HbA1c Levels Research Articles

Association Between Systemic Immune-Inflammatory Index (SIRI) and Diabetic Foot Ulcers in Individuals with Diabetes: Evidence from the NHANES.

Background: Diabetic Foot Ulcer (DFU) is a common and challenging complication of diabetes mellitus, associated with high recurrence, hospitalization, disability, and mortality rates. The Systemic Immune Inflammatory Index (SIRI) based on complete blood counts has been shown to correlate with several diseases but has not been widely studied in DFU.This study aimed to explore the relationship between SIRI and the presence of DFU in individuals with diabetes using data from the National Health and Nutrition Examination Survey (NHANES). Methods: A cross-sectional analysis was conducted on 1246 individuals with diabetes from NHANES cycles 1999-2000, 2001-2002, and 2003-2004. DFUs were identified through patient self-reported data. Multivariate logistic regression models assessed the association between SIRI and DFU, adjusting for potential confounders. Subgroup and interaction analyses were also performed. Results: A total of 117 patients were identified as having DFU. Elevated SIRI levels were significantly associated with DFU presence. In fully adjusted models, a 1-unit increase in SIRI was associated with 24.0% higher odds of DFU prevalence (OR = 1.24; 95% CI: 1.07, 1.43) Subgroup analyses revealed consistent associations across different groups of age, gender, body mass index (BMI), HbA1c, blood glucose, and hemoglobin levels. Conclusion: The findings indicate a positive correlation between SIRI and DFUpresence. Further research is warranted to elucidate the mechanistic links and explore the clinical utility of SIRI in DFU management.

Clinical Utility of Fasting Plasma Glucose and Hemoglobin A1C (HbA1C) for the Prediction of Type 2 Diabetes Mellitus Diagnosed by Oral Glucose Tolerance Testing in Cirrhotic Patients with Impaired Fasting Plasma Glucose

Objective: Use of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels has been ineffective in diagnosing diabetes in cirrhotic patients. The aim of this study was to determine the prevalence and optimal cut-off levels of FPG and HbA1c for effective prediction of type 2 diabetes mellitus (T2DM) as definitely diagnosed by the 75-gram oral glucose tolerance test (75-g OGTT) in cirrhotic patients with impaired fasting plasma glucose (IFG).Material and Methods: This single-center, cross-sectional study conducted in Nan Hospital included cirrhotic patients with IFG that were diagnosed as T2DM or non-T2DM via 75-g OGTT. The clinical factors associated with the presence of T2DM were investigated using univariate and multivariate regression models.Results: T2DM was diagnosed according to 75-g OGTT in 55 of the 103 participants (53.40%); impaired glucose tolerance (IGT) was diagnosed in 22.33%, and normal OGTT results were found in 24.27%. An FPG level of ≥104.5 mg/dL and an HbA1c level of ≥5.25% were found to be the optimal cut-off levels for the prediction of T2DM. The FPG level had a sensitivity of 76.4%, 95% confidence interval (CI) [63.0%, 86.8%], and a specificity of 37.5%; 95% CI [24.0%, 52.6%]. HbA1c levels had a sensitivity of 67.3%; 95% CI [53.3%, 79.3%] and a specificity of 37.5%; 95% CI [24.0%, 52.6%]. Hepatitis C virus (HCV) infection, high Child-Pugh score, and high level of FPG before the 75-g OGTT testing were significantly associated with T2DM.Conclusion: More than half of the cirrhotic patients with IFG had T2DM diagnosed by 75-g OGTT. An FPG level of ≥104.5 mg/dL and an HbA1c level of ≥5.25% were found to be the optimal cut-off levels for the prediction of the presence of T2DM in those with cirrhosis and IFG.

A prospective, multicentre study evaluating safety and efficacy of a fixed dose combination of Remogliflozin etabonate, Vildagliptin, and Metformin in Indian patients with type 2 diabetes mellitus (Triad-RMV)

AimsThe ICMR INDIAB-17 study revealed a diabetes prevalence of 11.4% in India, emphasizing the need for effective treatment for glycemic control. A Phase IV study was conducted to evaluate the safety and efficacy of a Fixed Dose Combination (FDC) of Remogliflozin, Metformin and Vildagliptin (RMV) in Type 2 Diabetes Mellitus (T2DM) patients uncontrolled on Metformin plus SGLT2 inhibitor or Metformin plus DPP4 inhibitor dual therapy.MethodsA total of 215 patients (mean age: 46.4 years; 64% male, 36% female) were enrolled across multiple centers in India. The study population included patients with a baseline HbA1c ≥ 8% at the time of screening. The primary objective was to assess safety based on treatment-emergent adverse events (TEAEs), while the secondary. aim was to evaluate effectiveness in terms of glycemic (HbA1c, fasting plasma glucose, postprandial glucose) and extra-glycemic measures (renal and lipid parameters). Statistical analysis was conducted using paired t-tests and the Wilcoxon signed-rank test for within-group comparisons, and the Bonferroni correction was applied to adjust for multiple comparisons. Effectiveness was evaluated at baseline, week 12, and week 24.ResultsThe study demonstrated statistically significant reductions in mean HbA1c levels from baseline to both week 12 and week 24 (p < 0.00001). At 24, weeks, 45.1% of patients achieved target HbA1c levels of ≤ 7%. Significant reduction was also observed in fasting plasma glucose (FPG) and postprandial glucose (PPG) levels. Renal parameters remained stable or improved, and lipid profile parameters, including LDL-C and triglycerides, showed favorable changes. Adverse events of special interest, including hypoglycemia and urinary tract infections, were reported in 4.7% of patients, with no serious adverse event recorded.ConclusionsThe twice daily triple FDC of RMV was well tolerated, safe and effective in patients with Type 2 Diabetes Mellitus uncontrolled on dual drug therapy of Metformin plus SGLT2i or Metformin plus DPP4i. The treatment led to significant improvements in glycemic control and other metabolic parameters over 24 weeks, without compromising renal function or causing serious adverse events.Trial registrationCTRI, CTRI/2022/05/042581. Registered 17 May 2022, https//ctri.nic.in/Clinicaltrials/rmaindet.php? trialid=68,757&EncHid=36127.16500&modid=1&compid=19.

Comparative Study of Dyslipidemia in Diabetic Patients with Diabetic Nephropathy and Diabetic Patients without Nephropathy

Background: Dyslipidemia is a significant risk factor for cardiovascular complications and renal damage in diabetic patients, particularly those with nephropathy. It exacerbates diabetic nephropathy (DN) progression through mechanisms such as oxidative stress and glomerulosclerosis. Objectives: This study aimed to compare lipid abnormalities between diabetic patients with nephropathy and those without, assess correlations with glycemic control and urinary microalbumin, and evaluate dyslipidemia’s impact on renal function. Methods: A cross-sectional study was conducted at Patna Medical College &amp; Hospital involving 60 diabetic patients aged 20–60 years, divided into two groups: diabetic patients with nephropathy (Group A, n=30) and without nephropathy (Group B, n=30). Demographics, lipid profiles, glycemic parameters, and renal function were analyzed. Dyslipidemia prevalence was assessed, and statistical significance was determined using SPSS (p&lt;0.05 considered significant). Results: Dyslipidemia was more prevalent in the nephropathy group (73.3% vs. 46.7%, p=0.03), with significantly elevated cholesterol, triglycerides, LDL-C, and reduced HDL-C levels. Mean fasting glucose, postprandial glucose, and HbA1c levels were also higher in the nephropathy group (p&lt;0.05). Conclusion: Dyslipidemia is significantly more severe in diabetic patients with nephropathy, linked to poor glycemic control and renal dysfunction. Targeted lipid management strategies are essential to mitigate cardiovascular and renal risks in these patients.

The effect of telehealth on clinical outcomes in patients with hypertension and diabetes: A meta-analysis of 106,261 patients.

Telemedicine, propelled by recent technological advancements, has transformed healthcare delivery, notably benefiting patients with chronic non-communicable diseases (NCDs) such as systemic arterial hypertension and diabetes mellitus. This meta-analysis of randomized clinical trials aimed to assess the efficacy of telehealth-based interventions on disease control rates and clinical parameters among NCD patients, including systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) levels. We conducted searches in PubMed, Scopus, Web of Science, and the Cochrane Database for interventional studies that compared tele-monitoring with usual care in patients with hypertension and type 2 diabetes mellitus. Odds ratios with 95% confidence intervals (CIs) were computed. Our meta-analysis included 75 studies, encompassing a total of 106,261 patients, with 50,074 (47.12%) receiving usual care and 56,187 (52.88%) receiving tele-monitoring care. The telemedicine group was associated with a statistically significant reduction in SBP (mean difference (MD) -4.927 mmHg; 95% CI -6.193 to -3.660; p < 0.001; I² = 90%), DBP (MD -2.019 mmHg; 95% CI -2.679 to -1.359; p < 0.001; I² = 54%), FBG (MD -0.405 mmol/L; 95% CI -0.597 to -0.213; p < 0.001; I² = 32%), and HbA1c (MD -0.418%; 95% CI -0.525 to -0.312; p < 0.001; I² = 76%). Our meta-analysis shows that telehealth technologies notably enhance blood pressure and blood glucose control. This supports integrating telemedicine into clinical protocols as a valuable complementary tool for managing hypertension and diabetes mellitus comprehensively.

Metabolomic studies reveal and validate potential biomarkers of diabetic retinopathy in two Chinese datasets with type 2 diabetes: a cross-sectional study

BackgroundDiabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus and causes vision impairment and blindness. The presence of major risk factors for DR, such as high levels of HbA1c, does not predict all DR pathogenesis in the clinic, which suggests that uncovering the underlying mechanisms and identifying novel markers are needed. Previous evidence has shown that the serum metabolic signature of DR is unique and detectable compared with that of diabetes mellitus (DM). Here, we aimed to identify serum metabolites as reliable biomarkers for the presence of DR in type 2 DM (T2DM) patients.MethodsWe performed untargeted and targeted metabolomic studies using liquid chromatography‒mass spectrometry (LC‒MS) and multiple reaction monitoring (MRM) methods on the serum samples of T2DM patients. For the discovery dataset, 39 DR patients and 39 non-DR (NDR) patients were included. For the validation dataset, 95 DR patients and 95 non-DR (NDR) patients were included. Receiver operating characteristic curve analysis was performed to evaluate the discriminating power of the metabolites. Binary logistic regression models were fit to evaluate the associations of metabolite peak areas or neurotransmitter concentrations with the presence of DR and adjusted for known risk factors.ResultsA total of 7123 metabolites were tested. The 39 DR patients had a mean age of 56 years with an average diabetes duration of 12 years, and the 39 NDR patients had a mean age of 57 years with an average diabetes duration of 11 years. Nine serum candidate markers were further identified. Six out of nine markers were associated with DR after we adjusted for covariates, including blood pressure, HbA1c, diabetes duration, fasting blood glucose, triglyceride, eGFR etc. Among them, eicosapentaenoic acid (EPA) and L-tyrosine were validated in an independent, risk factor-matched sample set. The serum L-tyrosine concentration was decreased in DR group by 47% (-0.22 ± 0.87 vs. 0.48 ± 1.05, P < 0.001), of which the cutoff value was 0.10 mg/ml, with 86% sensitivity and 40% specificity (AUC = 0.62, 95% CI = 0.54–0.70, P = 0.005).ConclusionsLow levels of circulating L-Tyrosine indicate retinopathy occurrence in T2DM population.

Identify unmet needs in diabetes care in Shandong, China: a secondary analysis of a cross-sectional study using cascade of care framework

BackgroundThe continuum management of diabetes remains under-evaluated in China. This study aimed to estimate the proportions of diabetes adults at each stage of the cascade of care framework in Shandong, China.MethodsWe conducted a secondary analysis using the 2018 China Adult Chronic Disease and Nutrition Surveillance (CACDNS) data in Shandong. This nationwide cross-sectional survey was conducted between September and November 2018, investigating the major chronic diseases among Chinese adults through interviews, physical examinations, and laboratory tests. We employed the cascade model to examine the proportion of diabetes adults, including both type 1 and type 2, from diabetes screening, diagnosis, pharmaceutical and non-pharmaceutical treatments, to single and comprehensive management targets, and quantified the attrition between each stage. Diabetes screening was defined as participants reported to have ever received a blood glucose test. Diabetes diagnosis was defined as: 1) fasting plasma glucose (FPG) ≥ 126 mg/dL, or 2) 2-h oral glucose tolerance test (2 h-OGTT) ≥ 200 mg/dL, or 3) hemoglobin A1c (HbA1c) ≥ 6.5%, or 4) self-reported diabetes. Diabetes management targets included: 1) single glycemic target of personalized HbA1c level, 2) comprehensive ABC targets of personalized HbA1c level, blood pressure (BP) < 140/80 mm Hg, and low-density lipoprotein cholesterol (LDL-c) level < 2.6 mmol/L, 3) lifestyle target of not currently smoking. The estimated proportion was calculated through self-reported diabetes status and FPG, 2h-OGTT and HbA1c. The number of diabetes cases in Shandong was extrapolated using the 2018 provincial census data for adults aged 18 years and above (N = 80.6 million). The cascade of diabetes care was further examined by age, sex, and Basic Public Health Service (BPHS) enrollment.ResultsThis secondary analysis included 8,462 individuals (47.8% males, median age: 49.0), among whom 12.4% had diabetes (self-reported: 4.2%, newly diagnosed: 8.2%) and 41.1% had prediabetes. In 2018, an estimated 9.2 million adults in Shandong had diabetes, with 6.4 million (69.6%) receiving diabetes screening but 6.2 million (67.7%) remaining unaware of their conditions. Among self-reported diabetes adults, 2.7 million (86.4%) and 2.8 million (89.6%) received pharmaceutical and non-pharmaceutical treatment, respectively. Of those with treatments, 1.2 million (58.2%) met personalized glycemic target. A rapid decline, however, was observed in BP (31.1%) and LDL-c (39.3%) control among diabetes patients with multimorbidity (≥ 2 diseases). Ultimately, 0.1 million self-reported diabetes adults (3.8%) achieved the ABC targets. BPHS Enrollment slightly improved comprehensive management with ABC targets.ConclusionsA significant unmet need exists for diabetes adults from screening to management, particularly the comprehensive management of glycemia, BP and LDL-c levels among those with multimorbidity. Tailored strategies and appropriate allocation of healthcare resource is needed to addressing gaps in care continuum and reduce long-term disease burden.

Heterogeneity in Health Outcomes in the Strong Hearts, Healthy Communities-2.0 Multilevel Intervention in a Community-Randomized Trial: An Exploratory Study of Moderators

Background/Objectives: Multilevel interventions have demonstrated efficacy in improving obesity and other related health outcomes. However, heterogeneity in individual responses indicates the need to identify the factors associated with responses and non-responses to multilevel interventions. The objective of this report is to identify the potential sources of heterogeneity through the exploration of the moderation effects of participant characteristics (sociodemographic and baseline physical/mental health) in the Strong Hearts, Healthy Communities-2.0 (SHHC-2.0) intervention. Methods: SHHC-2.0 is a 24-week multilevel intervention to improve people’s diet and physical activity evaluated using a cluster-randomized, controlled trial design conducted with women aged 40 and older living in rural communities with an elevated risk of cardiovascular disease, defined as having a BMI &gt; 30, or a BMI 25–30 plus &lt; 1 weekly occurrence of 30 min of physical activity during leisure time. Linear mixed models were used to compare the between-group changes in the outcomes (weight, systolic blood pressure, hemoglobin A1c [HbA1c], and triglycerides), with an interaction term included for each potential moderator. Results: Within the sociodemographic characteristics, there were no differences in effectiveness by age, income, or baseline BMI status, but the participants with a high school education or less experienced less weight loss. Among their health history, only a history of hypertension was associated with differential outcomes; those with a history of hypertension demonstrated a greater reduction in systolic blood pressure. The participants with elevated depressive symptoms demonstrated greater weight loss and a greater reduction in the HbA1c level. Conclusions: SHHC-2.0 was effective across a wide range of participants. The identified moderators (i.e., education level) may inform the future tailoring of the SHHC intervention to optimize the outcomes among participant subgroups, while more broadly, our findings can serve to inform the development and dissemination of multilevel interventions.

Standardized evaluation of diabetic retinopathy using artificial intelligence and its association with metabolic dysfunction-associated steatotic liver disease in Japan: A cross-sectional study.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in patients with obesity and diabetes and can lead to serious complications. This study aimed to evaluate fundus photographs using artificial intelligence to explore the relationships between diabetic retinopathy (DR), MASLD, and related factors. In this cross-sectional study, we included 1,736 patients with a history of diabetes treatment or glycated hemoglobin (HbA1c) levels of ≥6.5%. All participants were negative for hepatitis B surface antigen and hepatitis C virus antibody and were selected from 33,022 examinees at a health facility in Japan. Fundus photographs were analyzed using RetCAD software, and DR scores were quantified. The presence of DR was determined using two cutoffs: sensitivity (CO20) and specificity (CO50). Steatotic liver (SL) stages were assessed via ultrasound and fibrosis indices and classified into three groups: no SL (SL0), SL with low fibrosis (SL1), and SL with high fibrosis (SL2). Odds ratios (ORs) for the risk of DR associated with each SL stage were calculated using logistic regression, adjusted for age, sex, body mass index, HbA1c, C-reactive protein level, and alcohol consumption. The risk of DR was lower in the SL1 (OR: 0.63, 0.54) and SL2 (OR: 0.64, 0.77) groups compared to the SL0 group at CO20 for both the Fibrosis-4 Index (FIB-4) and the non-alcoholic fatty liver disease fibrosis score (NFS), respectively. Additionally, higher levels of cholinesterase were consistently associated with a reduced risk of DR (FIB-4: OR 0.52, NFS: OR 0.54) at CO50. This study demonstrates that MASLD was associated with a reduced risk of DR, with cholinesterase levels providing further protective effects, highlighting the need for further research into the protective mechanisms and refinement of DR evaluation techniques. The standardized AI evaluation method for DR offers a reliable approach for analyzing retinal changes.

IGHG4: innovative diagnostic biomarkers for iron overload in β-thalassemia patients

ABSTRACT Objectives This study aims to investigate the serotransferrin (TF), complement C1s subcomponent (C1S), immunoglobulin heavy constant gamma 4 (IGHG4), hemoglobin subunit alpha (HBA1), and clusterin (CLU) contents in β-thalassemia patients, and explores their physiological role as potential non-invasive bioindicators for disease diagnosis and iron overload. Methods A total of 62 children with β-thalassemia were recruited and categorized by genotype, along with 17 healthy pediatric volunteers for analysis. The circulating ferritin content was evaluated, and plasma levels of TF, C1S, IGHG4, HBA1, and CLU were assessed using ELISA. The primary outcome of this study was the correlation between the five protein marker levels and iron overload. Continuous variables were analyzed using the Student's t-test or the Mann–Whitney U test. A binary logistic regression model identified independent predictors of iron overload in patients with β-thalassemia. Receiver operating characteristics (ROC) were employed to evaluate the model's performance. Results The IGHG4 protein content was significantly lower in β-thalassemia patients compared to healthy controls. The IGHG4 protein content was reduced in the β+/β0 and β0/β0 patient populations compared to controls, with no significant difference observed between the β+/β0 group and healthy controls. A strong inverse relationship was identified between the IGHG4 protein content and SF concentration (r = −0.322, p = 0.004). Finally, plasma IGHG4 levels demonstrated adequate diagnostic capability, as indicated by our ROC curve analysis. Conclusion In conclusion, decreased IGHG4 protein levels are significantly associated with the degree of iron overload in β-thalassemia patients and may serve as a possible biomarker for evaluating iron overload.

Predictive Factors for Urinary Tract Infections in Patients with Type 2 Diabetes

Background/Objectives: Patients with diabetes (DM) are at an increased risk of infection, with urinary tract infections (UTIs) being common among individuals with type 2 DM (T2D). The aim of this study was to determine the prevalence and risk factors for UTIs among hospitalized T2D patients from Timișoara, Romania. Methods: The hospital records of 1139 T2D adult inpatients who were ordered to provide urine cultures during hospitalization were reviewed. Results: The prevalence of UTIs among T2D patients was 19.7%, and was higher in women than in men (27.5% vs. 9.8%, p &lt; 0.0001). Patients with UTIs presented a significantly older age, a longer duration of DM, a higher BMI, higher levels of HbA1c, higher renal function parameters, and more frequent DM-related complications and comorbidities than patients without UTIs. The following predictors were associated with increased UTI risk: age (OR = 1.05, p &lt; 0.0001); duration of DM (OR = 1.04, p &lt; 0.0001); BMI (OR = 1.05, p &lt; 0.0002); HbA1c levels (OR = 1.58, p &lt; 0.0001); female gender (OR = 3.47, p &lt; 0.0001); and the presence of retinopathy (OR = 1.47, p = 0.0118), chronic kidney disease (OR = 3.98, p &lt; 0.0001), distal symmetric polyneuropathy (OR = 7.65, p &lt; 0.0001), and cerebrovascular disease (OR = 4.88, p &lt; 0.0001). The use of sodium-glucose co-transporter 2 (SGLT2) inhibitors did not influence the risk of developing UTIs. Conclusions: T2D patients with prolonged disease duration, poor glycemic control, and DM-related complications are at an increased risk of developing UTIs. Therefore, a targeted therapeutic strategy addressing these risk factors is essential.

Effect of the consumption of cashew nut (Anacardium occidentale l.) flour-based biscuits in overweight children: a pilot randomized clinical trial.

cashew nut is an almond known for its cardiovascular benefits in adults and weight gain effects in malnourished children, as supported by research. However, its impact on overweight children remains unexplored. to analyze the effect of consuming biscuits made with cashew nut flour on the blood glucose and serum triglyceride levels of children with overweight/obesity over four weeks. a pilot, randomized, open-label clinical study was conducted with 19 overweight children (11 in intervention group 1 [G1] and 8 in group 2 [G2], aged between 7 and 15 years. Over four consecutive weeks, they consumed, daily, three biscuits with 50 % cashew nut flour composition (G1) and six biscuits with 50 % cashew nut flour composition (G2). The biomarkers analyzed were glycated hemoglobin (HbA1c), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and total cholesterol (TC) at baseline and seven days post-biscuit consumption. post-experiment, the TG (p = 0.153), HDL-C (p = 0.895), and TC (p = 0.122) biomarkers showed no significant changes. LDL-C levels experienced a slight but statistically significant increase of 0.52 % across all participants (p = 0.031). In contrast, non-HDL cholesterol levels saw a minor yet significant reduction of -1.7 % in serum concentration (p = 0.014). Independent of group allocation, the participants' HbA1c and average blood glucose levels significantly decreased by 12.1 % (p < 0.001) and 17.9 % (p < 0.001), respectively (Cohen's Δ = 1, in both instances). consumption of biscuits containing cashew nut flour by overweight/obese children positively affected the reduction of blood glucose and non-HDL cholesterol biomarkers in both groups, regardless of the formulations used.

Study on the mediating and moderating effects of food intake on blood glucose levels

Objective: Analyze the mediating and moderating effects of the relationship between food intake and blood glucose levels. Methods: This study uses data from the China Health and Nutrition Survey project in the survey 2018, involving 11 043 adults aged 18 years or older, who have complete dietary data, waist circumference (WC), glycated hemoglobin A1c (HbA1c) indicators, and other key variables. Food consumption data was gathered via three consecutive 24-hour dietary recalls and weighing accounting method, which included two weekdays and one weekend day. The average daily intake of various foods and total energy intake were calculated. The mediation effect and moderation effect analysis were conducted using simple mediation models, direct moderation effect models, and moderated mediation analysis theoretical models. The confidence interval method (bootstrap method) was performed for testing and analysis. Results: A total of 4 951 males and 6 092 females were included in the stratified analysis by gender. The mediating effects on the rice, wheat, and red meat→WC→HbA1c were all statistically significant in males. The standardized coefficients were -0.009 (P<0.001), 0.013 (P<0.001), and -0.005 (P=0.008), respectively. In females, the mediating effect on the wheat→WC→HbA1c was statistically significant, and the standardized coefficient was 0.017 (P<0.001); the impact of red meat intake on HbA1c is negatively regulated by the intake of dark vegetables, with a direct moderating effect; the standardized coefficient of the interaction term between red meat and dark vegetables was -0.024 (P=0.008). Dark vegetables have a moderated mediator on the pathway from rice to WC and HbA1c (a3b1=-0.003, P=0.041) in males. The mediating effect of WC is negatively regulated by the intake of dark vegetables (mediation effect difference U1/-1=-0.006, P=0.048). Dark vegetables showed a moderated mediator on the pathway from wheat to WC and HbA1c (a3b1=-0.004, P=0.045) in females. The mediating effect of WC is negatively regulated by the intake of dark vegetables (mediation effect difference U1/-1=-0.009, P=0.049). Conclusions: Changes in WC indicators caused by rice, wheat, and red meat intake. WC could mediate between rice, wheat, red meat, and HbA1c. Dark vegetables directly or indirectly regulate HbA1c levels by interacting with rice, wheat, and red meat.

Correlation Between Magnesium and HbA1C in Type 2 Diabetes Mellitus

Background: Magnesium (Mg) is most abundant electrolyte with unlimited physiologic importance in the body, playing a vital role in many fundamental processes. Cellular magnesium is an essential cofactor for various enzymes involved in glucose transport, insulin release and glucose oxidation. Mg has potential role in improving insulin sensitivity and preventing diabetes and its complications. Hypomagnesemia promotes to the initiation and progression of DM and its macrovascular and microvascular complications. Objectives: The aim of this study was to evaluate the correlation of magnesium with HbA1C in T2DM. Material and Methods: This cross sectional study conducted at Tribhuvan University Teaching Hospital, included 85 diagnosed with type 2 diabetes Mellitus visiting Medicine OPD and 85 apparently healthy controls. Clinical and anthropometric characteristics were documented using clinical proforma. The fasting blood samples were collected for estimating serum glucose, HbA1C and magnesium. Results: The mean values of BMI, FBG, HbA1C were found to be significantly elevated in T2DM, but that of Mg were higher in healthy controls (p&lt;0.05). The prevalence of hypomagnesemia in T2DM was found to be 32.94%. The Serum magnesium levels were moderate negatively correlated (r = -0.544, P&lt;0.001) with HbA1C. Conclusion: Patient with Type 2 Diabetes Mellitus showed significantly low magnesium levels compared to heathy controls as well as uncontrolled HbA1C levels also showed significantly low magnesium level than controlled HbA1C level. There was significant inverse correlation between serum Mg level and HbA1C level in patients with T2DM. So if serum magnesium values are made to rise, HbA1C values will fall.

Age and HbA1c in Diabetes: A Negative Association Modified by Red Cell Characteristics.

Background: While a positive correlation between age and HbA1c has been suggested in non-diabetic individuals, warranting higher HbA1c reference ranges for older adults, evidence among individuals with diabetes is less clear and may reveal an inverse trend. This study aimed to examine the relationship between age and HbA1c in a diabetic population, considering red cell parameters and other confounding factors; Methods: This cross-sectional study included 268 diabetic participants from Mongolia-Japan University Hospital (mean age 57.0 ± 9.9 years, 38.8% male, median diabetes duration 8.0 years, mean HbA1c 9.2 ± 3.3%). We analyzed the association between age and HbA1c using linear regression models, adjusting for diabetic characteristics, chronic complications, inflammation markers, and red cell indices. Subgroup analyses were conducted based on red cell distribution width (RDW) median splits; Results: A significant negative association between age and HbA1c was observed, with an unstandardized B coefficient (95% CI) of -0.112 (-0.166; -0.058, p < 0.001). This association persisted after adjustment for diabetic characteristics, complications, inflammation markers, and red cell indices (-0.115, -0.179; -0.051, p = 0.001). Subgroup analyses indicated a stronger negative association in participants with lower RDW levels (-0.174, -0.269; -0.079, p < 0.001) compared to those with higher RDW (-0.080, -0.147; -0.014, p = 0.019), suggesting that red cell characteristics may modify this relationship. No significant interactions were identified except for RDW; Conclusions: Our findings reveal a distinct negative association between age and HbA1c in diabetic individuals, independent of diabetic characteristics, complications, and inflammation markers. This association is particularly pronounced in individuals with lower RDW levels, highlighting the potential role of red cell morphology in influencing HbA1c levels with aging in diabetes.

The effect of eating motivation on adherence to the Mediterranean diet, glycemia and lipid profile in individuals with type 2 diabetes

ABSTRACT The aim of this study was to investigate the effect of eating motivation on Mediterranean diet adherence, glycemia and lipid profile in individuals with type 2 diabetes. A questionnaire consisting of general information, eating motivation scale and Mediterranean diet adherence scale was applied to 400 individuals with diabetes. Height, weight, plasma glucose, total cholesterol, triglycerides, low density lipoprotein and high density lipoprotein values were measured. Environmental and political, health, commercial and marketing, economic and affordability motivations are effective in individuals with diabetes. Emotional motivation and social motivation were positively correlated with body mass index, HbA1C, total cholesterol, triglyceride and low density lipoprotein levels. Health motivation increased the likelihood of having glucose levels below 130 mg/dl. Individuals with diabetes were influenced by eating motivations and these motivations were associated with adherence to the Mediterranean diet and glycemia. Eating motivation may be effective in the management of type 2 diabetes.

Impact of Apple Cider Vinegar on Insulin Resistance and Related Conditions: Benefits, Mechanisms, and Potential Risks - Literature Review

Introduction and purpose: The topic of apple cider vinegar supplementation and insulinresistance is becoming increasingly widespread, especially on the internet, which carriesmany potential risks. There is a need to understand both how apple cider vinegar reducesinsulin resistance and improves metabolic parameters, as well as the potential risks of its use.Material and methods: Medical databases like PubMed, Google Scholar, and Embase weresearched for scientific papers on the safety, benefits, mechanisms, and risks of apple cidervinegar in insulin resistance and related conditions. These were analyzed and summarized ina single review.State of knowledge: Apple cider vinegar supplementation contributes to a reduction ininsulin resistance, which is reflected in parameters such as decreased postprandial insulinsecretion, lower levels of triglycerides (TG) and total cholesterol (TC), reduced fastingglucose, lower HbA1c levels, and supports weight loss, potentially improving insulinsensitivity. In most cases, no adverse effects or serious side effects were observed with dosesof 15-30 ml per day. However, potential risks include delayed gastric emptying, exacerbationof gastroesophageal reflux disease (GERD), gastrointestinal disturbances, tooth erosion,although one study suggests that such supplementation may be associated with acutepancreatitis.Conclusions: More research is needed on supplementation, particularly regarding itsduration. Another risk is the search for health information online without critically evaluatingthe content. Weight loss through a proper diet and exercise appears to be key for improvinginsulin sensitivity, but supplementation may help achieve results in certain patient groups.

ASSOCIATIONS BETWEEN HBA1C LEVELS AND LIVER FUNCTION TESTS IN DIABETES: A COMPREHENSIVE ANALYSIS

Objective: To determine the liver function tests status among the diabetic patients. Diabetes mellitus (DM) is a chronic multi-system disease characterized by hyperglycemia. The most common type of DM, Type 2 DM (T2DM), is characterized by insulin resistance and insufficient insulin secretory response. T2DM is frequently associated with abnormal liver function tests (LFTs). Our study aims to widen our knowledge of the complex interrelationship between T2DM and LFTs. Methodology: This study was done in a multi-specialty hospital in Western part of Tamil Nadu among the patients who came for master health check-up between 2017 and 2024. From the laboratory database of 67,000 patients, patients who reported for the 1st time and had their hemoglobin A1c (HbA1c) and LFT values evaluated were selected. They were categorized as normal, pre-diabetic, and diabetic based on HbA1c values. Data were analyzed using SPSS 27. Categorical variables were expressed in the form of frequency and percentages whereas continuous variables were expressed in the form of mean and standard deviation. Analysis of variance (ANOVA) was used to find out any significant difference in lipid profile among the three groups. Results: Our study had 23,238 participants. Out of them 7168 (30.84%) had normal HbA1c levels, 8347 (35.91%) were pre-diabetics and 7955 (34.23%) were diabetic patients. The mean total protein (TP), serum glutamic-pyruvic transaminase (SGPT), and alkaline phosphatase (ALP) were higher among the diabetic patients. ANOVA showed that there was a significant difference in serum total bilirubin, TP, albumin, serum glutamic-oxaloacetic transaminase (SGOT), SGPT, and ALP between the three groups. Pearson correlation coefficient showed a positive correlation between SGOT, SGPT, ALP, and HbA1c. It showed a negative correlation between TB, albumin, and HbA1c. Conclusion: From the findings of this study, there is evidence that there exists a significant association between HbA1c levels and LFTs. Elevated HbA1c levels correlate with abnormal LFT results, suggesting a potential link between glycemic control and liver health. These results underscore the need for monitoring both HbA1c and LFTs in patients with diabetes to manage their overall health comprehensively.

Effects of the COVID-19 Lockdown on HbA1c Levels of Ethnic Minorities and Low-income Groups with Type 2 Diabetes in Israel.

To investigate the impact of low socioeconomic status (SES) and/or membership in ethnic minority has on HbA1c before and during the COVID-19 lockdown. A retrospective cohort study was conducted between March 2019 and March 2021, based on data from electronic medical records of 17,072 patients with type-2 diabetes, collected by Clalit (Israel's largest health maintenance organization). Low SES was compared to high and ethnic minorities (Arabs and ultra-Orthodox Jews) were compared to the general Israeli population of mostly Jewish, but not ultra-Orthodox, Israeli citizens. Quantile regressions were used to examine the impact of SES and ethnic minority membership on HbA1c levels in the 0.10, 0.25, 0.50, 0.75, 0.90 quantiles before and during the lockdown. In the pre-lockdown period, patients with type-2 diabetes of low versus high SES, and Arabs versus the general population, had higher HbA1c. During the lockdown HbA1c levels of low versus high SES rose significantly in the 0.10 and 0.90 quantiles, and among Arabs HbA1c levels rose significantly across all quantiles, with a remarkable increment in the 0.90 quantile (from 0.316% in the pre-lockdown period to 0.730% in the lockdown period). Ultra-Orthodox Jewish diabetic patients had a marginally higher mean HbA1C level regardless of the period. Quantile regressions did not reveal a significant difference between the ultra-Orthodox Jewish and the general population. The lockdown exacerbated disparities in glycemic control between low and high SES individuals and between Arab minority and the general population.

Age-dependent effects of lockdown and post-lockdown periods on HbA1c during the COVID-19 pandemic: A 3-year longitudinal cohort study.

The impact of COVID-19 lockdown on glycemic control in patients with diabetes mellitus (DM) remains unclear. This study aimed to investigate the effects of lockdown measures on the metabolic parameters of patients with DM, with particular emphasis on geriatric populations. In this retrospective, longitudinal cohort study, 1224 patients were analyzed. Three periods were identified to examine the effects of the lockdown: pre-lockdown, lockdown, and post-lockdown. Each period spanned 1-year. Within each 1-year period, at least 2 measurements were taken at least 3 months apart, and their arithmetic mean was calculated. Only patients who presented to the hospital for DM management during all 3 periods were included in the study. While HbA1c levels significantly increased in patients over 65 years old during the lockdown period (P = .017), we observed a significant decrease in HbA1c levels in patients under 65 years old (P = .014). Upon further stratification of patients over 65 by age groups, HbA1c levels increased the most among those aged 75 to 85 years, with a significant rise also observed in those aged 65 to 75 years during the lockdown. However, there was no change in HbA1c levels for patients over 85 years old during the lockdown. These findings highlight the need for careful monitoring of elderly patients with DM during lockdown periods, facilitated via home care or telehealth services. Structured diet and exercise programs should also be provided for at home adherence.