Indicator Of Glycemic Control Research Articles

Positive association of the anti-aging protein α-Klotho with insulin resistance and its inverse L-shaped relationship with glycaemic control in the middle-aged and elderly population.

α-Klotho has been linked to insulin resistance (IR) in basic research. However, experimental evidence is inconsistent, and there is a lack of data from human research. This study seeks to elucidate the association of α-Klotho with IR in a nationwide, multiracial population. A total of 5289 participants aged 40-79 years were included in the National Health and Nutrition Examination Survey (NHANES) spanning 2007-2016. Serum α-Klotho was measured using enzyme-linked immunosorbent assays (ELISA), and IR was evaluated by the homeostatic model assessment of insulin resistance (HOMA-IR). Weighted multivariate logistic and linear regression analysis, subgroup analysis stratified by demographic characteristics, medical condition or obesity status, and sensitivity analysis using propensity score matching (PSM) were performed. Restricted cubic splines (RCS) were performed to explore the nonlinear relationship. In the fully adjusted logistic regression model, a significant positive association was observed between log-transformed α-Klotho and IR (OR = 3.63, 95% CI: 1.56, 8.45), particularly in males or nonobese individuals (Pinteraction < 0.05). In the linear regression model, log10(α-Klotho) was associated with fasting blood glucose (FBG, β = 1.25, 95% CI: 0.74, 1.76) and glycosylated hemoglobin (HbA1c, β = 0.49, 95% CI: 0.20, 0.77). RCS revealed an inverse L-shaped dose-response relationship of α-Klotho with FBG and HbA1c (Pnonlinear <0.05). Beyond the inflection point of log10(α-Klotho) at 2.79, β coefficients sharply rose for these glycaemic control indicators. The study provides clinical evidence supporting a positive association between α-Klotho and IR. Moreover, the inverse L-shaped relationship suggests that α-Klotho should reach a certain level to predict glycaemic changes effectively.

Cross-sectional associations of self-perceived stress and hair cortisol with metabolic outcomes and microvascular complications in type 2 diabetes.

Increasing evidence supports chronic psychological stress as a risk factor for the development of type 2 diabetes. Much less is known, however, about the role of chronic stress in established diabetes. The aim of the current study was to comprehensively assess chronic stress in a sample of 73 patients with type 2 diabetes and 48 non-diabetic control participants, and to investigate associations with indicators of glycemic control (HbA1c), insulin resistance (HOMA-IR), β-cell functioning (C-peptide), illness duration, and the presence of microvascular complications. Chronic stress was measured using questionnaires [the Perceived Stress Scale (PSS), the Screening Scale of the Trier Inventory of Chronic Stress (SSCS), the Perceived Health Questionnaire (PHQ) as well as the Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R)]; hair cortisol was used as a biological indicator. We found that patients with type 2 diabetes had higher levels of hair cortisol in comparison to the control group (F(1,112) = 5.3; p = 0.023). Within the diabetic group, higher hair cortisol was associated with a longer duration of the illness (r = 0.25, p = 0.04). General perceived stress did not show significant associations with metabolic outcomes in type 2 diabetes patients. In contrast, higher diabetes-related distress, as measured with the QSD-R, was associated with lower glycemic control (r = 0.28, p = 0.02), higher insulin resistance (r = 0.26, p = 0.03) and a longer duration of the illness (r = 0.30, p = 0.01). Our results corroborate the importance of chronic psychological stress in type 2 diabetes. It appears, however, that once type 2 diabetes has developed, diabetes-specific distress gains in importance over general subjective stress. On a biological level, increased cortisol production could be linked to the course of the illness.

Results of a retrospective study of the clinical efficacy and safety of insulin RinFast® in children with type 1 diabetes mellitus

BACKGROUND: The relevance of the study is justified by the fact that in recent years, the original insulin preparations have been replaced with biosimilars in the regions of the Russian Federation, but there are currently few studies describing the use of insulin biosimilars in children with type 1 diabetes mellitus (DM1), both in domestic and foreign sources.AIM: To evaluate the efficacy and safety insulin therapy with RinFast® (GEROPHARM LLC, Russia) as bolus therapy in combination with long-acting insulin and as monotherapy in an insulin pump in children with DM1 in real clinical practice.MATERIALS AND METHODS: The dynamics of HbA1c after 3 and 6 months, the change in daily insulin requirements, the fre quency of episodes of postprandial hyper- and hypoglycemia, adverse reactions at injection sites, the number of patients who reached the target values of HbA1c in children with DM1 who received RinFast® at least 6 months after the original analogue of insulin aspart were evaluated.RESULTS: The study was conducted in 50 children with DM1 from 1 to 18 years old (average age 9.8±4.6 years), with a duration of DM1 of more than 1 year (average duration 3.5±2.1 years), who had glycated hemoglobin (HbA1c) at the beginning of follow-up of no more than 9.5% and received biosimilar RinFast® for at least 6 months after the transfer from the original analogue of insulin aspart. Basic bolus insulin therapy in 36 children was carried out using multiple injections of insulin (MII), in 14 — continuous supply of insulin (NPI) using an insulin pump. The study resulted in HbA1c levels comparable to the baseline 3 and 6 months after the start of therapy with the RinFast® biosimilar (p=0.05), no changes in the daily ­insulin ­requirement (p=0.05) and no increase in the frequency of episodes of postprandial hyper- (p=0.05) and hypoglycemia (p=0.05) and adverse events (p=0.05). High adherence to treatment with the RinFast® biosimilar was noted.CONCLUSION: The results obtained indicate the absence of a clinically significant deterioration in glycemic control indicators after the transfer of children with DM1 to therapy with the RinFast® biosimilar, which makes it possible to use it safely and effectively in this category of patients.

Use of HbA1c as index of glycemic control and lipid profile in diabetic individuals

Use of HbA1c as index of glycemic control and lipid profile in diabetic individuals

Associations Between HbA1c and Glucose Time in Range Using Continuous Glucose Monitoring in Type 1 Diabetes: Cross-Sectional Population-Based Study.

Continuous glucose monitoring (CGM) introduces novel indicators of glycemic control. This cross-sectional study, based on the Swedish National Diabetes Register, examines 27,980 adults with type 1 diabetes. It explores the relationships between HbA1c (glycated hemoglobin) and various CGM-derived metrics, including TIR (time in range, representing the percentage of time within the range of 4-10mmol/l for 2weeks), TAR (time above range), TBR (time below range), mean glucose, standard deviation (SD), and coefficient of variation (CV). Pearson correlation coefficients and linear regression models were utilized for estimation. The analysis included 46% women, 30% on insulin pump, 7% with previous coronary heart disease and 64% with retinopathy. Mean ± SD values were age 48 ± 18years, diabetes duration 25 ± 16years, HbA1c 58.8 ± 12.8mmol/mol, TIR 58.8 ± 19.0%, TAR 36.3 ± 20.0%, TBR 4.7 ± 5.4%, mean sensor glucose 9.2 ± 2.0mmol/l, SD 3.3 ± 1.0mmol/l, and CV 36 ± 7%. The overall association between HbA1c and TIR was -0.71 (Pearson's r), with R2 0.51 in crude linear regression and 0.57 in an adjusted model. R2values between HbA1c and CGM mean glucose were 0.605 (unadjusted) 0.619 (adjusted) and TAR (unadjusted 0.554 and fully adjusted 0.568, respectively), while fully adjusted R2values were 0.458, 0.175 and 0.101 between HbA1c and CGM SD, CGM CV and TBR, respectively. This descriptive study demonstrates that the degree of association between HbA1c and new and readily available CGM-derived metrics, i.e., time in range (TIR), time above range (TAR), and CGM mean glucose, is robust in assessing the management of individuals with type 1 diabetes in clinical settings. Metrics from CGM that pertain to variability and hypoglycemia exhibit only weak correlations with HbA1c.

A CORRELATION STUDY OF BLOOD HBA1C WITH FASTING AND POSTPRANDIAL BLOOD GLUCOSE

Objectives: This study aimed to evaluate the correlation between raised blood sugar and glycated hemoglobin (HbA1c), a gold standard test for the assessment of glycemic control. Serial monitoring of HbA1C in diabetes mellitus helps in the prevention of microvascular and macrovascular complications. Methods: We retrospectively reviewed the laboratory reports of 397 patients who visited the hospital for various reasons. There were 195 males and 202 females in the study group. We evaluated the correlation between HbA1c and two indicators of glycemic control: fasting blood glucose (FBG) and postprandial blood glucose (PPBG). Results: Both FBG and PPBG showed a significant positive correlation with HbA1c. However, PPBG had a stronger correlation with HbA1c than FBG. The Spearman’s correlation coefficient (r) was 0.610 (p&lt;0.05) for FBG and HbA1c and 0.683 (p&lt;0.05) for PPBG and HbA1c. Conclusions: PPBG was a better predictor of HbA1c than FBG. PPBG may be an alternative marker of HbA1c for the management and monitoring of diabetes mellitus.

Interactive effects of low-volume interval exercise and nutrition on glycemic control.

Low-volume interval training has been demonstrated to improve indices of 24 h glycemic control using continuous glucose monitoring in individuals with or at risk for metabolic diseases. Nonetheless, there are inconsistencies in the literature with respect to the effects of interval exercise on 24 h glycemia, which may partly result from different nutritional conditions and/or controls adopted across various studies. This current opinion aims to provide a concise overview of the effects of acute and chronic interval exercise on 24 h glycemic control, while also describing how nutrition can influence and modify these responses. Given the distinct impact of dietary intake on blood glucose regulation, the adoption of diverse dietary control strategies during measurement of 24 h glycemia-spanning from using the participant's habitual diet to providing standardized meals customized to individual energy requirements-may contribute to varying conclusions across studies regarding the influence of interval exercise on 24 h glycemia. In addition, nutritional manipulations surrounding exercise, including whether interval exercise commences in the fasted or fed state, the macronutrient composition of post-exercise meals, and the presence of an energy and/or carbohydrate deficit among participants, offer important context when considering the effects of interval exercise on 24 h glycemia. Additional well-controlled studies are warranted to explore the interactive effects of interval exercise and nutrition on 24 h glycemia. These efforts will assist in refining exercise and nutrition recommendations aimed at improving glycemic control.

A study on the impact of Magnesium on the Glycemic regulation

Objectives: The present study was to evaluate the impact of magnesium on glycemic regulation and also evaluate the changes of glycemic control indicators in type 2 diabetes mellitus patients. Methods: A total of 50 subjects aged 30–60 years with the FBS of more than 126 mg/dL who had been recently diagnosed with T2D (maximum one year) and were being treated with antidiabetic drugs were enrolled in the present study. All the subjects were instructed to follow a prescribed diet plan for one week to stabilize their serum glucose level (30% of total energy as fat, 15% of energy as protein, and 55% of energy as carbohydrate-focused, from complex carbohydrates). Both groups were instructed to consume a healthy diet of fruits and vegetables (five serving per day), legumes, nuts and whole grains. The intervention group consisted of 25 participants who were on Mg supplementation for three months. The control group (25 participants) were not received any type of supplement throughout the intervention period. Body weight and height were measured to calculate body mass index (BMI). All measurements and indicators were taken at the base line (Pre) and after three months of intervention (post changes). Results: Mean age group of intervention and control group was not significant (p=0.118). In both group, males were more preponderance than females. When we compared the mean BMI, HbA1C, C-peptide (ng/mL), HOMA.?%, and Mg (mg/dL) between intervention and control group subjects respectively. P-value was found to be 0.512, 0.588, 0.117, 0.606, 0.317, and 0.235 respectively. Mean FBS of interventional group patients was significantly (p=0.011) reduced in post intervention as compared to pre intervention. While in control group, mean FBS was not significant differences (p=0.184). Mean Ca of interventional group subjects was extreme significantly (p&lt;0.0001) decreased in post intervention as compared to preintervention. While in control group subjects, mean Ca was not significantly decreased in post-test as compared to pre-test. In interventional group subjects, mean Mg was highly significantly (p=002) increased in post intervention as compared to pre intervention. While in control group subjects, mean Mg level was extreme significantly (p&lt;0.0001) reduced in post-test as compared to pre-test. Conclusions: Oral magnesium supplement significantly decreases the fasting blood sugar level. And it reduces the insulin resistance and improves the glycaemic control indicators in type 2 diabetes mellitus patients. Key words: Magnesium, glycaemic control indicators, type 2 diabetes mellitus.

Impact of Iron Deficiency Anemia on Hemoglobin A1c Levels in Diabetic and Non-Diabetic Pregnant Women

Background: Gestational diabetes mellitus (GDM) is a well-known risk factor for pregnancy complications. While hemoglobin A1c (HbA1c) is widely used as a glycemic control indicator, it is known to exhibit falsely low or high levels during gestation. The purpose of the present study is to analyze the fluctuations in HbA1c levels throughout pregnancy in diabetic (DM) and non-DM women with or without iron deficiency anemia (A). Methods: Medical records of pregnant women who were followed up in our obstetrics clinic between 2018 and 2022 were reviewed. Demographics, gestational history, and biochemistry values including fasting glucose, HbA1c, erythrocyte and iron metabolism indexes were recorded. Statistical analysis was carried out by Mann-Whitney U and Bonferroni corrected one-way analysis of variance (ANOVA) tests. Results: 670 pregnant women (32 ± 14.2 years) were included with matched subgroups. In the non-DM and non-A group, HbA1c exhibited a significant decrease towards mid-pregnancy (5.29 vs. 5.08%, p &lt; 0.01), followed by a steep increase towards the second half of pregnancy, reaching its initial value (5.08 vs. 5.27%, p &lt; 0.01). In the non-DM and A pregnant women, HbA1c decreased from 5.25 to 5.19% (p &gt; 0.05) in first half, followed by a significant increase to 5.37% (p &lt; 0.05) in the second half of pregnancy when serum ferritin values dropped to 5.03 ± 3 µg/mL (p &lt; 0.01). As for DM and non-A group, a biphasic change in HbA1c level was also recorded, however not significant (6.05 vs. 5.81%, p &gt; 0.05). However, in the DM and A group, HbA1c levels were higher (7.09 vs. 6.01%, p &lt; 0.01), along with iron deficiency indicated by ferritin levels (4.7 ± 2.2 µg/mL, p &lt; 0.01). Conclusions: HbA1c exhibits biphasic changes throughout pregnancy, characterized by decreases towards mid-pregnancy and subsequentincreases in the third trimester. Therefore, questioning HbA1c levels is warranted, considering the changes in maternal physiology in early gestation and the increasing need for iron in later period. Furthermore, iron deficiency anaemia seems to have significant impact on the reliability of HbA1c in both the non-DM and DM pregnant women.

Association between brain imaging biomarkers and continuous glucose monitoring-derived glycemic control indices in Japanese patients with type 2 diabetes mellitus

IntroductionAlthough type 2 diabetes mellitus (T2DM) is associated with alterations in brain structure, the relationship between glycemic control indices and brain imaging markers remains unclear. This study aimed to investigate...

Quality assessment of diabetic care in Armed Force Hospital Southern region

Objective: This study aimed to assess the current status of care provided by the Diabetes Center at Armed Forces Hospital (AFH). Methods: This study was cross-sectional and conducted at the AFH in the Southern region during the period from January to June 2023. The study was conducted using the patient&amp;apos;s data sheet and a questionnaire to investigate the demographics and clinical characteristics of patients as well as the quality of care provided to the patients. Results: This study included 180 diabetic patients; 52.2% were males, 61.1% had uncontrolled blood sugar, 37.8% were hypertensive, and 45% were obese. Around 60.6% reported receiving high-quality care. The quality of care was significantly affected by secondary education (p = 0.037), university education (p = 0.006), monthly income of more than 10,000 SR (p = 0.022), glycemic control (p = 0.039), and body mass index (p = 0.0001). Conclusion: A good level of quality care was provided to the diabetic patients; however, it requires more improvement.

Correlation between HbA1c levels and left ventricular function in children with Type 1 Diabetes Mellitus

Background: Diabetic cardiomyopathy is one of the macrovascular complications in type 1 diabetes mellitus (T1DM). Left ventricular dysfunction primarily reflects diastolic dysfunction which is early sign of diabetic cardiomyopathy. Improved glycemic control can delay the onset and progression of this complication. An important indicator of long-term glycemic control is glycosylated hemoglobin (HbA1c). Objective: The aim of this study is to evaluate the correlation between HbA1c levels with left ventricular diastolic function in children with T1DM. Methods: This study was an observational study with cross-sectional design in children aged 1 month-18 years with T1DM, at Prof Dr. I.G.N.G. Ngoerah Hospital, Denpasar from November 2019–September 2021, using consecutive sampling. Glycosylated hemoglobin (HbA1c) was meassured by blood samping and LV function was assessed by using tissue Doppler imaging (TDI). Statistical analysis was done by Pearson and Spearman correlation test. A p-values of &lt;0.05 was considered statistically significant. Results: A total of 36 subjects were recruited in this study. There was a low positive correlation between HbA1c levels with E/e’ ratio (r=0.284, p=0.047), and MPI (r=0.358, p=0.020). After adjusting body mass index and duration of T1DM as confounding variables, we found a low positive correlation between HbA1c levels and E/e’ ratio (r=0.325, p=0.030), MPI (r = 0.390, p=0.020). Conclusion: HbA1C has a positive correlation with left ventricular diastolic function in children with T1DM.

An observational multi-center study on type 2 diabetes treatment prescribing pattern and patient adherence to treatment

In 2021, the International Diabetes Federation (IDF) reported that the prevalence of diabetes in Pakistan was 9.6%, higher than the global average. However, adherence to treatment guidelines, e.g., American Diabetes Association and Pakistan Endocrine Society and prescription patterns for Oral anti-diabetes (OAD), is poorly understood in Pakistan. Therefore, this study aimed to examine the prescribing practices of anti-diabetic medications, an association of lifestyle modification with drugs prescribed, and their effectiveness in preserving ideal glycemic levels in diabetic patients undergoing treatment in tertiary care teaching hospitals in rural and urban Pakistan. In this cross-sectional study, data were collected from prescriptions of outpatient diabetic patients from different rural and urban tertiary care hospitals between October 2021 and February 2022. 388 participants were enrolled in the study for a detailed interview on prescription evaluation and glycemic control. The coinvestigators conducted an interview with the patient and used a pre-validated questionnaire to collect the data. The relationship between following treatment guidelines and clinical and demographic factors was found using chi-square tests for bivariate analyses. The study reported that out of 388, the mean ages of the patients were 48 ± 12.4, and the majority were female. It was observed that 60.1% and 66.5% have uncontrolled fasting and random blood glucose, respectively. The education level of the study participants was also below par to have a complete understanding of the medical condition and self-management therapy. Even though they were taking the right medications—an average prescription regimen included 5.08 medications—52.1% of the studied people had glycated haemoglobin (HbA1c) levels higher than the therapeutic threshold set by the International Diabetes Federation. In this modern era, it was observed that the prescribing trend was still focused on traditional therapeutic options Biguanides, sulfonylureas, and dipeptidyl peptidase-4 inhibitors were prescribed in 64.6% of the patients. A significant association was found between glycemic control and body mass index, adherence to lifestyle modifications, and the number of medications prescribed (p-value < 0.05). The study reveals that Pakistan's prescribing practices do not align with international and national guidelines, leading to a high prevalence of uncontrolled diabetes and widespread use of polypharmacy among patients. To address this issue, policymakers should prioritize establishing a comprehensive national diabetes action plan. Additionally, there is a pressing need to develop diabetes education and awareness programs emphasizing the importance of lifestyle modifications for effective diabetes management.

Profile of type 2 diabetes mellitus patients attending family medicine clinic in a rural tribal locality in India.

Diabetes prevalence has been predicted to reach 578 million worldwide in 2030 and is estimated to increase by 51% (700 million) in 2045. Type 2 diabetes mellitus (T2DM) is frequently associated with various cardiovascular (CV) risk factors secondary to associated dyslipidemias and good glycemic control is key for the prevention of long-term CV complications; this study was conducted to assess present glycemic status and lipid profile of the population residing in a rural tribal locality of Jharkhand (India). This cross-sectional study was conducted as a project for Fellowship in diabetes course by the Department of Endocrinology, DEDU, CMC Vellore. Whole blood and sera were analyzed for fasting blood sugar (FBS), glycated-hemoglobin (HbA1c), total cholesterol (CH), triglycerides (TGs), high-density-lipoprotein-cholesterol (HDL-C), low-density-lipoprotein-cholesterol (LDL-C), and very-low-density-lipoprotein-cholesterol (VLDL-C). A correlation test of HbA1c with lipid ratios and individual lipid indexes was done. The mean Hb1Ac level was uncontrolled as 7.24 ± 1.80 and, interestingly, was marginally higher [7.31 ± 1.92 Vs 6.92 ± 1.16] in patients with T2DM <5 years as compared to those with T2DM >5 years. Mixed dyslipidemias were common with abnormal TG, LDL, VLDL, HDL, and total CH values. Hb1Ac levels showed a significant positive correlation with serum CH, TG, LDL, and VLDL levels, while a significant negative correlation with HDL levels in the study. Apart from being a reliable indicator of long-term glycemic control, HbA1c can also be used as a surrogate marker of dyslipidemia, and thus early diagnosis and treatment of dyslipidemia can prevent life-threatening cardiovascular complications that can be particularly useful in resource-poor rural tribal locality settings.

Effect of skipping breakfast on cardiovascular risk factors: a grade-assessed systematic review and meta-analysis of randomized controlled trials and prospective cohort studies.

Skipping breakfast is one of the most prevalent irregular eating habits. Several pieces of evidence have reported the association between breakfast omission and a higher risk of cardiovascular diseases. Numerous publications have focused on the impact of skipping breakfast on various cardiovascular risk factors. Therefore, the current systematic review and meta-analysis aimed to assess this impact, especially with regard to anthropometric measurements, serum lipid profiles, blood pressure, and glycemic control indicators. A comprehensive search was performed in PubMed, Web of Science, Embase, Scopus, and the Cochrane Central Register of Controlled Trials up to 1 April 2023. A total of 11 eligible trials were identified to evaluate the combined effects of skipping breakfast. Final integrated results demonstrated that breakfast omission significantly decreased the body weight (mean difference = -0.66, 95% CI: -1.09 to -0.24, p = 0.002, I2 = 0.0) and increased the level of serum low-density lipoprotein cholesterol (LDL-C) (mean difference = 9.89, 95% CI: 5.14 to 14.63, p = 0.000, I2 = 17.3). Subgroup analysis also revealed potential factors that may affect the outcomes, for example, the physiological condition of participants, duration, gender, and type of breakfast. In conclusion, skipping breakfast may reduce body weight while increasing the level of serum LDL-C at the same time. In view of the limited trials, further studies are needed to expound the role of breakfast omission in cardiovascular diseases.

Satisfaction with diabetes involvement: Exploring parent and adolescent perspectives.

Both parent and adolescent involvement in type 1 diabetes management are critical during adolescence. The current study sought to understand the factors associated with parent and adolescent satisfaction with their own and one another's involvement in diabetes management. Cross-sectional baseline data from 157 parent-adolescent dyads enrolled in an RCT were used. Adolescent ages ranged from 12 to 19 (Mage = 14.7, SD = 1.89) and were balanced by gender (50.3% male). Paired t-tests examined concordance between parent and adolescent satisfaction, bivariate correlations identified correlates, and regressions examined unique associations. Roughly, 43% of adolescents and 29% of parents were very satisfied with adolescent involvement in diabetes management, whereas 71% of adolescents and 26.1% of parents were very satisfied with parent involvement. Indicators of better glycaemic health (via higher percent time-in-range and lower HbA1c and percent time in hyperglycaemia) and psychosocial functioning (less diabetes distress and depression) were correlated with higher satisfaction. Parent satisfaction with adolescent involvement was higher among older adolescents (R = 0.198, p = 0.013). Non-Hispanic white youth were more satisfied with their own involvement than youth of colour (t(149) = -2.783, p = 0.003). Both percent time-in-range and one's own diabetes distress uniquely related to parent and adolescent satisfaction with adolescent involvement. Conversely, parent satisfaction with their own involvement was only uniquely associated with parent diabetes distress. Both adolescent and parents' satisfaction with adolescents' involvement in self-management are indicators of both glycaemic control and psychosocial well-being, whereas parents' self-evaluations are more closely tied to diabetes-specific distress.

Simultaneous electrochemical detection of glycated and human serum albumin for diabetes management

Developing highly selective and sensitive biosensors for diabetes management blood glucose monitoring is essential to reduce the health risks associated with diabetes. Assessing the glycation (GA) of human serum albumin (HSA) serves as an indicator for medium-term glycemic control, making it suitable for assessing the efficacy of blood glucose management protocols. However, most biosensors are not capable of simultaneous detection of the relative fraction of GA to HSA in a clinically relevant range. Here, we report an effective miniaturised biosensor architecture for simultaneous electrochemical detection of HSA and GA across relevant concentration ranges. We immobilise DNA aptamers specific for the detection of HSA and GA on gold nanoislands (Au NIs) decorated screen-printed carbon electrodes (SPCEs), and effectively passivate the residual surface sites. We achieve a dynamic detection range between 20 and 60 mg/mL for HSA and 1–40 mg/mL for GA in buffer solutions. The analytical utility of our HSA and GA biosensor architectures are validated in mice serum indicating immediate potential for clinical applications. Since HSA and GA have similar structures, we extensively assess our sensor specificity, observing high selectivity of the HSA and GA sensors against each other and other commonly present interfering molecules in blood such as glucose, glycine, ampicillin, and insulin. Additionally, we determine the glycation ratio, which is a crucial metric for assessing blood glucose management efficacy, in an extensive range representing healthy and poor blood glucose management profiles. These findings provide strong evidence for the clinical potential of our biosensor architecture for point-of-care and self-assessment of diabetes management protocols.

Association between continuous glucose monitoring-derived glycemic control indices and urinary biomarkers of diabetic kidney disease: Hyogo Diabetes Hypoglycemia Cognition Complications study

AimsGlomerular damage and proximal tubular damage play an important role in the pathogenesis of diabetic kidney disease. This study aimed to investigate the relationship between the urinary markers of proximal tubular injury, including urinary liver-type fatty acid-binding protein-to-creatinine ratio (uL-FABP/Cr) and urinary N-acetyl-β-d-glucosaminidase-to-creatinine ratio (uNAG/Cr), and glycemic control status.MethodsThis cross-sectional study included 245 and 39 patients with type 2 diabetes mellitus (T2DM) and non-T2DM (NDM), respectively. The participants of this study were fitted with retrospective CGM, and glycemic control indices, such as time in range (TIR) and glycemia risk index (GRI), were calculated.ResultsThe results were presented as medians (interquartile ranges). The uL-FABP/Cr was significantly higher in the microalbuminuria than in the normo-albuminuria group [4.2 (2.7–7.1) and 2.2 (1.4–3.4) μg/gCr, respectively, P < 0.001], while the uNAG/Cr in the normo-albuminuria group [6.3 (4.5–10.1) U/gCr] was significantly higher than that in the NDM group [5.3 (3.8–6.3) U/gCr, P = 0.048] but significantly lower than that in the microalbuminuria group [9.2 (6.4–11.1) U/gCr, P = 0.004]. The multivariate logistic regression analysis indicated that CGM-derived TIR was significantly associated with the urinary albumin-to-creatinine ratio [uAlb/Cr, odds ratio (OR) 0.985, 95% confidence interval (CI) 0.971–0.998, P = 0.029] and uNAG/Cr (OR 0.973, 95% CI 0.957–0.989, P = 0.001) independent of renal function. GRI was similarly associated with uAlb/Cr and uNAG/Cr.ConclusionThe findings of this study indicated that uNAG/Cr was elevated before albuminuria development and was associated with CGM-derived TIR and GRI.

Associated factors of diabetic retinopathy by artificial intelligence evaluation of fundus images in Japan

AbstractThis cross-sectional study aimed to investigate the promoting and inhibitory factors of diabetic retinopathy (DR) according to diabetes mellitus (DM) stage using standardized evaluation of fundus images by artificial intelligence (AI). A total of 30,167 participants underwent blood and fundus examinations at a health screening facility in Japan (2015–2016). Fundus photographs were screened by the AI software, RetCAD and DR scores (DRSs) were quantified. The presence of DR was determined by setting two cut-off values prioritizing sensitivity or specificity. DM was defined as four stages (no DM: DM0; advanced DM: DM3) based on treatment history and hemoglobin A1c (HbA1c) levels. Associated factors of DR were identified using logistic regression analysis. For cutoff values, multivariate analysis revealed age, sex, systolic blood pressure (SBP), smoking, urinary protein, and HbA1c level as positively associated with the risk of DR among all DM stages. In addition to glycemic control, SBP and Fibrosis-4 index might act as promoting factors for DR at all or an earlier DM stage. T-Bil, cholinesterase, and T-cho level might be protective factors at an advanced DM stage.

Worse glycemic control is associated with an impaired arterial energy transfer pattern in elderly with diabetes

Abstract Background Worse glycaemic control is known to exacerbate endothelial insult, increasing macro- and microvascular complication risks in diabetes. Impaired intracranial haemodynamics have been frequently reported in patients with diabetes alongside with malperfusion causing structural abnormalities, and poor cognitive and cortical functionality (1-2).Assessment of the alterations in energy transfer characteristics derived from hemodynamic signals may provide novel mechanistic information about how worse glycaemic control may affect cerebrovascular perfusion. Wave reflection index(WRI) is a previously proposed measure of arterial energy transfer efficiency which reflects distal impedance mismatch(3-4). Purpose We aim to interrogate potential relationship between a worse glycaemic control and a less efficient arterial energy transfer, which could enhance our understanding of the cerebrovascular-cortical functional coupling on a mechanistic basis in elderly with diabetes. Methods Left middle cerebral artery wave intensity (WI) was computed with arterial blood pressure and flow velocity (transcranial Doppler) signal as previously described (WI = (dP/dt)*(dU/dt)) (Figure 1). Standard statistical tests were used to interrogate the relationship between glycated haemoglobin levels (HbA1c) and WI parameters. Results In 36 patients with diabetes mellitus type-2 (DM2) (mean age = 65.7 ± 8.8 years), backward compression wave intensity (BCWI) and wave reflection ratio (WRI= BCWI/FCWI) were significantly correlated with HbA1c levels before (rBCWI: 0.409 pBCWI:0.013; rWRI:0.345 pWRI:0.040) and after (rBCWI: 0.410 pBCWI:0.018, rWRI:0.351 pWRI:0.045) adjusting for age, sex and mean arterial pressure (Figure 2). Conclusion(s) In elderly patient with DM2, higher HbA1c values indicating worse glycaemic control are significantly correlated with altered cerebrovascular energy transfer characteristics as assessed by MCA wave intensity analysis. Continuous relationship between worse glycaemic control and higher wave reflection index (a measure of less efficient energy transfer in arterial system and distal impedance mismatch) may imply that the use of energy transfer related indices alongside with conventional hemodynamic indices may help providing a more comprehensive pathophysiological understanding about how cardiovascular risk factors interfere with perfusion.Computation of Wave IntensityMain Results