Higher HbA1c Levels Research Articles

Pola penggunaan obat anti diabetes mellitus tipe-II pada pasien rawat inap di RSUD Praya tahun 2021

Diabetes mellitus is a metabolic disease characterized by hyperglycemia due to abnormalities in insulin secretion. The prevalence of people with diabetes mellitus in Indonesia reached 6.2% per year in 2020 and ranks 7th in the world with 8.5 million people. Based on the results of observations at the Praya Hospital in 2021, type-II diabetes mellitus is the 4th highest-order disease suffered by the community, especially Central Lombok Regency, with a total incidence of 131 patients. This study aims to determine the pattern of drug use and HbA1c profile in patients with type-II diabetes mellitus in the inpatient installation of Praya Hospital in 2021. This study was retrospective, using the Nonprobability Sampling method, namely the type of purposive sampling so that a sample of 96 medical records of diabetes mellitus patients was obtained type-II. The data is presented as pie charts and tables in percentages, which were analyzed using Microsoft Excel and SPSS version 25. From the results of this research, it was found that the pattern of drug use at Praya Hospital in 2021 was given the highest from each group namely the oral antidiabetic drug group (OAD) was in the Biguanid class with 61 drugs (8,13%), while insulin drugs were in the Rapid-Acting class with 343 drugs (45,73%), and the OAD + Insulin combination with 119 drugs (15,87%). For the HbA1c profile, high HbA1c levels were found in 76 patients (79%). This shows that blood glucose control is not reasonable. Based on the study's results, the recommended recommendation is that patients routinely control blood sugar and be educated on the accuracy of drug use to control blood sugar.

High levels of blood glycemic indicators are associated with chronic kidney disease prevalence in non-diabetic adults: Cross-sectional data from the national health and nutrition examination survey 2005–2016

ObjectiveHyperglycemia in individuals with diabetes is associated with chronic kidney disease (CKD); however, little is known about its association with those without diabetes. Our goal was to investigate the association between glycemic indicators and CKD in individuals without diabetes. MethodsThis cross-sectional study included 9610 participants without diabetes who participated in the Health and Nutrition Examination Survey between 2005 and 2016. Exposures included postprandial glucose dip (PGD), fasting blood glucose (FBG), oral glucose tolerance test two-hour blood glucose (OGTT-2HBG), and glycated hemoglobin (HbA1C) levels. Moreover, CKD was defined as an estimated glomerular filtration rate below 60 mL/min per 1.73 m2 or a urinary albumin-creatinine ratio of ≥ 30 mg/g. Two multivariate models were constructed. Interaction effects were also explored. ResultsThe mean age of the participants was 46.0 years, with 50.3 % being females. The prevalence of CKD was 12.6 %. In the final multivariable models, the odds ratios (ORs) for CKD were 1.51 (95 % confidence interval [CI]: 1.22,1.88, p < 0.001) for participants in the highest quartile of PGD,1.46 (95 %CI: 1.13,1.87, p = 0.004) for OGTT-2HBG, and 1.33 (95 %CI: 1.04,1.70, p = 0.020) for HbA1C, when compared with the quartile 1. No significant association was observed between FBG levels and CKD in the final model. Additionally, interactions were observed between PGD and body mass index, as well as between PGD and alcohol consumption in relation to CKD. ConclusionThe study identified that high levels of PGD, OGTT-2HBG, and HBA1C were significantly associated with a high prevalence of CKD in individuals without diabetes.

Rest-activity rhythm disruption and metabolic health in schizophrenia: a cross-sectional actigraphy study of community-dwelling people living with schizophrenia and nonpsychiatric comparison participants.

People living with schizophrenia (PLWS) have increased physical comorbidities and premature mortality which may be linked to dysregulated rest-activity rhythms (RARs). This study aimed to compare RARs between PLWS and nonpsychiatric comparison participants (NCs) and to examine the relationships of RARs with age, sleep, metabolic, and physical health outcomes and, among PLWS, relationships of RARs with illness-related factors. The study sample included 26 PLWS and 36 NCs, assessed with wrist-worn actigraphy to compute RAR variables and general sleep variables. Participants completed assessments for clinical symptoms, physical health, sleep quality, medication use, and assays for fasting glycosylated hemoglobin (hemoglobin A1c) levels. We examined group differences in RAR and sleep variables, relationships of RAR variables with metabolic and physical health measures, and, among PLWS, relationships between RAR variables and illness-related measures. PLWS had significantly shorter active periods, lower relative amplitude, and lower mean activity during their most active 10 hours compared to the NCs (Cohen's d = 0.79, 0.58, and 0.62, respectively). PLWS had poorer sleep quality, greater mean percent sleep, less wake after sleep onset, and higher total sleep time variability compared to NCs. PLWS had higher rates of antidepressant, anxiolytic, and antipsychotic medication use compared to NCs, which may have impacted sleep quality and objective sleep measures. Across both groups, more fragmented and variable RARs were associated with higher HbA1c levels (ηp2 = .10) and worse physical health (ηp2 = .21). Among PLWS, RARs were correlated with total sleep time (rs = .789, P < .01) and percent sleep (rs = .509, P < .05), but not with age, sleep quality, or other illness-related factors. RARs provide unique information about sleep and activity for PLWS and have the potential for targeted interventions to improve metabolic health and mortality. Mahmood Z, Ramsey A, Kidambi N, etal. Rest-activity rhythm disruption and metabolic health in schizophrenia: a cross-sectional actigraphy study of community-dwelling people living with schizophrenia and nonpsychiatric comparison participants. J Clin Sleep Med. 2024;20(9):1505-1516.

Risk predictors of glycaemic control in children and adolescents with type 1 diabetes: A systematic review and meta-analysis.

To conduct systematic evaluation of the risk predictors of glycaemic control in children and adolescents with type 1 diabetes mellitus. Cohort studies on risk predictors of glycaemic control in children and adolescents with type 1 diabetes were retrieved from CNKI, PubMed, Web of Science, Embase databases, etc. from the construction of the repository to 3 February 2023. Literature screening was conducted according to inclusion and exclusion criteria, then data extraction of region, sample size, age, follow-up time, risk predictors, outcome indicators, etc., and quality evaluation of The Newcastle-Ottawa Scale were conducted by two researchers while the third researcher makes decisions if there are disagreements. Finally, Revman5.4 and StataMP17 were used for meta-analysis. A total of 29 studies were included, and the results showed that insulin pump [Weighed mean difference (WMD) = -.48, 95% CI (-.73, -.24), p < .01], high-frequency sensor monitoring, early use of insulin pumps, prospective follow-up male, white race, large body mass index-standardised scoring, conscientiousness, agreeableness of mothers, eicosapentaenoic acid, leucine and protein (p < .05) were beneficial for reducing HbA1c levels in children and adolescents with diabetes. Ketoacidosis [WMD = .39, 95% CI (.28, .50), p < .01], selective admission, higher HbA1c level at one time (p < .01), higher glutamate decarboxylase antibody at 1 month after diagnosis, lower socio-economic status, non-living with biological parents, non-two-parent family, family disorder, family history of diabetes and high carbohydrate intake (p < .05) increased HbA1c levels in children and adolescents with diabetes. For children and adolescents with type 1 diabetes mellitus, the use of insulin pump, high-frequency sensor monitoring, prospective follow-up, good family support and reasonable diet are conducive to blood glucose control, while selective admission and DKA are not. Disease characteristics and demographic characteristics of children are closely related to subsequent blood glucose control, and the relationship between diagnosis age and blood glucose control needs to be further explored.

Association of Glycated Hemoglobin With Acute Ischemic Stroke in a Tertiary Care Center in a Tribal Region of Jharkhand.

Increased glycated hemoglobin (HbA1c) levels have shown an association with an increased risk of stroke in patients admitted to a tertiary care center in Jharkhand. To find out and estimate the risk of acute ischemic stroke in patients with increased HbA1c levels compared with controls. This observational case-control study was conducted on patients admitted to the department of general medicine at a tertiary care center in Ranchi from June 2021 to November 2022. The patients included in this study were those aged 18 years or older and who were clinically and radiologically diagnosed with acute ischemic stroke. Only patients with a first episode of stroke were included, and patients with hemorrhagic stroke or transient ischemic attack were excluded from this study. An equal number of control participants were also included. Ion exchange high-performance liquid chromatography was used to perform the HbA1c tests. The same method was used to measure HbA1c levels in the controls. All findings were recorded in aMicrosoft Excel sheet (Microsoft Corporation, Redmond, WA), and the data were analyzed using SPSS version 22.0software (IBM Corp., Armonk, NY). After performing a descriptive statistical analysis, the findings were classified over a range of values and described accordingly. For each variable, an independent t-test was performed to compare the cases with the controls. A multivariable logistic regression analysis was used to choose the appropriate potential factors to determine the association in the multivariable analysis. A total of 185 cases and 185 controls were included. The mean age of the cases with ischemic stroke was 63.77 ± 10.312, and that of the controls was 53.18 ± 11.35 (p < 0.01). The mean HbA1c level in the patients of acute ischemic stroke was 6.97 ± 1.84, and that of the controls was 5.99 ± 1.69 (p < 0.01). The mean random blood sugar (RBS) value in the ischemic stroke cases was 170.21 ± 84.16, and that of the controls was 150.03 ± 82.25 (p = 0.02). To compare the factors that were determined to be statistically significant between ischemic stroke cases and controls, a multivariable logistic regression analysis was performed. The HbA1c p-value was 0.01, the odds ratio (OR) was 1.280, and the 95% CI was 1.11-1.48. The other variables apart from HbA1c that were statistically significant between the ischemic stroke cases and the controls were age (p < 0.01, OR: 1.280, 95% CI: 1.06-1.11), hypertension (p = 0.618, OR: 1.130, 95% CI: 0.70-1.83), and high-density lipoprotein (p = 0.055, OR: 0.975, 95% CI: 0.95-1.00). When other cofounders were considered, it was concluded that with a 1% increase in HbA1c, the risk of stroke increases by 28% (OR: 1.28, 95% CI: 1.11-1.48). To compare the variables that were determined to be statistically significant between the control and ischemic stroke case groups, a multivariable logistic regression was used. The area under the receiver operating characteristic curve for HbA1c was 0.773and RBS was 0.600. This study shows that higher HbA1c levels in patients increase the risk of ischemic stroke. This study brings to light the need to screen the population periodically for diabetes by routinely testing for Hba1c in those who are at high risk of diabetes. Stroke risk can be reduced with early management and intervention. This study also concludes that HbA1c is a better predictor for assessing the risk of ischemic stroke than RBS levels.

Factors associated with development of retinopathy in patients with type 2 diabetes mellitus at onset and within three years after diagnosis

Objective To investigate the prevalence of diabetes retinopathy and evaluate the factors influencing its occurrence both at the onset of type 2 diabetes (T2D) and three years into its duration. Design Retrospective population-based study. Setting Data was retrieved from Regional Healthcare Information Platform in Region Halland 2016–2020. Subjects Patients 35-75 years old in Region Halland receiving first-time diabetes diagnosis according to ICD-code E11-14 in 2016–17. The total cohort consisted of 1659 patients. Main outcome measures The main outcome measure of the study was the occurrence of diabetes retinopathy at onset and within three years from the diabetes diagnosis. Multivariate logistic regression analysis was conducted for diabetes retinopathy at onset and within three years, adjusted for age, gender, comorbidities, levels of HbA1c, cholesterol, kidney functional and blood pressure. Results At onset, there were 12% with diabetes retinopathy and after three years, 32% of the patients had developed diabetes retinopathy. In the study cohort, 71 of patients who were examined with fundus photography within three years after onset, and 8% had had dietary recommendation without pharmacotherapy. High HbA1c levels, blood pressure values and impaired renal function already at onset were associated with development of diabetes retinopathy at onset and this association persisted after three years. The odds ratio for diabetes retinopathy was increased adjusted for HbA1c elevations, renal impairment, and increased blood pressure at index and when adjusted for these variables three years from index. Conclusion These findings indicate that the risk of developing diabetes retinopathy is present early on at onset and within the first three years of diabetes diagnosis. This highlights the importance of promptly regulating glucose- and blood-pressure levels and follow up kidney dysfunction to mitigate the risk of diabetes retinopathy.

Prevalence and risk factors of wound complications after transtibial amputation in patients with diabetic foot

BACKGROUND Diabetic foot (DMF) complications are common and are increasing in incidence. Risk factors related to wound complications are yet to be established after trans-tibial amputation under the diagnosis of DMF infection. AIM To analyze the prognosis and risk factors related to wound complications after transtibial amputation in patients with diabetes. METHODS This retrospective cohort study included seventy-two patients with DMF complications who underwent transtibial amputation between April 2014 and March 2023. The groups were categorized based on the occurrence of wound complications, and we compared demographic data between the complication group and the non-complication group to analyze risk factors. Moreover, a multivariate logistic regression analysis was performed to identify risk factors. RESULTS The average follow-up period was 36.2 months. Among the 72 cases, 31 (43.1%) had wound complications. Of these, 12 cases (16.7%) received further treatment, such as debridement, soft tissue stump revision, and re-amputation at the proximal level. In a group that required further management due to wound complications after transtibial amputation, the hemoglobin A1c (HbA1c) level was 9.32, while the other group that did not require any treatment had a 7.54 HbA1c level. The prevalence of a history of kidney transplantation with wound complications after transtibial amputation surgery in DMF patients was significantly greater than in cases without wound complications (P = 0.02). Other factors did not show significant differences. CONCLUSION Approximately 43.1% of the patients with transtibial amputation surgery experienced wound complications, and 16.7% required additional surgical treatment. High HbA1c levels and kidney transplant history are risk factors for postoperative wound complications.

High-Frequency Audiovestibular Dysfunction in Long-Standing Diabetes Mellitus: Insights from a Cross-Sectional Study.

This study investigates audiovestibular dysfunction in individuals with long-standing diabetes mellitus (DM). A cross-sectional study was conducted involving 100 patients (DM for ≥ 10years) at the Department of E.N.T. in Prakash Institute of Medical Sciences and Research, Sangli, Maharashtra. A mean age of 43.09years among patients, with 64% male and 36% female participants. Hearing loss was the most common complaint, affecting 46% of subjects, followed by vertigo in 23%. Pure tone audiometry revealed that 34% of patients had sensorineural hearing loss, with varying degrees of severity. Vestibular dysfunction was observed in 10% of cases. Correlation analysis indicated a significant positive relationship between the duration of DM and hearing thresholds at various frequencies, as well as with HbA1c levels. This suggests a worsening of hearing with longer DM duration and higher HbA1c levels. The prevalence of hearing impairment was higher at higher frequencies, with vestibular dysfunction also noted in a subset of patients.

Tailored care by diabetes nurses is not enough to overcome disparities in the regulation of type 2 diabetes between Dutch natives and ethnic minority groups

Background: Differences in diabetes regulation between patients from different ethnic background have been described. This may be reduced by regular visits to a diabetes nurse (RVDN) with the same mother tongue. We explored whether equal access to diabetes-related care, including RVDN with the same mother tongue, may result in similar diabetes regulation among ethnic minorities and Dutch natives. Methods: Patients with type 2 diabetes and an annual comprehensive diabetes evaluation were included in this study. For the analysis, we emphasized on the data of patients with RVDN and used descriptive statistics and nonparametric tests for between group comparisons. Results: From a total of 983 patients, 581 patients had RVDN of whom 266 (46%) Dutch natives, 199 (34%) Turks/Moroccans, and 116 (20%) patients from other ethnicities. Within the group of patients with RVDN, Turks/Moroccans had higher median fasting plasma glucose levels as compared with Dutch natives and other ethnic minorities (8.4 vs 7.9 and 7.3 mmol/L, P &lt; 0.001), and a higher HbA1c level was found for both the Turks/Moroccans and other ethnic minorities, as compared to Dutch natives (62 vs 55 mmol/mol, P &lt; 0.001). In addition, only 22% of Turks/Moroccans and 26% of other minorities achieved the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD)-recommended HbA1c target ≤53 mmol/mol, compared to 39% in Dutch natives. Conclusions: In patients with RVDN with the same mother tongue, we still found disparities in HbA1c levels between Dutch natives, Turks/Moroccans and other ethnic minorities. Other factors beyond Dutch language skills are likely to interfere.

Associations of onset age, diabetes duration and glycated hemoglobin level with ischemic stroke risk in type 2 diabetes patients: a prospective cohort study

Objective: To investigate the associations of onset age, diabetes duration, and glycated hemoglobin (HbA1c) levels with ischemic stroke risk in type 2 diabetes patients. Methods: The participants were from Comprehensive Research on the Prevention and Control of the Diabetes in Jiangsu Province. The study used data from baseline survey from December 2013 to January 2014 and follow-up until December 31, 2021. After excluding the participants who had been diagnosed with stroke at baseline survey and those with incomplete information on onset age, diabetes duration, and HbA1c level, a total of 17 576 type 2 diabetes patients were included. Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95%CI of onset age, diabetes duration, and HbA1c level for ischemic stroke. Results: During the median follow-up time of 8.02 years, 2 622 ischemic stroke cases were registered. Multivariate Cox proportional risk regression model showed that a 5-year increase in type 2 diabetes onset age was significantly associated with a 5% decreased risk for ischemic stroke (HR=0.95, 95%CI: 0.92-0.99). A 5-year increase in diabetes duration was associated with a 5% increased risk for ischemic stroke (HR=1.05, 95%CI: 1.02-1.10). Higher HbA1c (per 1 standard deviation increase:HR=1.17, 95%CI: 1.13-1.21) was associated with an increased risk for ischemic stroke. Conclusion: The earlier onset age of diabetes, longer diabetes duration, and high levels of HbA1c are associated with an increased risk for ischemic stroke in type 2 diabetes patients.

Psychosocial Factors and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes

Youth-onset type 2 diabetes is associated with poor glycemic control and early onset of complications. Identification of psychosocial factors associated with poor glycemic control is needed to inform efficacious interventions. To identify psychosocial factors associated with glycated hemoglobin (HbA1c) levels in young adults with youth-onset type 2 diabetes. For the iCount cohort study, HbA1c levels were measured twice (at baseline [T1] and at 1 year [T2]) during the last years (2017-2019) of the observational phase of the multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study. Participants were young adults who had been diagnosed with type 2 diabetes during childhood or adolescence. Data were analyzed from December 2021 to September 2023. Glycemic control was examined categorically (high [≥8.0%] vs low [<8.0%] HbA1c), continuously (HbA1c level), and over time (change in HbA1c: decreased ≥0.5%, remained stable, or increased ≥0.5%). Psychosocial measures included beliefs about medicines, depression and anxiety symptoms, diabetes distress, diabetes self-efficacy, self-management support, and unmet material needs. Multivariable logistic and linear regression models evaluated the association of each psychosocial factor with the probability of T2 HbA1c of 8.0% or greater, T2 HbA1c level, and change in HbA1c. Of the 411 TODAY2 participants approached, 381 enrolled in the iCount study, and 348 with T1 and T2 HbA1c data comprised the analysis group. The 348 participants had a mean (SD) age of 26.1 (2.5) years and a mean (SD) HbA1c of 9.4% (2.8%). Most participants (229 [65.8%]) were women. In adjusted multivariable regressions, greater beliefs that diabetes medicines are necessary (odds ratio [OR], 1.19 [95% CI, 1.03-1.37]; P = .02), concerns about medicines (OR, 1.20 [95% CI, 1.00-1.45]; P = .049), diabetes distress (OR, 1.08 [95% CI, 1.02-1.15]; P = .006), and high distress (OR, 2.18 [95% CI, 1.15-4.13]; P = .02) increased the odds of high HbA1c at T2. Greater support (OR, 0.67 [95% CI, 0.46-0.97]; P = .04) and diabetes self-efficacy (OR, 0.91 [95% CI, 0.84-0.99]; P = .02) decreased the odds of high HbA1c at T2. Diabetes distress was associated with higher HbA1c level at T2 (coefficient, 0.08 [95% CI, 0.02-0.13]; P = .01). Beliefs that diabetes medicines are necessary (OR, 1.20 [95% CI, 1.03-1.39]; P = .02) and concerns about medicines (OR, 1.22 [95% CI, 1.00-1.47]; P = .048) increased the odds of an HbA1c decrease of at least 0.5% over 1 year. In this cohort study of young adults with youth-onset type 2 diabetes, beliefs about medicines, high diabetes distress, low diabetes self-efficacy, and self-management support were associated with high HbA1c over time. Future research should assess whether interventions that address these factors result in improved glycemic control in this at-risk group.

Evaluation of Correlation between the Level of Vitamin D and Glycosylated Hemoglobin in Type 2 Diabetic Mellitus and Nondiabetic Mellitus

Background: The pancreas contains Vitamin D (Vit.-D) and an enzyme that regulates insulin levels. Vitamin D deficiency is associated with several severe health conditions, such as cardiovascular disease, diabetes, various cancers, and multiple sclerosis (MS). Therefore, the objective of the current study is to investigate the correlation between Vitamin D levels and glycosylated hemoglobin (HbA1c) in both patients and controls. Materials and Methods: The study enrolled 163 T2DM (Group I) and 174 healthy (Group II) subjects to estimate the level of Vit.-D and HbA1c in the blood serum of all subjects, using radioimmunoassay and high-performance liquid chromatography, respectively. Results: The results revealed that Group I had a lower level of Vit.-D (17.82 ± 2.23 ng/mL) than Group II. Similarly, they have high HbA1c levels, showing significant ( P &lt; 0.001; Student’s t-test). Further, in Group I, Vit.-D levels were negatively correlated with HbA1c levels ( P &lt; 0.001; r2 = 0.07, linear regression). Group I and II combined analysis revealed an inverse relationship between Vit.-D levels and HbA1c ( P &lt; 0.001; r2 = 0.021). Conclusion: The study concluded a negative correlation between Vit.-D levels and HbA1c levels in T2DM. However, Vit.-D therapy can recover this correlation, which helps control glycemic levels.

Household food insecurity and associations with hemoglobin A1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for Diabetes in Youth study

AimsTo examine, among youth and young adults (YYA) with type 1 diabetes (T1D), the association of household food insecurity (HFI) with: 1) HbA1c and 2) episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia. MethodsHFI was assessed using the U.S. Household Food Security Survey Module in SEARCH for Diabetes in Youth participants with T1D between 2016 and 2019. Linear and logistic regression models adjusted for age, diabetes duration, sex, race, ethnicity, clinic site, parent/participant education, household income, health insurance, and diabetes technology use. ResultsOf 1830 participants (mean age 20.8 ± 5.0 years, 70.0 % non-Hispanic White), HbA1c was collected for 1060 individuals (mean HbA1c 9.2 % ± 2.0 %). The prevalence of HFI was 16.4 %. In the past 12 months, 18.2 % and 9.9 % reported an episode of DKA or severe hypoglycemia, respectively. Compared to participants who were food secure, HFI was associated with a 0.33 % (95 % CI 0.003, 0.657) higher HbA1c level. Those with HFI had 1.58 (95 % CI 1.13, 2.21) times the adjusted odds of an episode of DKA and 1.53 (95 % CI 0.99, 2.37) times the adjusted odds of an episode of severe hypoglycemia as those without HFI. ConclusionsHFI is associated with higher HbA1c levels and increased odds of DKA in YYA with T1D.

Neonatal Outcomes in Different Maternal Diabetes Types: Experience from a Tertiary Care Unit

Objective: Infants of mothers with diabetes (IMD) may require hospitalization in neonatal intensive care units (NICU) for various reasons. In our study, our objective was to compare clinical and laboratory findings, as well as malformations and morbidities among IMD based on the types of maternal diabetes. Material and Methods: The diabetic status of mothers of 4713 infants admitted to tertiary neonatal intensive care unit (NICU) at Ankara Bilkent City Hospital between January 1, 2020, and January 1, 2022, was examined. We retrospectively analyzed demographic data, clinical and laboratory characteristics, and morbidities for 616 infants born to mothers with impaired glucose tolerance (IGT), gestational diabetes mellitus (GDM), or pre-existing gestational diabetes mellitus (Pre-GDM). Results: Of the 616 cases, 167 (27.1%) were infants of mothers with IGT, 394 (64%) with GDM and 55 (8.9%) with Pre-GDM. The prevalence of macrosomia was significantly higher in Pre-GDM (30.9%) than in the IGT (15%) and GDM (19.3%) groups (p=0.033). The most common malformations in the cases were related to the cardiovascular system (CVS) (77.4%). The frequency of septal hypertrophy was significantly higher in the Pre-GDM group compared to the IGT and GDM groups, and in the GDM group compared to the IGT group (p&amp;lt;0.001). The rates of septal hypertrophy, CVS malformation, LGA/macrosomia, and hypocalcemia were found to be significantly higher in infants of mothers with insulin requirement and high HbA1c levels, particularly in Pre-GDM group (p&amp;lt;0.001). According to the ROC analysis for the optimum maternal HbA1c value predicting septal hypertrophy, the threshold value was found to be 6% (AUC=0.693) with 62% sensitivity and 66% specificity. In logistic regression analysis, macrosomia and maternal HbA1c ≥6% were determined as independent risk factors for the presence of septal hypertrophy. Conclusion: Despite variations in the type of maternal diabetes, IDM experience significant clinical challenges when hospitalized and monitored in the NICU. Infants born to mothers with IGT may also be subjected to maternal hyperglycemia. The likelihood of certain complications rises in infants born to pregnant women with inadequate glycemic control, particularly those with elevated HbA1c levels. By ensuring maternal glycemic control and closely monitoring these infants, it is possible to reduce both mortality and morbidity.

The Value of Admission Glycated Hemoglobin and Associated Factors in Non-Diabetic Patients with Heart Failure in Aden

Introduction: Heart failure (HF) is a multifactorial disorder characterized by impaired cardiac function, systemic inflammation and neurohormonal activation. It is a major cause of morbidity and mortality worldwide and has significant impacts on the quality of life, cost and longevity. This study was conducted to investigate the value of admission glycated hemoglobin (HbA1c) and associated factors among non-diabetic patients with heart failure. Methods: This is a descriptive prospective-hospital based study included 42 non-diabetic patients with HF on first occasion for admission at three major Aden hospitals for the period (January1st–December 31st, 2021). After thorough clinical history and examination, patients were investigated for random blood sugar, lipid profile, Pro Brain Natriuretic Peptide (Pro-BNP), HbA1c and followed till hospital discharge. Results: HF in non-diabetic patients predominates in males (81.0%) with a mean age of 56.0 ±11.5 years. The main associated factors were arterial hypertension (47.6%), coronary artery disease (9.5%), Khat chewing (57.1%), smoking (31.0%), obesity (28.6%), and family history of HF (21.4%). patients presented with New York Heart Association (NYHA) class III (47.6%) and low ejection fraction of ≤40.0% (76.2%). The median Pro-BNP was 2166.0 pg/mL, the mean admission HbA1c was 5.8% and the case fatality rate was 4.8%. The mean body mass index (BMI) was increasing with increasing level of admission HbA1c. HbA1c of 6.0-6.4% was associated with mortality cases and had significant positive association with BMI and significant negative association with total cholesterol. Conclusion: The admission HbA1c of 6.0-6.4% was associated with HF hospitalization and mortality in non-diabetic patients. This association is independent of age, gender, hypertension, hypercholesterolemia, glycemia, and clinical outcome suggesting direct effects of BMI on the development of high HbA1c level in non-diabetic patients with HF.

Irreversible atrophy in memory brain regions over 7 years is predicted by glycemic control in type 2 diabetes without mild cognitive impairment.

Memory-related impairments in type 2 diabetes may be mediated by insulin resistance and hyperglycemia. Previous cross-sectional studies have controversially suggested a relationship between metabolic control and a decrease in hippocampal volumes, but only longitudinal studies can test this hypothesis directly. We performed a longitudinal morphometric study to provide a direct test of a possible role of higher levels of glycated hemoglobin with long term brain structural integrity in key regions of the memory system - hippocampus, parahippocampal gyrus and fusiform gyrus. Grey matter volume was measured at two different times - baseline and after ~7 years. We found an association between higher initial levels of HbA1C and grey matter volume loss in all three core memory regions, even in the absence of mild cognitive impairment. Importantly, these neural effects persisted in spite of the fact that patients had significantly improved their glycemic control. This suggests that early high levels of HbA1c might be irreversibly associated with subsequent long-term atrophy in the medial temporal cortex and that early intensive management is critical.

Association between napping and type 2 diabetes mellitus.

As the incidence of type 2 diabetes mellitus (T2DM) is increasing rapidly and its consequences are severe, effective intervention and prevention, including sleep-related interventions, are urgently needed. As a component of sleep architecture, naps, alone or in combination with nocturnal sleep, may influence the onset and progression of T2DM. Overall, napping is associated with an increased risk of T2DM in women, especially in postmenopausal White women. Our study showed that napping >30 minutes (min) increased the risk of T2DM by 8-21%. In addition, non-optimal nighttime sleep increases T2DM risk, and this effect combines with the effect of napping. For nondiabetic patients, napping >30 min could increase the risks of high HbA1c levels and impaired fasting glucose (IFG), which would increase the risk of developing T2DM later on. For diabetic patients, prolonged napping may further impair glycemic control and increase the risk of developing diabetic complications (e.g., diabetic nephropathy) in the distant future. The following three mechanisms are suggested as interpretations for the association between napping and T2DM. First, napping >30 min increases the levels of important inflammatory factors, including interleukin 6 and C-reactive protein, elevating the risks of inflammation, associated adiposity and T2DM. Second, the interaction between postmenopausal hormonal changes and napping further increases insulin resistance. Third, prolonged napping may also affect melatonin secretion by interfering with nighttime sleep, leading to circadian rhythm disruption and further increasing the risk of T2DM. This review summarizes the existing evidence on the effect of napping on T2DM and provides detailed information for future T2DM intervention and prevention strategies that address napping.

Treatment intensification following glucagon-like peptide-1 receptor agonist in type 2 diabetes: Comparative effectiveness analyses between free vs. fixed combination of GLP-1 RA and basal insulin. RESTORE-G real-world study

Background and aimsAdd-on of basal insulin (BI) to intensify the ongoing therapy with glucagon-like peptide 1 receptor agonist (GLP-1 RA) is recommended, but it is unclear if free or fixed combination of BI and GLP-1 RA produce similar outcomes. A retrospective comparative effectiveness analysis of the add-on of glargine 300 U/mL (Gla-300) to ongoing GLP-1 RA vs. switch to fixed ratio combination of degludec and liraglutide (iDegLira) was performed. Methods and resultsReal-world data collected in electronic medical records by 32 Italian diabetes clinics. Propensity score (PS) adjustment was applied to assess changes in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), body weight, and BI dose after 6 months from Gla-300 or iDegLira initiation.Compared to iDegLira group (N = 260), Gla-300+GLP-1 RA group (N = 255) had older age and higher levels of HbA1c (9.1 vs. 8.9%). After 6 months, statistically significant greater FBG improvement [estimated mean difference and 95% confidence intervals: −24.05 mg/dl (−37.04; −11.06; p = 0.0003) and BI dose increase [+0.03 U/kg (95%CI 0.00; 0.06); p = 0.009] were found in the free vs. fixed combination group, although low doses of BI (0.2 U/kg) were reached in both groups. Trends of larger HbA1c and body weight reductions with the free combination were also found, without reaching the statistical significance. ConclusionAlthough inertia in insulin initiation and titration was documented in both groups, higher benefit on FBG control was obtained with free vs. fixed combination, likely due to a better titration of BI and GLP-1 RA.

Characteristics Associated With Elevated Time Below Range in Elderly Patients With Type 1 Diabetes Using an Automated Insulin Delivery System.

This study investigated the characteristics associated with an increased risk of hypoglycemia, in elderly patients with type 1 diabetes mellitus (T1D) using automated insulin delivery (AID) systems. Cross-sectional observational study including patients >60 years, using sensor-augmented insulin pump therapy with predictive low-glucose management (SAPT-PLGM), hybrid closed-loop (HCL), and advanced hybrid closed-loop (AHCL), for more than three months. A geriatric assessment was performed, and body composition was determined to investigate its association with achieving time below range (TBR) <70 mg/dL goals. The study included 59 patients (47.5% of men, mean age of 67.6 years, glycated hemoglobin [HbA1c] of 7.5 ± 0.6%, time in range (TIR) 77.8 ± 9.9%). Time below range <70 and <54 mg/dL were 2.2 ± 2.3% and 0.4 ± 0.81%, respectively. Patients with elevated TBR <70 mg/dL (>1%) had higher HbA1c levels, lower TIR, elevated time above range (TAR), and high glycemic variability. Regarding body composition, greater muscle mass, grip strength, and visceral fat were associated with a lower TBR <70 mg/dL. These factors were independent of the type of technology used, but TIR was higher when using AHCL systems compared with SAPT-PLGM and HCL systems. In elderly patients treated with AID systems with good functional status, lower lean mass, lower grip strength, and lower visceral fat percentage were associated with TBR greater than 1%, regardless of the device used. A similar finding along was found with CGM indicators such as higher HbA1c levels, lower TIR, higher TAR, and higher CV. Geriatric assessment is crucial for personalizing patient management.

Early HbA1c Levels as a Predictor of Adverse Obstetric Outcomes: A Systematic Review and Meta-Analysis.

Background: The objective was to assess the association between early HbA1c levels and pregnancy complications and whether this relationship is affected when HbA1c thresholds are greater than or less than 39 mmol/mol (5.7%). Methods: Electronic searches of the MEDLINE and EMBASE databases up to October 2022 were conducted. We included retrospective and prospective observational studies. The inclusion criteria were as follows: HbA1c measurements taken at <20 weeks' gestation, singleton pregnancy, and no pre-existing diabetes mellitus. Results: We assessed the certainty of the evidence with the GRADE system. We determined the proportion of patients in each group who met the criteria for obstetrical outcomes and pooled data into two subgroups according to the HbA1c threshold: <39 mmol/mol or >39 mmol/mol (5.7%). Sixteen studies with a total of 43,627 women were included. An association between elevated early HbA1c levels and pre-eclampsia, large for gestational age (LGA), macrosomia, and preterm delivery (RR 2.02, 95% CI 1.53-2.66; RR 1.38, 95% CI 1.15-1.66; RR 1.40, 95% CI 1.07-1.83; and RR 1.67, 95% CI 1.39-2.0, respectively) was shown, with a moderate-high grade of certainty. According to the subgroup analysis of all studies, LGA, pre-eclampsia, and labour induction were associated with elevated HbA1c levels only in studies using an HbA1c threshold >39 mmol/mol (5.7%). The association between HbA1c levels and premature birth was statistically significant in studies using both higher and lower HbA1c thresholds. Conclusions: Women with high early HbA1c levels below the range of diabetes presented an increased risk of pregnancy complications such as macrosomia, LGA, and pre-eclampsia. An early HbA1c threshold of >39 mmol/mol (5.7%) showed the strongest association with pregnancy complications.