Higher HbA1c Research Articles

Determination of SRPA and adiposity measures and its association with glycemic status in type 2 diabetics having high mean HbA1c in a private clinic of a city in west India.

Indian type 2 diabetics (T2D) is known for poor disease control on which self-reported physical activity (SRPA) and optimum body composition have positive impact. We determined prevalence of SRPA and general/visceral obesity and its impact on HbA1c-based glycemia. By a cross-sectional study conducted on 200 T2Ds in a private clinic, HbA1c-based glycemic status, WHO questionnaire-based SRPA, BMI-based general obesity, and bipolar bioelectrical impedance-based visceral obesity were evaluated. SRPA and obesity were compared and associated with glycaemic status keeping mean HbA1c as cutoff. Mean age, male%, mean duration of T2D, mean BMI, mean HbA1c, and SRPA prevalence were 54 years, 42.5%, 4.82 years, 25.49, 8.69%, and 61.5%, respectively. Comparison of groups based on either SRPA or BMI (cutoff 25) showed better HbA1c with the presence of SRPA and BMI <25. Physical inactivity imposed odds risk of 3.44 for visceral fat (VF) ≥10% and odds risk of 2.6 for more than mean HbA1c with statistical significances. VF ≥10% imposed odds risk of 4 for higher than mean HbA1c. Physical inactivity and visceral obesity together imposed ⅓rd prevalence of better glycaemic value, while physical activity and controlled visceral obesity yielded ¾th prevalence of good glycaemic value. In T2D with poor glycaemic status and moderately prevalent physical activity, we found strongly significant association of SRPA and controlled body adiposity with HbA1c-based glycaemic status. It reaffirms physical activity and control of central obesity as forerunners of better glycaemic status and calls for further studies having vertical follow-up.

Examining Food Security, Fruit and Vegetable Intake, and Cardiovascular Disease Risk Outcomes of Produce Prescription (PPR) Programs: A Systematic Review

Outcomes from produce prescription (PPR) programs, an exemplar of a Food is Medicine intervention, have not been synthesized. The objective of this study was to conduct a systematic review to examine the impact of PPR programs on food security, fruit and vegetable (FV) intake, and/or cardiovascular risk factors (HbA1c, blood pressure, and blood lipids). Searches were conducted across three databases (PubMed, CINAHL, and Web of Science). Eligible studies were published between August 2012 and April 2023, conducted in the US in child/family, or adult populations, written in English and had a PPR program as an exposure. Food security, FV intake, and/or cardiovascular risk factors. Twenty studies ranging from a duration of between 6 weeks to 24 months were included. Of the 5 studies (3 in child/family and 4 in adult populations) that analyzed changes in food security status, all reported significant (P < 0.05) improvements after the PPR program. Approximately half of the included studies found significant (P < 0.05) increases in fruit, vegetable, and/or FV intake. Only studies in adult populations included cardiovascular risk factor outcomes. In these studies, mixed findings were reported; however, there were significant (P < 0.05) improvements in HbA1c when PPR programs enrolled individuals with type 2 diabetes. PPR programs provide an opportunity to improve food security in child/family, and adult populations. Evidence to support whether PPR programs increase FV intake and improve cardiovascular disease risk factors outside of HbA1c in adult populations with high HbA1c upon enrollment is less known.

Type 2 diabetes mellitus as an independent risk factor of pulmonary tuberculosis: A hospital based cross-sectional study

Background: The growing frequency of infectious and non-communicable illnesses on a global scale is primarily associated with the changing patterns observed in epidemiology. Diabetes mellitus (DM) significantly leads to the development of tuberculosis (TB) and less effective treatment outcomes if not identified early. Objective: This study aims to investigate type 2 DM as a risk factor for TB infection.Methods: Participants in this cross-sectional research study comprised DM patients who reported cough complaints at the TB treatment center and the internal medicine department of Zainoel Abidin Hospital. Random blood glucose and glycated hemoglobin (HbA1c) levels were measured in all respondents. The Chi-Square test assesses the association between DM and Pulmonary TB.Results: There are 48 DM patients with new pulmonary TB, an averageage of 53 years (SD 9.1). Most of them have symptoms of cough for more than 2 weeks (85.4%), loss of body weight (77.1%), chest pain (58.3%), and loss of appetite (72.9%). The high HbA1c levels were associated with TB, as detected by Xpert MTB/RIF assay and typical radiographic signs (p&lt;0.05). DM patients with increased HbA1c were found to have a two times chance of showing results from a chest x-ray typical of TB and probability of TB infection (PR: 2.850, 95% CI (1.152-7.053); 2.745, 95% CI (0.969-7.780)) respectively.Conclusion: DM patients had two times the risk of lung damage based on chest X-rays and having TB. DM may seriously compromise the efficacy of TB control programs and impede a nation's progress toward TB elimination.

Cachexia-related consequences of glycemic metabolism: A multivariable and two-step Mendelian randomization study

BackgroundCachexia is a global burden that is caused by chronic diseases such as cancer. It is characterized by inflammation and progressive loss of muscle and adipose tissue, aggravating the patient’s health. Glycemic metabolism disorders exacerbate cachexia and mutually reinforce each other. Thus far, no research has established a connection between the two. Therefore, we aim to explore the influence of glucose metabolism on cachexia using Mendelian randomization (MR) and provide a theoretical basis for the early prediction of cachexia. MethodsWe used glycemic traits (type 2 diabetes (T2D), fasting glucose (FG), fasting insulin (FI), hemoglobin A1c (HbA1c), and 2-hour postprandial glucose (2hPG)) as exposures; and cachexia traits (hand grip strength (HGS), appendicular lean mass (ALM), and walking pace (WP)) as outcomes. 22 mediators were included for mediating effects. Multivariable and mediation MR were used to assess the impact of glycemic metabolism on cachexia. ResultsIn univariate MR, higher FI increased HGS (β = 0.113, 95% confidence interval (CI): 0.060–0.166) and WP (β = 0.066, 95% CI: 0.021–0.112). Higher HbA1c was associated with higher ALM (β = 0.067, 95% CI: 0.017–0.117). Higher 2hPG was associated with weaker HGS (β = −0.037, 95% CI: −0.054 to −0.021). In multivariable MR, only FI maintained a relationship with HGS after adjustments for T2D (β = 0.103, 95% CI: 0.026–0.181), FG (β = 0.101, 95% CI: 0.034–0.169), HbA1c (β = 0.115, 95% CI: 0.055–0.176), and 2hPG (β = 0.101, 95% CI: 0.033–0.169). In mediation MR, three mediators were found to be significant between FI and HGS: waist circumference (WC) (48.1%), lumbar spine bone mineral density (LSBMD) (21.3%) and insulin-like growth factor 1 (IGF-1) (6.7%). ConclusionsUsing multivariable and mediation MR, our finding suggests that higher FI increases HGS with an independent effect. WC, LSBMD, and IGF-1 mediate between FI and HGS. This study offers a theoretical framework for the early prediction and assessment of the prognosis of cachexia in cancer patients with glycemic metabolism disorders.

Sex-based differences in the associations between abdominal obesity and diabetic retinopathy in diabetic patients with normal weight

PurposeTo investigate sex-specific differences in associations of abdominal obesity indexes, systemic factors, and diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) subjects with normal body mass index (BMI). MethodsThis cross-sectional study comprised 653 T2DM subjects (402 women and 251 men) with normal BMI (18.5 kg/m2<BMI<24.0 kg/m2). All participants completed a standard questionnaire and underwent comprehensive ocular and systemic examinations. Anthropometric parameters were measured and recorded, including weight, height, waist circumference (WC), hip circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Sex-specific associated factors for DR were assessed using logistic regression models. ResultsIn the multivariate logistic regressions, the presence of any DR was associated with a longer duration of T2DM (OR = 1.07, p = 0.007) and higher HbA1c (OR = 1.40, p = 0.001) in women, while any DR was associated with younger age at T2DM diagnosis (OR = 0.94, p = 0.020) and higher HbA1c (OR = 1.29, p = 0.011) in men. For women, we identified a positive association between WC (OR = 1.07, p = 0.011), WHR (OR = 1.67, p = 0.002), and WHtR (OR = 1.57, p = 0.004) with any DR after adjusting for confounders, and the third tertiles of WC (OR = 2.29, p = 0.028), WHR (OR = 3.03, p = 0.003), and WHtR (OR = 2.84, p = 0.007) were at high risk of any DR. For men, there were no associations between abdominal obesity indexes and any DR in either continuous variables or categorical variables (all p > 0.05). Main conclusionsThere were sex differences in the relationships between WC, WHR, WHtR, and DR in this T2DM population with normal BMI. Our findings provide new insight into a sex-specific mechanism of DR and management of the condition.

Immunosuppression and transplantation-related characteristics affect the difference between eGFR equations based on creatinine compared to cystatin C in kidney transplant recipients.

Previous studies show heterogeneity when applying estimated glomerular filtration (eGFR) equations to kidney transplant recipients (KTRs). However, research on the impact of transplantation-related characteristics on eGFR equations using creatinine (eGFRcr) compared to cystatin C (eGFRcys) is scarce. We conducted a comprehensive analysis with three eGFRcr equations (Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009, European Kidney Function Consortium (EKFC) 2021, kidney recipient specific-glomerular filtration rate KRS-GFR) 2023), comparing them to two eGFRcys (CKD-EPI 2012 and EKFC 2023) in 596 KTRs. Bland-Altman plots demonstrated relative differences according to different eGFR-stages. Multivariable logistic regression identified transplantation-related characteristics independently associated with smaller or greater differences between eGFRcr and eGFRcys equations. 94.3% of the cohort were White individuals. Median eGFR differed as much as 9ml/min/1.73 m2 between equations. The median relative differences (Q2) were greater (more negative) when comparing the eGFRcr equations to eGFRcys CKD-EPI 2012, than when comparing them to eGFRcys EKFC 2023 (P<.001). Better average eGFR was associated with smaller mean relative differences in all comparisons but eGFRcr CKD-EPI 2009 with eGFR EKFC 2023 and eGFRcr EKFC 2021 with eGFRcys EKFC 2023. Living kidney donation and belatacept use were independent factors associated with a smaller difference (≥Q3) between eGFRcr and eGFRcys equations, while prednisone use or higher HbA1c were independently associated with a greater difference (≤Q1) between equations. Different eGFR-stages, donor, or recipient characteristics, along with immunosuppression such as belatacept or prednisone, contribute to differences between eGFRcr and eGFRcys. These effects need to be considered in the clinical management of KTRs.

Racial Discrimination, Religious Coping, and Cardiovascular Disease Risk Among African American Women and Men.

This cross-sectional study examined whether religious coping buffered the associations between racial discrimination and several modifiable cardiovascular disease (CVD) risk factors-systolic and diastolic blood pressure (BP), glycated hemoglobin (HbA1c), body mass index (BMI), and cholesterol-in a sample of African American women and men. Participant data were taken from the Healthy Aging in Neighborhoods of Diversity Across the Life Span study (N = 815; 55.2% women; 30-64years old). Racial discrimination and religious coping were self-reported. CVD risk factors were clinically assessed. In sex-stratified hierarchical regression analyses adjusted for age, socioeconomic status, and medication use, findings revealed several significant interactive associationsand opposite effects by sex. Among men who experiencedracial discrimination, religious coping was negatively related to systolic BP and HbA1c. However, in men reporting no prior discrimination, religious coping was positively related to most risk factors. Among women who had experienced racialdiscrimination, greater religious coping was associated with higher HbA1c and BMI. The lowest levels of CVD risk were observed among women who seldom used religious coping but experienced discrimination. Religious coping might mitigate the effects of racial discrimination on CVD risk for African American men butnot women. Additional work is needed to understand whether reinforcing these coping strategies only benefits those who have experienced discrimination. It is also possible that religion may not buffer the effects of other psychosocial stressors linked with elevated CVD risk.

Association between Glycosylated Hemoglobin Levels and Vaccine Preventable Diseases: A Systematic Review.

People with diabetes are at higher risk of serious complications from many vaccine-preventable diseases (VPDs). Some studies have highlighted the potential impact of glycosylated hemoglobin levels (HbA1c), but no systematic review has synthesized these findings. Of the 823 identified studies, 3 were included, for a total of 705,349 participants. Regarding the incidence of herpes zoster (HZ), one study found that higher HbA1c levels at the baseline (>10.3%) were associated with a significantly higher risk of HZ of 44%, compared to those with a good HbA1c control (6.7%). On the contrary, the second one reported that when compared to the reference group (HbA1c of 5.0-6.4%), participants with a HbA1c less than 5.0% were at higher risk of HZ of 63%, whilst participants with a HBA1c more than 9.5% had a similar risk. Finally, the third study observed that diabetes, defined using a value of HbA1c more than 7.5%, was associated with an increased risk of mortality in men with COVID-19. In conclusion, both high and low HBA1c levels appear to be associated with a higher risk of HZ. Regarding COVID-19, a value of HbA1c more than 7.5% was associated with a higher risk of death in COVID-19, but only in men.

Longitudinal analysis of serum urate in prediabetic phase.

Despite the well-established association between prediabetes and hyperuricaemia, knowledge about serum urate (SU) trends during the prediabetic phase is limited. Therefore, we aimed to assess the longitudinal changes of SU in individuals with prediabetes. Individuals with prediabetes, defined by initial haemoglobin A1c (HbA1c) levels between 5.7% and 6.4%, were identified using electronic health records from an academic health system (2007-2022). We required at least one SU test before and after the prediabetes diagnosis. The primary outcome was the longitudinal SU trends during the follow-up period, estimated with a multivariable mixed-effects model. Patients were censored at diabetes onset. Marginal effects of covariates on SU changes were estimated. Subsequent analyses examined SU variations in subgroups stratified by age, sex, BMI, HbA1c, estimated glomerular filtration rate and metformin use. Out of 25 526 individuals with prediabetes, 1521 met the SU cohort requirements, contributing to 6832 SU observations. At baseline, median age was 63 years and 40% were female. Median values were SU 6.3 mg/dl, HbA1c 5.9% and BMI 30 kg/m2. Median follow-up was 7.4 years. Older age, male sex, greater BMI and higher HbA1c were significant predictors of increased longitudinal SU levels. Individuals with a BMI ≥30 kg/m2 exhibited higher SU levels compared with those with lower BMI values. Among individuals with prediabetes, several baseline variables were significant predictors of increased SU levels over time. These longitudinal trends in SU, support the potential for early intervention during the prediabetic phase, possibly reducing the risk of gout.

Disruption of insulin receptor substrate 2 (IRS2) causes non-obese type 2 diabetes with β-cell dysfunction in the golden (Syrian) hamster

Because of the advent of genome-editing technology, gene knockout (KO) hamsters have become attractive research models for diverse diseases in humans. This study established a new KO model of diabetes by disrupting the insulin receptor substrate-2 (Irs2) gene in the golden (Syrian) hamster. Homozygous KO animals were born alive but with delayed postnatal growth until adulthood. They showed hyperglycemia, high HbA1c, and impaired glucose tolerance. However, they normally responded to insulin stimulation, unlike Irs2 KO mice, an obese type 2 diabetes (T2D) model. Consistent with this, Irs2 KO hamsters did not increase serum insulin levels upon glucose administration and showed β-cell hypoplasia in their pancreas. Thus, our Irs2 KO hamster provide a unique T2D animal model that is distinct from the obese T2D models. This model may contribute to a better understanding of the pathophysiology of human non-obese T2D with β-cell dysfunction, the most common type of T2D in East Asian countries, including Japan.

Effects of ACLY Inhibition on Body Weight Distribution: A Drug Target Mendelian Randomization Study.

Background: Adenosine triphosphate-citrate lyase (ACLY) inhibition has proven clinically efficacious for low-density lipoprotein cholesterol (LDL-c) lowering and cardiovascular disease (CVD) risk reduction. Clinical and genetic evidence suggests that some LDL-c lowering strategies, such as 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) inhibition with statin therapy increase body weight and the risk of developing type 2 diabetes mellitus (T2DM). However, whether ACLY inhibition affects metabolic risk factors is currently unknown. We aimed to investigate the effects of ACLY inhibition on glycaemic and anthropometric traits using Mendelian randomization (MR). Methods: As genetic instruments for ACLY inhibition, we selected weakly correlated single-nucleotide polymorphisms at the ACLY gene associated with lower ACLY gene expression in the eQTLGen study (N = 31,684) and lower LDL-c levels in the Global Lipid Genetic Consortium study (N = 1.65 million). Two-sample Mendelian randomization was employed to investigate the effects of ACLY inhibition on T2DM risk, and glycaemic and anthropometric traits using summary data from large consortia, with sample sizes ranging from 151,013 to 806,834 individuals. Findings for genetically predicted ACLY inhibition were compared to those obtained for genetically predicted HMGCR inhibition using the same instrument selection strategy and outcome data. Results: Primary MR analyses showed that genetically predicted ACLY inhibition was associated with lower waist-to-hip ratio (β per 1 standard deviation lower LDL-c: -1.17; 95% confidence interval (CI): -1.61 to -0.73; p < 0.001) but not with risk of T2DM (odds ratio (OR) per standard deviation lower LDL-c: 0.74, 95% CI = 0.25 to 2.19, p = 0.59). In contrast, genetically predicted HMGCR inhibition was associated with higher waist-to-hip ratio (β = 0.15; 95%CI = 0.04 to 0.26; p = 0.008) and T2DM risk (OR = 1.73, 95% CI = 1.27 to 2.36, p < 0.001). The MR analyses considering secondary outcomes showed that genetically predicted ACLY inhibition was associated with a lower waist-to-hip ratio adjusted for body mass index (BMI) (β = -1.41; 95%CI = -1.81 to -1.02; p < 0.001). In contrast, genetically predicted HMGCR inhibition was associated with higher HbA1c (β = 0.19; 95%CI = 0.23 to 0.49; p < 0.001) and BMI (β = 0.36; 95%CI = 0.23 to 0.49; p < 0.001). Conclusions: Human genetic evidence supports the metabolically favourable effects of ACLY inhibition on body weight distribution, in contrast to HMGCR inhibition. These findings should be used to guide and prioritize ongoing clinical development efforts.

Study of clinical and histopathological factors predicting rapid progression in biopsy-proven type 2 diabetic kidney disease

Introduction: Rapid progression of diabetic kidney disease (DKD) is a significant concern, particularly in developing countries. It remains uncertain whether histopathological parameters, in addition to clinical factors, can predict DKD progression. Objectives: To evaluate renal histopathological and clinical parameters in predicting rapid progression to end-stage kidney disease (ESKD) in type 2 diabetes mellitus (Type 2 DM) patients with biopsy-proven DKD. Patients and Methods: This was an observational retrospective study that included 49 biopsy-proven DKD from January 2018 to December 2022. Those with less than six months of follow-up and CKD stage 5 were excluded. The outcomes studied were rapid progression and progression to ESKD. Patients were categorized into rapid progressors and non-progressors based on the estimated glomerular filtration (eGFR) decline of &gt; or &lt;10 mL/min/1.73 m2 /year, respectively. The association of histopathological factors and clinical parameters with rapid progression and independent risk factors for progression to ESKD were analysed using SPSS 22. Results: In a median follow-up of 1.6 years, 57% were rapid progressors, and 42.9% were non-progressors, with a median eGFR decline of 21 mL/min/1.73 m2 /year and 5 mL/min/1.73 m2 /year, respectively. Among histopathological factors, global glomerular sclerosis (class 4) predicted rapid progression (P= 0.03), since among clinical factors, hypertension (89.3%) elevated hemoglobin A1c (HbA1c) (9.6%), and massive proteinuria (75.1%) were significant parameters associated with rapid progression (P&lt;0.05). In Cox regression analysis, the progression to ESKD was independently associated with global glomerular sclerosis (HR 1.1, CI 1.0-1.4, P=0.04) and massive proteinuria (HR 1.6, CI 1.0-2.1, P=0.01) Conclusion: In our cohort, hypertension, high HbA1c, severe proteinuria, and global glomerular sclerosis (Class 4) were associated with rapid progression. Severe proteinuria and global glomerular sclerosis were independent risk factors for progression to ESKD. This highlights the need for large prospective studies in identifying the factors predicting rapid progressors in DKD; therefore, timely intervention can be considered.

Diabetes‐related distress in people with type 2 diabetes: experience from a community diabetes clinic

AbstractBackground: Diabetes distress is the term used to describe the diabetes‐specific emotional distress resulting from the challenges of managing this demanding chronic condition.Aims: This study aimed to determine the prevalence of diabetes distress and its subtypes in adults with type 2 diabetes who attended our community‐based clinics and to investigate the relationship between diabetes distress scores and demographic factors and diabetes variables (HbA1c and treatment regimen).Methods: Patients were referred to our specialist diabetes team by primary care teams. Clinical details, including current treatment regimen and recent HbA1c result, were recorded. Patients then completed the Diabetes Distress Scale (DDS) 17 questionnaire. Data from all 82 patients who attended our clinic from May 2022 to November 2022 were analysed.Results: A high level of diabetes distress (mean score of ≥3) was found in 17 patients (20.7%), and a moderate level of diabetes distress was found in 22 patients (26.8%). Patients with an HbA1c of &gt;90mmol/mol had significantly higher mean regimen‐related distress than those with an HbA1c of &lt;60mmol/mol (2.58±1.18 vs 1.86±0.8, respectively; p=0.03). In addition, patients with higher HbA1c had higher diabetes‐related emotional distress than those with lower HbA1c. However, this result did not demonstrate statistical significance. Conversely, patients with optimal HbA1c levels had significantly lower mean interpersonal distress scores than the rest of the cohort (1.13±0.99 vs 1.80±0.99, respectively; p=0.01).Conclusions: Diabetes distress is common among patients attending community‐based diabetes services. Further research is needed to determine the most effective strategies for reducing diabetes distress and improving clinical outcomes.

Predictors of limb saving in diabetic foot ulcer.

This study was aimed to determine the various factors which could serve as predictor of saving of lower limb from amputation in patients with diabetic foot ulcer (DFU). This three-year retrospective study was conducted in the Diabetes and Endocrinology Unit of Hayatabad Medical complex Peshawar, Pakistan. Demographic, clinical, laboratory and radiological information of the diabetic patients with DFU admitted between January 2020 to December 2022 was retrieved from the hospital files. Information regarding initial and final decision regarding amputation and the outcome of the ulcer was also recorded. A total of 502 patients of diabetes mellitus (DM) with DFU were included in the study, of whom there were 279 (55.6%) males and 223 (44.4%) females. The mean age of the study population, mean duration of DM and mean HbA1c were 55.2 ± 9.8 years, 13.7 ± 6.7 years and 11.2 ± 2.4 %, respectively. Patients who had an amputation of their lower limbs had an increased age (p= 0.034), raised total leucocyte count (TLC) (p= <0.001), higher HbA1c (p= 0.025), had osteomyelitis (p= <0.001), and had a higher-grade ulcer (p= <0.001). On binary logistic regression analysis, ulcer grade (OR=7.4, p= <0.001), osteomyelitis (OR=11.8, p= <0.001), and initial decision of no amputation at the time of admission (OR=33.6, p=<0.001) were independently associated with the lower limb salvage. DFU which were of grade I to II, had no evidence of osteomyelitis and for which an initial decision was of no amputation were more likely to be salvaged.

Gestational Diabetes and Subsequent Metabolic Dysfunction: An National Health and Nutrition Examination Survey Analysis (2011-2018).

Background: Gestational diabetes mellitus (GDM) complicates ∼10% of pregnancies, with the highest rates among Asian women. Evidence suggests that GDM is associated with an increased risk for future chronic health conditions, yet data for Asian women are sparse. We explored the association between prior GDM and metabolic dysfunction with nationally representative data to obtain Asian-specific estimates. Methods: For this cross-sectional study, data were drawn from the National Health and Nutrition Examination Survey for 7195 women with a prior pregnancy. GDM (yes/no) was defined using the question "During pregnancy, were you ever told by a doctor or other health professional that you had diabetes, sugar diabetes, or gestational diabetes?." Current metabolic dysfunction (yes/no) was based on having at least one of four indicators: systolic blood pressure (SBP, ≥130 mmHg), waist circumference (≥88 cm), high-density lipoprotein (HDL) cholesterol (<50 mg/dL), and glycosylated hemoglobin (HbA1c) (≥6.5%). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between prior GDM and metabolic outcomes, overall and by race. Models included sampling weights and demographic and behavioral factors. Results: Overall, women with prior GDM had 46% greater odds of high waist circumference (OR: 1.5; 95% CI: 1.1-2.0) and 200% greater odds (OR: 3.0; 95% CI: 2.1-4.2) of high HbA1c. Prior GDM was not associated with high blood pressure or low HDL cholesterol. In race-specific analyses, prior GDM was associated with increased risk of elevated HbA1c among Asian (OR: 6.6; 95% CI: 2.5-17.2), Mexican American (OR: 3.0; 95% CI: 1.5-5.8), Black (OR: 3.0; 95% CI: 1.7-5.5), and White (OR: 2.6; 95% CI: 1.5-4.6) women. Prior GDM was associated with elevated SBP among Mexican American women and low HDL among Black women. Discussion: Prior GDM is associated with elevated HbA1c among all women, yet is a stronger predictor of elevated HbA1c among Asian women than other women. Race-specific associations between prior GDM and metabolic dysfunction were observed among Mexican American and Black women. Further research is warranted to understand the observed race/ethnic-specific associations.

Temporal Relationship between HbA1c and Depressive Symptom Trajectories in a Longitudinal Cohort Study: The Mediating Role of Healthy Lifestyles.

This study analyzed China Health and Retirement Longitudinal Study data to explore the HbA1c-depression link, including depressive trajectories, while considering the mitigating impact of healthy lifestyles. Cross-lagged panel models and group-based trajectory modeling were performed to investigate the temporal relationship between HbA1c levels and depressive symptoms, as well as the depressive trajectories. Structural equation models were used to assess the mediating effects of healthy lifestyles. The mean age of the participants was 57.66 ± 9.04 years, with 53.68% being female. Analyzing 8826 participants across three waves, we observed a significant prediction of subsequent depressive symptoms by the preceding HbA1c levels (β = 0.296; p < 0.001). Four distinct trajectories of depressive symptoms were distinguished: stable low, stable moderate, increasing, and stable high. Elevated HbA1c levels were associated with a higher risk of developing stable high (OR 1.12 and 95% CI 1.02-1.23), increasing (OR 1.21 and 95% CI 1.11-1.32), and stable moderate depressive symptoms (OR 1.07 and 95% CI 1.01-1.13). Engaging in two healthy life behaviors reduced stable high and increasing depressive pattern risks by 32% and 30%, respectively. Adherence to a healthy lifestyle lessened 7.2% of the impact of high HbA1c levels on the subsequent depressive symptoms. These findings highlight the potential benefits of incorporating adequate sleep and light physical activities, which might reduce the adverse impact of elevated HbA1c levels on depressive symptoms.

Prediction of retinopathy through machine learning in diabetes mellitus

Aims: Development of a machine learning model on an electronic health record (EHR) dataset for predicting retinopathy in people with diabetes mellitus (DM), analysis of its explainability. Methods: A public dataset based on EHR records of patients diagnosed with DM located in İstanbul, Turkiye (n=77724) was used. The categorical variable indicating a retinopathy-positive diagnosis was chosen as the target variable. Variables were preprocessed and split into training and test sets with the same ratio of class distribution for model training and evaluation respectively. Four machine learning models were developed for comparison: logistic regression, decision tree, random forest and eXtreme Gradient Boosting (XGBoost). Each algorithm’s optimal hyperparameters were obtained using randomized search cross validation with 10-folds followed by the training of the models based on the results. The receiver operating characteristic (ROC) area under curve (AUC) score was used as the primary evaluation metric. SHapley Additive exPlanations (SHAP) analysis was done to provide explainability of the trained models. Results: The XGBoost model showed the best results on retinopathy classification on the test set with a low amount of overfitting (AUC: 0.813, 95% CI: 0.808-0.819). 15 variables that had the highest impact on the prediction were obtained for explainability, which include eye-ear drugs, other eye diseases, Disorders of refraction, Insulin aspart and hemoglobin A1c (HbA1c). Conclusion: Early detection of retinopathy based on EHR data can be successfully detected in people with diabetes using machine learning. Our study reports that the XGBoost algorithm performed best in this research, with the presence of other eye diseases, insulin dependence and high HbA1c being observed as important predictors of retinopathy.

Liver fibrosis prediction models in a population of Latina and White women.

Point-of-care tools to assess advanced liver fibrosis, including the NFS, BARD, FIB-4, and APRI, are of major interest due to their noninvasive nature. However, these tools have not been investigated extensively in the Latina population. Given that the highest rate of NAFLD in Latinos and the most severe presentation of non-alcoholic fatty liver disease (NAFLD) is more common in women, we hypothesize that ethnicity may play a role in predicting liver fibrosis, particularly in women. We determined whether ethnicity alone or in association with other parameters can predict the severity of fibrosis in women with NAFLD when included in four tools. We retrospectively included 562 Latina and 133 White Caucasian women with a history of NAFLD. Associations between ethnicity and liver fibrosis severity using the four fibrosis predictor models were studied using backward selection multinomial logistic regression. Latina women compared to White showed lower body mass index (p < 0.001), higher HbA1c (p < 0.001), lower prevalence of bariatric surgery (p < 0.001), lower likelihood to smoke (p = 0.003), and higher prevalence of chronic kidney disease stages 3-5 (p = 0.01). Some clinical variables were associated with fibrosis but not univocally in each tool. We did not find differences in the outcome of the four models when holding all other factors and examining ethnicity alone between Latina and White women. Although we did not include data on liver histology, this is the first study examining the role of ethnicity in predicting the severity of fibrosis using established noninvasive scores and documenting no association between Latina ethnicity and the severity of fibrosis in women with NAFLD.

Perceived glucose levels matter more than CGM-based data in predicting diabetes distress in type 1 or type 2 diabetes: a precision mental health approach using n-of-1 analyses.

Diabetes distress is one of the most frequent mental health issues identified in people with type 1 and type 2 diabetes. Little is known about the role of glucose control as a potential contributor to diabetes distress and whether the subjective perception of glucose control or the objective glycaemic parameters are more important for the experience. With the emergence of continuous glucose monitoring (CGM), this is a relevant question as glucose values are now visible in real-time. We employed a precision monitoring approach to analyse the independent associations of perceived and measured glucose control with diabetes distress on a daily basis. By using n-of-1 analyses, we aimed to identify individual contributors to diabetes distress per person and analyse the associations of these individual contributors with mental health at a 3 month follow-up. In this prospective, observational study, perceived (hypoglycaemia/hyperglycaemia/glucose variability burden) and measured glucose control (time in hypoglycaemia and hyperglycaemia, CV) were assessed daily for 17 days using an ecological momentary assessment (EMA) approach with a special EMA app and CGM, respectively. Mixed-effect regression analysis was performed, with daily diabetes distress as the dependent variable and daily perceived and CGM-measured metrics of glucose control as random factors. Individual regression coefficients of daily distress with perceived and CGM-measured metrics were correlated with levels of psychosocial well-being at a 3 month follow-up. Data from 379 participants were analysed (50.9% type 1 diabetes; 49.6% female). Perceived glucose variability (t=14.360; p<0.0001) and perceived hyperglycaemia (t=13.637; p<0.0001) were the strongest predictors of daily diabetes distress, while CGM-based glucose variability was not significantly associated (t=1.070; p=0.285). There was great heterogeneity between individuals in the associations of perceived and measured glucose parameters with diabetes distress. Individuals with a stronger association between perceived glucose control and daily distress had more depressive symptoms (β=0.32), diabetes distress (β=0.39) and hypoglycaemia fear (β=0.34) at follow-up (all p<0.001). Individuals with a stronger association between CGM-measured glucose control and daily distress had higher levels of psychosocial well-being at follow-up (depressive symptoms: β=-0.31; diabetes distress: β=-0.33; hypoglycaemia fear: β=-0.27; all p<0.001) but also higher HbA1c (β=0.12; p<0.05). Overall, subjective perceptions of glucose seem to be more influential on diabetes distress than objective CGM parameters of glycaemic control. N-of-1 analyses showed that CGM-measured and perceived glucose control had differential associations with diabetes distress and psychosocial well-being 3 months later. The results highlight the need to understand the individual drivers of diabetes distress to develop personalised interventions within a precision mental health approach.

The clinical utility of handgrip strength as a malnutrition screening tool in hospitalized older adults: a cross-sectional study in Saudi Arabia.

Malnutrition is prevalent among hospitalized older patients. Early identification is therefore essential to implementing appropriate therapeutic interventions. This study aimed to explore the correlation between handgrip strength (HGS) and nutritional status in hospitalized older adults. This observational cross-sectional study was conducted at King Abdulaziz University Hospital, where a consecutive cohort of older adult inpatients was enrolled for participation. Shortly after admission, HGS and nutritional status were assessed using a dynamometer and the most recent version of the Mini-Nutritional Assessment Short Form (MNA-SF) test, respectively. Key anthropometric and biochemical indicators were also collected. A total of 135 consecutive patients were evaluated. Among participants with low HGS, 18 (16.22%) were malnourished, 43 (38.74%) were at risk of malnutrition, and 50 (45.05%) had normal nutrition status. The participants with low HGS had low hemoglobin, low lymphocyte levels, high creatinine levels, high BUN levels, high CRP levels, high HbA1c levels, and high vitamin B12 levels. Multiple logistic regression analysis showed that age, hemoglobin, and HbA1C were independently associated with low HGS. Based on the cut-off values for the HGS by the European Working Group on Sarcopenia in Older People-2 (EWGSOP2), low HGS showed high sensitivity to detect "malnourished and at risk of malnutrition" as well as "malnourished alone;" however, the specificity was low to exclude "malnourished and at risk of malnutrition" as well as "malnutrition alone." Age over 75 years, low hemoglobin, and elevated HbA1C levels were independent risk factors for low HGS. While HGS was sensitive in detecting malnutrition or risk, its specificity was low. Therefore, HGS may not be adequate as a standalone tool to assess nutritional status in hospitalized older adults. Replication of this study using locally reliable and validated HGS cut-off values is warranted to confirm these findings.