrinogen, diabetic retinopathy, and diabetic peripheral neuropathy (AUROC 0.847, p &lt; 0.001). Conclusions: There is a high frequency of dental and periodontal complications in patients with T2DM. Patients with microvascular complications, elevated fasting blood glucose, and chronic inflammation, as evidenced by elevated fibrinogen, are more likely to develop complicated dental and periodontal lesions.

Metformin effectively alleviates the symptoms of Alzheimer in rats by lowering amyloid β deposition and enhancing the insulin signal

Alzheimer’s disease (AD) exhibits distinct biochemical and histopathological attributes, encompassing cellular, neuronal, and oxidative impairment. There is also an abnormal buildup, misfolding and clumping of amyloid β (Aβ). The present study aimed to explore the influence of the antihyperglycemic agent metformin on rats with AD-like symptoms, while also elucidating the intricate relationship between insulin resistance and AD. The rats were categorized into five groups: a control group, a saline-administered group, a metformin-treated group, AD-model rats, and AD-rats treated with a 200 mg/kg dose of metformin. Cognitive impairment was rated using the classical labyrinth test. Moreover, serum biochemical parameters, encompassing glucose levels, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Glycated hemoglobin (HbA1c), lipid profile, kidney, and liver function, were evaluated. Additionally, oxidative, antioxidant, and neurotransmitter parameters were measured in hippocampus tissues. Also, the Aβ and insulin receptor substrate 2 (IRS-2) were measured by immunoblotting. Besides hippocampal histopathology, glial fibrillary acidic protein (GFAP) and calretinin immunoreactivity were monitored. The study findings disclosed deficits in memory and learning capabilities among AD rats. Furthermore, AD-afflicted rats exhibited heightened glucose levels, elevated HOMA-IR and HbA1c values, alongside compromised liver, and kidney functions. Additionally, an upsurge in oxidative stress coincided with a notable reduction in the antioxidant system and neurotransmitters activities. The levels of Aβ deposition increased, while IRS-2 expression subsided, accompanied by alterations in the hippocampal structure and neuronal damage. These changes were paralleled by an intensification in GFAP reactivity and a detracting in calretinin reactivity. Metformin was altogether able to move forward cognitive execution by means of bringing down oxidative stress and Aβ conglomeration. Furthermore, metformin was able to improve neurotransmitters and insulin signals. AD, glucose impairment, and brain insulin resistance are completely interlinked, and future AD medications may be inspired by diabetic medication.

Determining how the gestational changes, including low hemoglobin influence the hba1c and estimated average glucose relationship

ABSTRACT Background: Gestational Diabetes Mellitus (GDM) affects up to 14% of pregnancies globally, with accurate glycemic control critical for preventing adverse outcomes. While HbA1c is a standard marker for long-term glucose control, its reliability in pregnant women with anemia is debated. This study explores the association between anemia and glycemic indicators (Glycosylated hemoglobin HbA1c, Random plasma glucose (rPG), and Estimated average glucose (eAG) in pregnant women with GDM. Additionally, it examined the correlation between average glucose levels or eAG, measured by random plasma glucose rPG, and HbA1C. Methods: A prospective case-control study was carried out over eight months at the Departments of Chemical Pathology and Obstetrics and Gynecology, Dow University of Health Sciences (DUHS). Pregnant women in their second trimester after being diagnosed for GDM through oral glucose tolerance test were classified into anemic (hemoglobin &lt; 10.5 g/dL) and non-anemic groups. Blood samples were collected and analyzed for HbA1c, hemoglobin, and random plasma glucose levels. Data were processed using SPSS (version-26) different variables compared by using independent t-test and correlation analyses at a significance level of p &lt; 0.05. Results: Mean values for eAG, HbA1C, and rPG were 174.22 ± 24.489 mg/dl, 8.342 ± 1.6152%, and 166.21 ± 21.478 mg/dl, respectively. Anemia was associated with significantly higher HbA1C (p &lt; 0.001), eAG (p &lt; 0.001), and rPG (p = 0.004). A strong positive correlation was observed between eAG and rPG (r = 0.958, p &lt; 0.01), while eAG showed a moderate correlation with HbA1C (r = 0.501, p &lt; 0.01). In contrast, the correlation between HbA1C and rPG was weaker (r = 0.331, p &lt; 0.01). Conclusion: eAG proved to be a good indicator for assessing glycemic control in pregnant non-anemic women with GDM. Anemia significantly affected glycemic metrics, leading to higher HbA1C and glucose levels.

The effect of diabetes education on maternal and neonatal outcomes in pregnant women diagnosed with gestational diabetes

BackgroundEducation during pregnancy is important for the development of the pregnant woman’s ability to adapt to change and for a healthy birth. In this study, we aimed to examine the effects of education through a diabetes education program on maternal and newborn health in women diagnosed with gestational diabetes.Materials and methodsIn our study, we compared the maternal and neonatal health outcomes of pregnant women who participated in the diabetes education program and were diagnosed with gestational diabetes with the outcomes of pregnant women who did not participate in the diabetes education program and were diagnosed with gestational diabetes. The study included patients who were diagnosed with diabetes between 24and 26 weeks gestation at a tertiary education and research hospital and who underwent a 75-gram OGTT test. Age, BMI, parity, method of delivery, weight gain during pregnancy, newborn birth weight, gestational age and Apgar scores were compared.ResultsThe study included 119 patients and analyzed maternal-neonatal outcomes. There were no statistically significant differences in age (33 ± 5.7 versus 31 ± 5.2), body mass index (BMI) (32.2 vs. 31.2), gravidity, parity, number of miscarriages, mode of delivery, family history of diabetes, smoking, prenatal corticosteroid use, and gestational age at delivery. The HbA1c value (p: 0.013), the total weight gain during pregnancy (p: 0.015), the need for insulin treatment (p: 0.002), and the birth weight (0.005) were significantly higher in the group without diabetes education.ConclusionIn our study, diabetic school education was associated with lower HbA1c levels, less weight gain and less need for insulin therapy. When the results were categorized by insulin use, it was found that in patients using insulin, those who received diabetic school education had fewer macrosomic fetuses, whereas in patients not using insulin, those who received diabetic school education had lower maternal weight gain during pregnancy.

Post Hoc Analysis of SURPASS-1 to -5: Efficacy and Safety of Tirzepatide in Adults with Type2 Diabetes are Independent of Baseline Characteristics.

Newer incretin-based therapies for type2 diabetes (T2D) have the potential to substantially reduce glycated hemoglobin (HbA1c) and weight with a low associated risk of hypoglycemia. This study aimed to assess the percentage of participants randomized to tirzepatide or comparator who achieved the composite endpoint of HbA1c ≤ 6.5% and weight reduction ≥ 10% without hypoglycemia across prespecified baseline characteristics: T2D duration (≤ 5, > 5-10, or > 10years), sex, HbA1c (≤ 8.5% or > 8.5%), age (< 65 or ≥ 65years), and body mass index (< 30, 30 to < 35, or ≥ 35kg/m2). This post hoc analysis of SURPASS-1 through -5 evaluated adult study participants with T2D treated with tirzepatide 5, 10, or 15mg versus placebo or active comparator. Missing HbA1c and weight values were imputed from mixed models for repeated measures. Logistic regression was used to compare tirzepatide versus comparators for the percentage of participants reaching the composite endpoint. Across subgroups, the composite endpoint was achieved by a median of approximately 30%, 45%, and 54% of participants who received tirzepatide 5, 10, and 15mg, respectively; this was consistent across baseline subgroups, except that a greater percentage of women than men achieved the composite endpoint. The most common treatment-emergent adverse events were gastrointestinal in nature. In this post hoc analysis, tirzepatide achieved the composite outcome of glycemic control and weight loss with no hypoglycemia, irrespective of baseline characteristics. This may help clinicians as they select suitable treatment in diverse populations. ClinicalTrials.gov: NCT03954834, NCT03987919, NCT03882970. NCT03730662, and NCT04039503.

Type 2 diabetes pathway-specific polygenic risk scores elucidate heterogeneity in clinical presentation, disease progression and diabetic complications in 18,217 Chinese individuals with type 2 diabetes.

Type 2 diabetes is a complex and heterogeneous disease and the aetiological components underlying the heterogeneity remain unclear in the Chinese and East Asian population. Therefore, we aimed to investigate whether specific pathophysiological pathways drive the clinical heterogeneity in type 2 diabetes. We employed newly developed type 2 diabetes hard-clustering and soft-clustering pathway-specific polygenic risk scores (psPRSs) to characterise individual genetic susceptibility to pathophysiological pathways implicated in type 2 diabetes in 18,217 Chinese patients from Hong Kong. The 'total' type 2 diabetes polygenic risk score (PRS) was summed by genome-wide significant type 2 diabetes signals (n=1289). We examined the associations between psPRSs and cardiometabolic profile, age of onset, two glycaemic deterioration outcomes (clinical requirement of insulin treatment, defined by two consecutive HbA1c values ≥69 mmol/mol [8.5%] more than 3 months apart during treatment with two or more oral glucose-lowering drugs, and insulin initiation), three renal (albuminuria, end-stage renal disease and chronic kidney disease) outcomes and five cardiovascular outcomes. Although most psPRSs and total type 2 diabetes PRS were associated with an earlier and younger onset of type 2 diabetes, the psPRSs showed distinct associations with clinical outcomes. In particular, individuals with normal weight showed higher psPRSs for beta cell dysfunction and lipodystrophy than those who were overweight. The psPRSs for obesity were associated with faster progression to clinical requirement of insulin treatment (adjusted HR [95% CI] 1.09 [1.05, 1.13], p<0.0001), end-stage renal disease (1.10 [1.04, 1.16], p=0.0007) and CVD (1.10 [1.05, 1.16], p<0.0001) while the psPRSs for beta cell dysfunction were associated with reduced incident end-stage renal disease (0.90 [0.85, 0.95], p=0.0001) and heart failure (0.83 [0.73, 0.93], p=0.0011). Major findings remained significant after adjusting for a set of clinical variables. Beta cell dysfunction and lipodystrophy could be the driving pathological pathways in type 2 diabetes in individuals with normal weight. Genetic risks of beta cell dysfunction and obesity represent two major genetic drivers of type 2 diabetes heterogeneity in disease progression and diabetic complications, which are shared across ancestry groups. Type 2 diabetes psPRSs may help inform patient stratification according to aetiology and guide precision diabetes care.

Effects of thyroid status on HbA1c

Introduction: Altered erythrocyte turnover may not adequately reflect the glycemic status in the glycated hemoglobin (HbA1c) levels. Hypothyroidism is one such condition that might cause reduced erythropoiesis and falsely high HbA1c values. The aim of the study is to evaluate the effect of thyroid hormone on HbA1c levels on non-diabetic hypothyroid individuals and also to evaluate HbA1c levels in hypothyroid individuals with diabetes and to compare them with normal healthy subjects. Methods: This prospective study was conducted on 210 individuals, of whom 70 were assigned to group I- hypothyroid individuals, 70 to group II- hypothyroid individuals with diabetes, and 70 to group III—Normal individuals. Following data regarding laboratory investigations were collected which included fasting blood sugar (FBS), postprandial blood sugar (PPBS), HbA1c, free triiodothyronine (fT3), free thyroxine (fT4), and thyroid stimulating hormone (TSH). Data analysis was performed using SPSS version 16.0. Results: The median level of HbA1c was significantly higher in hypothyroid than in normal individuals (5.6 [5.5-5.7] % vs 5.2 [5-5.3] %, P≤0.001). The median level of TSH was significantly higher in hypothyroid than in normal individuals (11.13 [6.9-22.9] μIU/mL vs 2.15 (1.33-1.60) μIU/mL). The serum level of HbA1c was significantly positively correlated with TSH in hypothyroid individuals (r=0.281, P≤0.01). Conclusion: There is a positive correlation between HbA1c and TSH, and a negative correlation between HbA1c and fT4 levels. Serum HbA1c levels were significantly higher in hypothyroid individuals than the normal individuals. Therefore, our study suggests that we should proceed with caution while interpreting HbA1c levels in individuals with hypothyroidism.

Clinical and Microbiological Periodontal Biofilm Evaluation of Patients with Type I Diabetes.

Background/Objectives: The purpose of this study was to assess the microbial composition and density of subgingival plaque samples for periodontal pathogens while correlating the values with glycemic control levels via glycated hemoglobin (HbA1c), a type of hemoglobin that has chemically linked glucose, in type I diabetes individuals who will undergo complex oral rehabilitation through orthodontic treatment and implant surgery. Methods: A cohort of 42 adults with type I diabetes were included in this study. The subjects sustained a comprehensive periodontal clinical examination as well as microbiological assessments of their subgingival plaque samples through quantitative real-time PCR. The samples were collected from the two deepest pockets of each subject. Results: The highest number of periodontopathogenic bacteria was observed in the pockets of 5-7 mm. T. forsythia showed the highest prevalence (20.48%), with decreasing numbers as follows: T. denticola (13.31%), P. gingivalis (11.26%), A. actinomycetemcomitans (7%), and P. intermedia (4.9%). T. denticola and T. forsythia were significantly more commonly observed in individuals with elevated HbA1c serum levels. No correlation was observed between P. gingivalis, A. actinomycetemcomitans, P. intermedia presence, and the HbA1c value. Conclusions: Periodontopathogenic agents' presence in subgingival biofilm samples varied in accordance with the pocket probing depth and metabolic control of the diabetic individuals. In our study, the appearance of these periodontopathogenic agents was linked to lowered metabolic control in patients with type I diabetes mellitus.

Assessing the diagnostic utility of urinary albumin-to-creatinine ratio as a potential biomarker for diabetic peripheral neuropathy in type 2 diabetes mellitus patients

Background and aimsDiabetic peripheral neuropathy (DPN) and diabetic nephropathy (DN) both have microcirculation dysfunction. Urinary albumin-to-creatinine ratio (UACR) is a biomarker for DN. We aimed to explore the links between DPN and UACR in patients with type 2 diabetes mellitus (T2DM).MethodsA total of 195 T2DM patients were defined as Control or DPN group. Clinical parameters were compared, and the association between HbA1c (or UACR) and DPN was analyzed. Risk factors for DPN were observed, and the diagnostic values of HbA1c and UACR were assessed.ResultsCompared with 104 participants without DPN, 91 individuals with DPN exhibited higher HbA1c and UACR levels. In all patients, increased HbA1c and UACR were identified as risk factors for DPN in individuals with T2DM. Moreover, increased HbA1c was a risk factor for DPN in volunteers without DN, whereas elevated UACR was determined as a risk factor for DPN in participants with DN. The cut-off point for HbA1c (7.65%) in patients without DN had a sensitivity of 86.0% and specificity of 44.6%, while the cut-off point for UACR (196.081 mg/g) in patients with DN had a sensitivity of 52.9% and specificity of 76.2%.ConclusionElevated HbA1c and UACR levels are risk factors for DPN and may serve as potential biomarkers for DPN in T2DM patients.

Effect of Glycated Haemoglobin (HBA1c) on Cardiorespiratory Fitness (CRF) in a Population with Type 2 Diabetes Mellitus (T2DM): A Cross-Sectional Study.

Background and Objective: The aim of this study was to evaluate cardiorespiratory fitness (CRF) measures, maximal oxygen consumption (VO2 max), and minute ventilation/carbon dioxide production (VE/VCO2 slope and others) among the T2DM population based on glycated haemoglobin (HBA1c). Material and Methods: The present study comprised a cross-sectional design, with two groups, based on HbA1c values (≤7 and ≥7.1). Laboratory samples were taken to evaluate glycated haemoglobin and fasting blood glucose (FBS). Cardiopulmonary exercise testing was performed to calculate various fitness-related parameters. Data analysis: An independent t-test was used to analyse the outcomes in the two groups. p < 0.05 was considered significant. Linear regression was used to examine the influence of predictor variables on dependent variables. Results: A total of 70 patients agreed to participate in the study, with 19 females and 51 males. The mean (standard deviation) BMI (body mass index) of all participants was 29.7(5.2), the mean (SD) weight was 84.4 (18.9) kg, and the mean height was 167.4 (23) cm. The average age of the individuals was 52 ± 8 years. The independent t-test revealed a significant difference between the two groups in terms of CRF measures. Conclusions: The current research identified the presence of poor glycaemic control and cardiorespiratory fitness measures among the Brazilian population with T2DM. HBA1c, duration of diabetes, age, and BMI can be employed to predict the ventilatory threshold (VT) and VO2 max.

Older Adults Benefit From Virtual Support for Continuous Glucose Monitor Use But Require Longer Visits.

Older adults may be less comfortable with continuous glucose monitoring (CGM) technology or require additional education to support use. The Virtual Diabetes Specialty Clinic study provided the opportunity to understand glycemic outcomes and support needed for older versus younger adults living with diabetes and using CGM. Prospective, virtual study of adults with type 1 diabetes (T1D, N = 160) or type 2 diabetes (T2D, N = 74) using basal-bolus insulin injections or insulin pump therapy. Remote CGM diabetes education (3 scheduled visits over 1 month) was provided by Certified Diabetes Care and Education Specialists with additional visits as needed. CGM-measured glycemic metrics, HbA1c and visit duration were evaluated by age (<40, 40-64 and ≥65 years). Median CGM use was ≥95% in all age groups. From baseline to 6 months, time 70 to 180 mg/dL improved from 45% ± 22 to 57% ± 16%; 50 ± 25 to 65 ± 18%; and 60 ± 28 to 69% ± 18% in the <40, 40-64, and ≥65-year groups, respectively (<40 vs 40-64 years P = 0.006). Corresponding values for HbA1c were 8.0% ± 1.6 to 7.3% ± 1.0%; 7.9 ± 1.6 to 7.0 ± 1.0%; and 7.4 ± 1.4 to 7.1% ± 0.9% (all P > 0.05). Visit duration was 41 min longer for ages ≥65 versus <40 years (P = 0.001). Adults with diabetes experience glycemic benefit after remote CGM use training, but training time for those >65 years is longer compared with younger adults. Addressing individual training-related needs, including needs that may vary by age, should be considered.

Achievement of ABC Goals in Type 2 Diabetes in Real-life.

Introduction: This real-life observational study from a diabetes centre in Western India reports the status of A1C (glycated hemoglobin), blood pressure, and cholesterol levels (ABC goals) currently achieved in type 2 diabetic patients. Research design and methods: A cohort of 497 patients of type 2 diabetes first seen at the Diabetes Endocrine Nutrition Management and Research Centre from the years 2014 to 2017 were followed for a median [interquartile range (IQR)] duration of 21.5 (7, 33) months. A minimum of two follow-up clinical evaluations and investigations were analyzed. Results: Hemoglobin A1C (HbA1c) dropped significantly in the whole cohort (HbA1c, Percent: initial 9.0 ± 1.98, follow-up 7.66 ± 1.73; p < 0.0001). Increasing duration of diabetes showed a significantly poorer achievement of HbA1c targets on follow-up (HbA1c 0-5 years vs 5.1-10 years and >10 years, p < 0.001). Pretreatment HbA1c of <6, 6.1-7, 7.1-7.5, 7.6-8, 8.1-9, and >9% was seen in 2, 15, 11, 8, 20, and 44%, respectively. The corresponding HbA1c values on follow-up were 5, 30, 14, 11, 17, and 23%, respectively. Sodium-glucose transport protein 2 inhibitor (SGLT2i) group was in poorer control (HbA1c 8.20 ± 1.71) at follow-up than non-SGLT2i group (HbA1c 7.55 ± 1.72), p < 0.001) probably due to significantly greater use of sulphonylurea as background therapy in SGLT2i group (SGLT2i group 72.2%, non-SGLT2i group 58.7%, p < 0.02). Initial ABC targets were at goal for HbA1c, high blood pressure, and low-density lipoprotein (LDL) cholesterol in 17, 40, and 33% of patients, respectively. On follow-up, percent of patients at goal were HbA1c 35%, hypertension 95.77%, and LDL cholesterol 75.85%. Conclusion: The study brings out the difficulties in achieving HbA1c goals as compared to blood pressure and LDL cholesterol goals. Additionally, it brings out the efficacy of sulphonylureas as a treatment modality. Longer duration of diabetes resulted in lower achievement of glycemic targets.

Efficacy of Ma'aljobon Aftimouni (Cuscuta Reflexa and Whey) on HbA1c and Blood Glucose Levels in Patients with Type 2 Diabetes: A Randomized Triple-Blind Clinical Trial

Introduction and ObjectiveType 2 Diabetes is a common and chronic metabolic disease. Complementary and alternative medicine can provide a suitable option for demands for new treatments. Therefore, the present study aimed to investigate the effect of Persian medicine on the glycemic status of patients with Type 2 Diabetes. MethodThis randomized, controlled, and triple-blind trial study was conducted from November 2021 to August 2022 on 102 diabetic patients referred to the diabetes clinic in Iran. In this regard, patients with inclusion criteria were randomly divided into three groups Ma'aljobon with Aftimoun (n = 34), Ma'aljobon without Aftimoon (n = 34), and the control group (n = 34). The control group received a placebo of medicinal salt, light calcium carbonate, lactose, and carboxymethyl cellulose. In contrast, the treatment groups received 25 grams of drug powder (in 250 cc of lukewarm water) on an empty stomach for 8 consecutive weeks. Patients' fasting blood sugar (FBS) levels and HbA1c were measured at the beginning and end of the intervention. Data were analyzed using SPSS 23, employing paired t-tests, ANOVA, and chi-square tests for comparison between groups. ResultsData analysis was conducted on 90 patients with Type 2 Diabetes. The findings revealed a significant reduction in fasting blood sugar levels post-intervention in the Ma'aljobon Aftimouni group (134.27± 21.79 vs. 152.3± 31.37, mean difference 18.03± 5.63, 95% CI: 6.53 to 29.53, p = 0.003). Additionally, a significant difference in HbA1c values was observed post-intervention in both the Ma'aljobon Aftimouni group (7.88± 0.77 vs. 8.09± 0.73, mean difference 0.21± 0.09, 95% CI: 0.03 to 0.39, p = 0.031) and the Ma'aljobon without Aftimoun group (7.97± 0.84 vs. 8.25± 0.78, mean difference 0.28± 0.08, 95% CI: 0.11 to 0.45, p = 0.002). ConclusionThe findings showed that daily consumption of Ma'aljobon supplements on an empty stomach before breakfast may have a beneficial effect on the glycemic indices of patients. However, further studies seem to be necessary in this regard.

Impact of Opuntia ficus-indica Juice and Empagliflozin on Glycemic Control in Rats.

Diabetes mellitus (DM) is a major global health concern characterized by high blood glucose levels. This study investigates the effects of Opuntia ficus-indica (cactus) juice and empagliflozin, both alone and in combination, on glycated hemoglobin (HbA1c) levels in healthy and streptozotocin-induced diabetic rats. Eighty Wistar albino male rats were divided into eight groups, with four groups being diabetic. Treatment options included cactus juice, empagliflozin, or both. HbA1c levels were measured at baseline and 100 days later using ELISA. In diabetic and non-diabetic rats treated with cactus juice or empagliflozin, HbA1c levels were significantly reduced, but diabetic rats had significantly lower HbA1c values than non-diabetic rats. The combined treatment provided no additional benefits over individual therapies. These findings indicate that cactus juice and empagliflozin effectively lower HbA1c levels, making their use a promising complementary approach to diabetes management. However, the combined treatment of Opuntia ficus-indica juice and empagliflozin did not yield additional reductions in HbA1c levels compared to individual treatments, with no significant synergistic effects observed throughout the study period. More research is needed to better understand the clinical applications and mechanisms in humans.

Severe Hypertriglyceridemia in Patients with Type 2 Diabetes Mellitus Participating in the AMD Annals Initiative.

Background: Familial chylomicronemia syndrome (FCS) is a rare inherited condition due to lipoprotein lipase deficiency, characterized by hyperchylomicronemia and severe hypertriglyceridemia. Diagnosis is often delayed, thus increasing the risk of acute pancreatitis and hospitalization. Hypertriglyceridemia is a common finding in patients with type 2 diabetes (T2D), who may harbor FCS among the most severe forms. Aim of the Study: We investigated the prevalence and clinical characteristics associated with severe hypertriglyceridemia in a range indicative of FCS, in a large population of subjects with T2D. Methods: Within the large population of the AMD Annals Initiative, patients with T2D with a lipid profile suggestive of FCS [triglycerides >880 mg/dL and/or high-density lipoprotein (HDL)-cholesterol <22 mg/dL or non-HDL-cholesterol ≤70 mg/dL] and their clinical features have been identified. Results: Overall, 8592 patients had triglyceride values >880 mg/dL in a single examination, 613 in two examinations, and 34 in three or more measurements. Patients with high triglyceride levels were mostly male (80%), with a relatively young age (54 years), short duration of diabetes (6.3 years), and elevated hemoglobin A1c (HbA1c) levels (9.4%). By stratifying this group of patients according to the severity of hypertriglyceridemia, more severe hypertriglyceridemia (triglyceride levels ≥2000 mg/dL) was associated with an even younger age (52 vs. 54 years), even higher mean HbA1c values (10.0% vs. 9.4%), and significantly higher HDL-cholesterol levels (37.9 vs. 32.4 mg/dL; P < 0.0001). Patients with persistently elevated triglyceride levels (n = 34), on three measurements, had a younger age; lower body mass index, HbA1c, and HDL-cholesterol levels; more frequent use of fibrates and insulin; and a higher prevalence of major cardiovascular events. Conclusions: Severe hypertriglyceridemia is a frequent condition in outpatients with T2D participating in the AMD Annals Initiative, and it is associated with male sex, young age, short disease duration, and a worse glycemic profile. Among patients with persistent severe hypertriglyceridemia, hidden FCS may be present.

The Potential Risk: Evaluation of HgA1c Levels Prior to Dental Implant Surgery in Patients without a Diagnosis of Diabetes Mellitus.

Diabetes Mellitus (DM) poses a significant global health concern, with approximately one in two affected individuals remaining undiagnosed. The failure to diagnose or inadequately control DM can lead not only to systemic complications but also to decreased dental implant survival rates, increased marginal bone loss, and increased susceptibility to peri-implantitis. This study aims to evaluate glycated hemoglobin (HbA1c) levels in patients who have not been diagnosed with DM but exhibit oral DM symptoms prior to dental implant surgery. This study was designed as a retrospective cohort. It was conducted on patients who previously presented to the Department of Oral and Maxillofacial Surgery for dental implant surgery and had not been diagnosed with DM. The inclusion criteria included the need for dental implants and augmentation, presence of oral DM symptoms, and having blood tests that included HbA1c. Patients with a prior diagnosis of DM were excluded from the study. A retrospective analysis was conducted on data from 253 patients who applied for dental implant surgery. Among them, 72 patients underwent HbA1c levels assessment through blood tests. Patients with previously uncontrolled DM (n:21) and those whose blood tests were performed at different institutions (n:8) were excluded from the study. Consequently, the study encompassed a cohort of 43 patients. Among the participants, 55% were female and 45% were male. The HbA1c values of the patients ranged from 5.1 to 10.9, with an average value of 6.57±1.44. Of the patients, 41.8% were diagnosed with DM, 30.2% were prediabetic (preDM), and 27.9% did not receive any diagnosis. There was no statistically significant relationship between the combinations of xerostomia, delayed wound healing, oral infection, burning sensation in the mouth, periodontitis, and dental caries with HbA1c levels (p>0.05). In this study, patients presenting to the clinic for dental implant surgery were directed based on oral symptom findings, and the rates of diagnosed DM and preDM were determined to be 7.11% and 5.14%, respectively. Considering the negative effects and prevalence of uncontrolled DM, it may be recommended to assess the HbA1c levels in patients with oral symptoms before dental implant surgery.

Effect of Iron Deficiency Anemia on HbA1c Levels in a cohort of patients with Type 2 diabetes mellitus in a tertiary care hospital

Introduction: Studies have reported that HbA1c levels can be changed by iron deficiency (ID) which is the commonest nutritional anaemia globally. This study was aimed at determining the effect of iron deficiency anaemia (IDA) on HbA1c levels in a cohort of type 2 diabetes mellitus (T2DM) attending a tertiary care hospital in Sri Lanka. Methods: A retrospective analytical study was performed for a period of six months from January 2021. Laboratory records of 281 adult T2DM patients both, anaemic (n=135) with Hb &lt;12g/dL in females and &lt;13g/dL males and transferrin saturation &lt;16%, and nonanaemic (n=146) with Hb &gt;12g/dL in females and &gt;13g/dL in males were analyzed. Data were analyzed using (SPSS) version 20, descriptive statistical methods, Pearson’s Correlation test, independent sample t-test, one-way analysis of variance (ANOVA) and Chi-Square test were used. P&lt;0.05 was considered significant. Results: Out of the total 281 patients diagnosed with T2DM, 150 were female, and 131 were male, spanning an age range of 22 to 96 years. The mean ± standard deviation (SD) values for HbA1c in both anaemic and non-anemic groups were 7.4±2.2% g/dL and 7.3±2.36% g/dL, respectively. Importantly, no statistically significant relationship was observed between the two groups (p=0.889). Furthermore, there was no significant correlation between HbA1c levels with serum iron (p=0.617), total Iron Binding Capacity (TIBC) (p=0.340), and transferrin saturation (p=0.168). Conclusion: The study reveals, HbA1c in T2DM patients with and without IDA show no significant difference. Therefore, HbA1c could be reliably used in monitoring patients with T2DM and IDA. Keywords: T2DM, HbA1c, iron deficiency anaemia, red blood cell indices

Association of serum bilirubin levels and glycemic measurements in Type 2 diabetic patients

Introduction: Bilirubin, a waste product of the heme catabolic pathway, has proven to be a natural antioxidant associated with a lower prevalence of oxidative stress-mediated diseases. This study evaluates the association of serum bilirubin levels with Glycated Hemoglobin (HbA1c), Fasting Blood Sugar (FBS) and Post Prandial Blood Sugar (PPBS) in diabetic patients. Methods: A retrospective analytical study was conducted at the Department of Haematology of the Sri Jayewardenepura General Hospital. Data was obtained through a laboratory information system of randomly selected 201 adult patients diagnosed with T2DM and grouped as poorly and well controlled using HbA1c values over and below 7%, respectively. Normal ranges for serum bilirubin, FBS, and PPBS were (0.3-1.2) mg/dL, (75-110) mg/dL and (80-140) mg/dL, respectively. Data were analyzed using (SPSS) version 20, descriptive statistical methods, Pearson’s Correlation test and independent sample t-test. P&lt;0.05 was considered significant. Results: A negative correlation between total bilirubin and HbA1c (r = -0.234, p=0.001) was observed. There was no statistically significant correlation between total bilirubin level and FBS (p=0.131), PPBS (p=0.408), and age (p=0147). However, the mean values of total bilirubin (p=0.001), FBS (p&lt;0.001) and PPBS (p&lt;0.001) were significant between diabetes well controlled and poorly controlled groups. A statistically positive correlation was observed between HbA1c and FBS (p&lt;0.001) and PPBS (p&lt;0.001), but not with age (p=0.887). Conclusion: There was a significant relationship between total bilirubin with FBS, and PPBS in both groups. A significant negative correlation was found between total bilirubin and HbA1c, suggesting a potential protective or modulatory role of bilirubin in glycemic control. No significant correlation was observed between total bilirubin levels and FBS, PPBS, or age in the total population.Keywords: T2DM, HbA1c, bilirubin, FBS, PPBS