HbAlc Levels Research Articles

Clinical Characteristics and Risk Factors of Sepsis in Patients with Liver Abscess.

Aims/Background Liver abscess (LA) is a serious medical condition that predisposes patients to sepsis. However, predicting sepsis in LA patients has rarely been explored. This study employed univariate and multivariate logistic regression analyses to identify independent risk factors for sepsis, which would provide guidance for clinical diagnosis and treatment. Methods A total of 122 patients with LA treated in Peking University People's Hospital from 1 January 2016 to 31 October 2022 were recruited. Among the cases, 35 patients had sepsis (sepsis group) while the remaining 87 did not have sepsis (non-sepsis group). Clinical data were collected for all enrolled cases. Univariate analysis was performed to identify potential predictors, which were tested in multivariable logistic analysis to pinpoint the independent risk factors for sepsis in LA patients; these findings were utilized to develop a prediction model. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of the prediction model. Informed consent to participate was obtained from the patients or their relatives. Results The incidence of shivering in the sepsis group was significantly higher than that in the non-sepsis group (p < 0.05). Through the univariate analysis, it was found that the reduction in platelet count and prothrombin time activity and the elevation of glycosylated hemoglobin (HbAlc) and procalcitonin (PCT) were more significant in the sepsis group than in the non-sepsis group (p < 0.05). Multivariate logistic regression analysis revealed that PCT and HbAlc were independent risk predictors of sepsis in LA patients within the derivation cohort (p < 0.05). Conclusion Elevated levels of HbAlc and PCT were independent risk factors for sepsis associated with LA. Patients with LA exhibiting elevated PCT levels demonstrated a 21% increased susceptibility to sepsis, and those with elevated HbAlc levels showed a 38% heightened risk for sepsis.

The effect of health quotient and time management skills on self-management behavior and glycemic control among individuals with type 2 diabetes mellitus.

The aim of this study was to evaluate the present status of self-management behavior and glycemic control in individuals diagnosed with Type 2 Diabetes Mellitus (T2D), as well as to examine the impact of health quotient (HQ) and time management skills on both self-management behavior and glycemic control. Between October 2022 and March 2023, a purposive sampling method had been utilized to select 215 participants with type T2D. The survey concluded a general information questionnaire, an HQ scale, a diabetes time management questionnaire and a self-management behavior questionnaire. The health quotient(HQ)encompasses the individuals' knowledge, attitude toward health, and the ability to maintain their own well-being. The diabetes time management questionnaire was reverse-scored, with higher scores indicating an enhanced competence in time management. The path among variables was analyzed using structural equation modeling(SEM). SEM showed that the direct effect of HQ on time management was -0.566 (p < 0.05), the direct effect of time management on the effect of self-management was -0.617 (p < 0.05), the direct effect of HQ on self-management was 0.156, and the indirect effect was 0.349 (p < 0.05); the relationship between health quotient and self-management was partially mediated by time management, with a mediating effect size of 68.8%. In addition, self-management had a direct effect on HbAlc, with a size of -0.394 (p < 0.05); The impacts of both HQ and time management on HbAlc were found to be mediated by self-management, with HQ demonstrating an indirect effect of -0.199 (p < 0.05) and time management showing an indirect effect of 0.244 (p < 0.05). Health quotient and time management in patients with T2D serve as catalysts for self-management behavior. They affect HbAlc level indirectly through self-management practices. The suggestion is to prioritize the cultivation of rational time organization and management skills in T2D patients, as well as enhance their health quotient level. This can facilitate a more effective improvement in patients' self-management behaviors, ultimately achieving the objective of maintaining optimal glycemic control.

Effect of Helicobacter Pylori Infection on Glucose Metabolism, Lipid Metabolism and Inflammatory Cytokines in Nonalcoholic Fatty Liver Disease Patients.

To probe into the influence of Helicobacter pylori (Hp) infection on glucose metabolism, lipid metabolism, and inflammatory cytokines in patients with nonalcoholic fatty liver disease (MASLD). A total of 140 MASLD patients admitted to our Hospital between June 2020 and May 2021 were selected as the research objects. Based on the presence or absence of Hp infection, they were divided into the study group (73 cases with infection) and control group (67 cases without infection). Glucose metabolism indicators [fasting blood glucose (FBG), 2-hour postprandial glucose (2hPG), fasting insulin (FINS), glycated hemoglobin (HbAlc)], lipid metabolism indicators [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)], and inflammatory indicators [interleukin-37 (IL-37), interleukin-18 (IL-18)] were measured and compared between the two groups. In terms of glucose metabolism indicators, the study group exhibited higher levels of FBG (5.84±0.49 vs 5.40±0.51, t=2.535, P=0.012), 2hPG (7.26±1.30 vs 6.50±1.53, t=3.321, P<0.001), and FINS (11.13±4.13 vs 9.12±3.72, t=3.224, P<0.001), and Insulin resistance index (HOMA-IR) (2.97±0.35 VS 2.13±0.54, t=3.761, P<0.001) and a lower level of HbAlc (5.25±0.56 vs 6.12±0.57, t=5.473, P<0.001) compared to the control group. Regarding lipid metabolism indicators, the study group exhibited higher levels of TC (5.64±1.49 vs 5.01±1.32, t=3.332, P<0.001), TG (1.89±0.34 vs 1.32±0.43, t=3.411, P<0.001), and LDL-C (3.31±0.43 vs 2.12±0.29, t=4.142, P<0.001), and a lower level of HDL-C (1.45±0.21 vs 1.78±0.42, t=4.347, P<0.001) compared to the control group. As for the inflammatory indicators, the study group exhibited higher levels of IL-37 (45.56±6.02 vs 34.02±3.28, t=9.332, P<0.001) and IL-18 (73.57±5.82 vs 60.34±4.84, t=10.141, P<0.001) compared to the control group. It is crucial to place appropriate emphasis on the impact of Hp infection on the glucose metabolism, lipid metabolism, and inflammatory response in MASLD patients, warranting careful consideration during the treatment of these patients.

The Complex Network of Cytokines and Chemokines in Pediatric Patients with Long-Standing Type 1 Diabetes.

Type 1 diabetes (T1D) is a progressive disorder leading to the development of microangiopathies and macroangiopathies. Numerous cytokines and chemokines are involved in the pathogenesis of T1D complications. The study aimed to assess the presence of complications in patients with long-standing T1D and its relationship with serum biomarker concentrations. We examined 52 T1D subjects, with a disease duration ≥4 years and 39 healthy controls. The group of T1D patients was further divided into subgroups based on the duration of the disease (<7 years and ≥7 years) and the metabolic control assessed by the HbAlc level (<8% and ≥8%). We used Luminex Technology to assess a wide range of biomarker concentrations. A 24 h urine test was done to evaluate the rate of albuminuria. Optical coherence tomography (OCT) was conducted to detect early retinopathic changes. Subclinical atherosclerosis was assessed by measuring the carotid intima-media thickness (IMT). T1D patients showed remarkably higher concentrations of EGF, eotaxin/CCL11, MDC/CCL22, sCD40L, TGF-α, and TNF-α. Moreover, we reported statistically significant correlations between cytokines and IMT. Biomarker concentrations depend on numerous factors such as disease duration, metabolic control, and the presence of complications. Although the majority of pediatric T1D patients do not present signs of overt complications, it is indispensable to conduct the screening for angiopathies already in childhood, as its early recognition may attenuate the further progression of complications.

Pranic Healing as a Complementary Therapy in Diabetic Foot Ulcer Management: A Randomised, Controlled, Double-Blind Trial.

Diabetic Foot Ulcers (DFUs), a serious complication of diabetes, have limited solutions in conventional therapies. The condition needs holistic management of blood glycemic levels; foot wounds; and possible regeneration of nerves in the soles of patients. To evaluate the efficacy of Pranic Healing as a complimentary therapy in managing Diabetic Foot Ulcers (DFUs). Thirty diabetic subjects already on standard therapy for Diabetes, co morbidities and wound care for Diabetic Foot Ulcers were assigned on a 1:1 basis to the trial and control groups. While both groups continued to receive standard therapy, the trial group additionally received Pranic Healing therapy. The Clinician, nursing staff, assessors and patients were blinded. Pranic Healers carried out healing on the trial group remotely, every day for 50 to 60 minute for stress, diabetes, local wound healing, blood cleansing and regeneration of nerves in the soles. The efficacy variables were the mean change from baseline in wound parameters and grade of DFU, overall well-being and HbAlc levels. At the end of the trial, about 83.33% participants in the trial group demonstrated lowering of size and severity of the ulceration and improved to a lower grade of DFU compared to 44.4% in control group. The trial group reported a significant reduction in wound area and HbA1c levels. The trial group showed better readings for improved sensory perception in the soles through changes in the large fibre dysfunction and damaged nerves as compared to the control group. Approximately 76.9% of participants in the trial group reported lower stress levels compared to 22.22% in the control group. Pranic Healing intervention can be a safe and effective adjunct in managing Diabetic Foot Ulcers.

Correlation Analysis of Vascular Endothelial Growth Factor Level with Clinicopathological Features and Prognosis in Patients with Diabetic Nephropathy: A Biopsy-based Study.

Globally, Type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic diseases, which poses a great potential threat to the human body. Diabetic nephropathy (DN), a very common complication in T2DM, is also the main trigger for end-stage renal disease. A thorough understanding of the pathogenesis is the key as well as the breakthrough for future diagnosis and treatment of DN. This investigation aims to provide more in-depth and accurate guidance for future follow-up research by analyzing the role of vascular endothelial growth factor (VEGF) in the kidney tissue of DN patients. Seventy-nine patients with suspected DN who underwent renal needle biopsy in our hospital from January 2015 to June 2019 were selected as the research participants. After the biopsy, 36 cases were confirmed as DN, and the other 43 were T2DM with primary glomerulonephritis. Determination of VEGF mRNA and protein expression in renal tissue employed PCR and Western blot, and the connection between VEGF mRNA level and clinical pathology (such as renal function, inflammatory factors and pathological manifestations) was discussed. The disease recurrence in DN patients was recorded through the 3-year prognostic followed up, and the related influencing factors were analyzed. In kidney tissue, VEGF mRNA level and protein expression were notably higher in DN patients than in diabetic patients (P<0.05). Pearson correlation coefficient analysis identified that VEGF mRNA and protein had a positive connection with blood urea nitrogen (BUN), serum creatinine (Scr), 24-hoururinetotalprotein(24hUTP) and C-reactive protein (CRP) (P<0.05). Among the various clinicopathological features of DN patients, age, BMI, sex, family history, smoking, drinking, exercise habits, clinical presentations and pathological changes had no significant relationship with VEGF level (P>0.05), but the course of the disease, fasting blood glucose (FBG), glycosylated hemoglobin (HBALC) and pathological stages of nephropathy had a close connection with VEGF level (P<0.05). Prognostic follow-up revealed that VEGF mRNA was noticeably higher in patients with recurrence than in those without (P<0.05). When VEGF mRNA >5.20 in kidney tissue, the sensitivity and specificity for predicting the 3-year recurrence were 85.71% and 84.00% respectively (P<0.05). Finally, Logistic regression analysis identified the independence of FBG, HBALC and VEGF levels as the influencing factors for the prognostic recurrence of DN (P<0.05).VEGF expression in kidney tissue of DN patients is closely linked to renal function and increases as the disease progresses, which is an independent risk factor associated with the prognostic recurrence of DN, with great potential significance for future DN diagnosis and treatment.

Hepatoprotective and hypoglycemic effect of lactic acid fermented Indian Gooseberry-Amla beverage on chronic alcohol-induced liver damage and diabetes in rats

BackgroundPlant-based fermented foods rich in lactic acid bacterial metabolites, antioxidants, and phytochemicals, can promote recovery from ethanol-induced liver damage by restoring liver antioxidant levels and suppressing liver inflammation, and improving certain metabolic disorders such as diabetes mellitus. MethodsIn the present study, the protective effects of nutraceutical-enriched lactic acid-fermented Amla beverage on chronic alcohol-induced biochemical modulations and diabetes in Wistar rats were investigated. ResultsThe hepatoprotective studies showed that the fermented beverage was able to reverse the damage caused to the liver with ethanol administration in terms of liver index, liver enzymes (AST, ALT), serum enzymes (g-GT), and serum TG, TCH, hepatic TG, LPO levels, antioxidants (GSH, TSOD, CAT, GSH-Px). Along similar lines, in the hypoglycemic studies, the fermented beverage evidently improved body weight, and fasting blood glucose levels, reducing fasting HbAlc levels, improving C-peptide and GLP-1 levels, and alleviating renal dysfunction and lipid metabolism compared with diabetic rats. All these outcomes were supported by histological observations within the liver and pancreas. ConclusionThe present study suggests that the consumption of fermented Amla beverage may have a protective effect against chronic alcohol-induced toxicity and diabetes. The effects of fermented Amla beverage may be attributed to antioxidant activity, flavonoids, bioactive compounds produced by LAB and their metabolites, which help to counteract free radicals induced by ethanol and in reducing glucagon levels, enhancing glucose utilization, leading to a decrease in blood glucose. The results show that fermented Amla beverage has positive effects in reducing the detrimental effect of alcohol and diabetes.

The effect of glycaemic control on neutralizing antibody response to COVID-19 among patients with Type 2 diabetes mellitus in the Kurunegala District of Sri Lanka; A prospective cohort study

Background: The antibody response following COVID-19 vaccination among patients with diabetes mellitus (DM) is of particular concern given the increased risk of severe disease in this population. The correlation between glycaemic control among persons with DM and the antibody response was not published in Asian populations. Hence, this study aimed to determine whether glycaemic control has an association with the development of an adequate antibody response for SARS-CoV-2 among patients with DM following the administration of two doses of the COVID-19 vaccine.Methods: A prospective cohort study was carried out at three vaccination centers in the Kurunegala district from November 2021 to January 2022. Seventy-one patients with type 2 diabetes were recruited for this study and followed up on vaccination with the Sinopharm COVID-19 vaccine. HbA1 c levels at the first dose and after 6-8 weeks from the second dose of vaccine were analyzed. The neutralizing antibodies (NAbs) were analyzed using C Pass™ neutralizing antibody detection ELISA Kit following 6-8 weeks of the 2nd dose.Results: The median (IQR) age of the total population (63.4% females) was 53 years (44.0-58.0) and they were diagnosed with diabetes for 6 years (3-11 years). The median first and second HbAlc values were 9.3% (7.2-10.7%) and 8.2% (7.1-10.2%) respectively. From the total population, only 66.2% developed protective levels of NAbs after 6-8 weeks of the second dose of the vaccine. The second HbAlc value was significantly lower compared to the first (z=-2.63, p=0.008). There was no significant difference in terms of sex, age, duration of diabetes, pre-vaccination HbAlc level, or HbAlc level 6-8 weeks after the vaccination among those who developed protective levels of antibodies and those who did not (p&gt;0.05). There was no difference in sero-conversion depending on the abnormal HbAlc value (.28%) (1st HbAlc p=0.957, 2nd HbAlc p=0.360).Conclusion: We did not detect an association between glycaemic control and sero-conversion. However, 1/3rd of patients with diabetes did not have a protective level of NAbs following 2 doses of Sinopharm COVID-19 vaccination. Furthermore, glycaemic control did not deteriorate with COVID-19 vaccination.

Idealism of Physical Activity Interventions in Type 2 Diabetes Mellitus Patients: A Literature Review

Diabetes Mellitus (DM) could be an inveterate illness related with insufficiency and the failure of the pancreas to create sufficient insulin. WHO predicts that the number of individuals with sort Il diabetes mellitus in Indonesia will increment to 12 million in 2030. The ponder pointed to depict Physical Action Intercessions in sort 2 diabetes mellitus patients. Utilizing the online dialy database that gives free afficles and diaries from 2010 -2020 in PDF shape such as: Scinapse, Pubmed, ProQuest, NIDPI and Google Researcher utilizing the catchphrases "Physical Movement", "Effectiveness of Physical Action". Neural physical actions can advance the condition of persistent diabetics in the event that routinely done. Admissions of physical action intercession can control HbAlc levels and blood sugar, body weight and other glycemic control. Physical movement of nerves is able to advance the condition of patients with diabetes mellitus. Keywords: Physical Activity, Diabetes Mellitus

Clinical Efficacy of Dapagliflozin in the Treatment of Patients with Diabetic Nephropathy and Its Effect on Proteinuria Level.

This study aimed to analyze the clinical efficacy of dapagliflozin in the treatment of diabetic kidney disease and its impact on proteinuria levels in patients. Retrospective analysis of medical records of 176 patients with diabetic kidney disease treated at our hospital from January 2020 to January 2022. According to the different treatment methods, the patients were divided into a control group (n=88) receiving enalapril maleate treatment and an observation group (n=88) receiving dapagliflozin treatment. The clinical treatment effects, blood glucose levels, renal function indicators, inflammation factor indicators, and adverse reactions were compared between the two groups. The total effective rate of treatment (97.73%) in the observation group was significantly higher than that (79.55%) in the control group (P<0.05). After treatment, the FPG, 2hPG, and HbAlc levels in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the Scr, BUN, UmAlb, UAER, UACR, and 24-hour urine protein quantitative levels in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the hs-CRP, IL-1β, and TNF-α levels in the observation group were significantly lower than those in the control group (P<0.05). The incidence of adverse reactions in the observation group significantly lower than the control group (P<0.05). Compared with enalapril maleate alone, the combined application of dapagliflozin in the treatment of diabetic kidney disease has more significant clinical efficacy. It can further control patients' blood sugar, reduce their body's inflammatory response, alleviate or eliminate their proteinuria symptoms, promote the recovery of their renal function, and enhance the safety of their treatment to a certain extent, which helps to further improve the clinical treatment effect of patients.

The associations of ferritin, serum lipid and plasma glucose levels across pregnancy in women with gestational diabetes mellitus and newborn birth weight

BackgroundWomen with gestational diabetes mellitus (GDM) are at greater risk of abnormal birth weight. Since the level of biochemical indicators could often affect the intrauterine growth and development of the fetus, it is of great practical significance to understand the changes of biochemical levels across pregnancy in women with GDM and to find out the indicators that play an important role in predicting birth weight.MethodsThe data source of this study was from the Xi'an Longitudinal Mother–Child Cohort study (XAMC), in which women with GDM with normal and high pre-pregnancy body mass index (BMI) and their newborns between January 1st and March 31st in 2018 were included. The data of ferritin, serum lipid profile and fasting plasma glucose (FPG) of mothers in the three trimesters of pregnancy, as well as birth weight of newborns were all collected from medical records. Multiple linear regression and multivariate logistic regression analyses were used to explore the association of the biochemical indexes and birth weight. A P value < 0.05 was considered statistically significant.ResultsA total of 782 mother-infant pairs were finally included and divided into normal weight group (NG) (n = 530, 67.8%) and overweight/obesity group (OG) (n = 252, 32.2%) according to maternal pre-pregnancy BMI. The level of ferritin in both NG and OG decreased during pregnancy (P for trend < 0.001 for all), whereas the levels of total cholesterol (TC), high density cholesterol (HDL-C), low density cholesterol (LDL-C) and triglycerides (TG) all showed an upward trend (P for trend < 0.05 for all). The levels of FPG in the two groups remained in a relatively stable during the whole pregnancy even though it was higher in OG during the 2nd and 3rd trimesters, whilst HbAlc levels in NG women increased (P for trend = 0.043) during pregnancy. Meanwhile, the risk of macrosomia and large-for-gestational-age (LGA) increased with the increase of FPG level (P for trend < 0.05). Multivariate logistic regression analyses results showed that only FPG level in the 3rd trimester was correlated with birth weight, with birth weight increased by 44.9 g for each SD increase in FPG level.ConclusionMaternal FPG in the 3rd trimester is an independent predictor of newborn birth weight, and a higher level of that is associated with an increased risk of macrosomia and LGA.

Relationship between Changes in Blood Glucose and Blood Lipid Levels and the Risk of Thyroid Cancer in Patients with Type 2 Diabetes Mellitus.

To investigate the relationship between changes in blood glucose and blood lipid levels and the risk of thyroid cancer in patients with type 2 diabetes mellitus. A total of 159 patients with type 2 diabetes who were treated in our hospital between June 2018 and February 2021 were recruited and assigned into the observation group, including 136 patients with type 2 diabetes without thyroid cancer (nonthyroid cancer group) and 23 patients with type 2 diabetes complicated with thyroid cancer (thyroid cancer group), and 120 healthy subjects during the same period were selected as the control group. Glycated hemoglobin (HbAlc), total cholesterol (TC), triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were detected and compared. Pearson's method was conducted to analyze the correlation between serum HbAlc level and TC, TG, HDL-C, and LDL-C levels in patients with type 2 diabetes mellitus; multivariate logistic regression analysis was performed to analyze the influencing factors of thyroid cancer in patients with type 2 diabetes mellitus. The serum HbAlc level and the incidence of thyroid cancer in patients with type 2 diabetes mellitus in the observation group were significantly higher than those in the control group (P < 0.05). The levels of TC, TG, and LDL-C in patients with type 2 diabetes mellitus in the observation group were significantly higher than those in the control group, and the level of HDL-C was significantly lower than that in the control group (P < 0.05). The correlation analysis showed that serum HbAlc levels in patients with type 2 diabetes were positively correlated with TC and TG levels and negatively correlated with HDL-C levels (P < 0.05) and not correlated with LDL-C levels (P > 0.05). Compared with the type 2 diabetes patients without thyroid cancer, the serum HbAlc, TC, and TG levels of the patients with type 2 diabetes mellitus in the thyroid cancer group were significantly higher, and the levels of HDL-C were significantly lower (P < 0.05). There was no significant change in the level of LDL-C (P > 0.05). Multivariate logistic regression analysis showed that serum HbAlc, TC, and TC levels were all risk factors for thyroid cancer in patients with type 2 diabetes mellitus (P < 0.05), while serum HDL-C level was a protective factor for thyroid cancer in patients with type 2 diabetes mellitus (P < 0.05). Thyroid cancer in type 2 diabetes patients may be linked to elevated levels of blood HbAlc, TC, and TG. HbAlc may raise the risk of thyroid cancer in type 2 diabetes patients by modulating blood lipid levels, which might serve as a marker to assess the risk of thyroid cancer in type 2 diabetes mellitus patients. However, since this study did not conduct in vitro and in vivo experiments, how HbAlc affects the pathogenesis of thyroid cancer has not been described in this study, which is also our future research direction. It is expected to provide new ideas for the prevention and treatment of thyroid cancer.

Analysis of magnetic resonance splectroscopy characteristics in patients with type 2 diabetes complicated with stroke.

In this study, we investigated the metabolism of white matter by magnetic resonance spectroscopy (MRS) in stroke complicated with diabetes mellitus in combination with glycosylated hemoglobin (HbAlc) detection and clinical neurological deficit score (NIHSS). Fifty-three patients with stroke within 24 h after onset were collected and scanned by MRS. The biochemical, clinical and imaging characteristics of patients were analyzed. Patients were divided into three groups according to HbAlc levels: Good glycemic control (A): < 6.5%; satisfactory glycemic control (B): 6.5-7.5% and poor glycemic control (C): > 7.5%. The results showed that HbA1c levels were positively correlated with NIHSS in patients with acute ischemic stroke (AIS). There is significant difference in NAA/Cr between the infarcted site of the three groups and the mirror site. HbA1C level was negatively correlated with NAA/Cr in patients with AIS, and there was no significant correlation between NIHSS score and NAA/Cr. The data above demonstrated that the MRS imaging can be used to explain the adverse effects of hyperglycated hemoglobin on brain parenchyma from the perspective of imaging. This imaging technique and clinical NIHSS score have a high consistency in evaluating stroke.

Associations between glycated hemoglobin and the risks of incident cardiovascular diseases in patients with gout

BackgroundEvidence for the relationship between glycated hemoglobin (HbA1c) levels and risk of cardiovascular diseases (CVD) in patients with gout remained sparse and limited. This study aims to explore the associations between HbA1c levels and risks of incident CVD in patients with gout.MethodsWe included patients with gout who had an HbA1c measurement at baseline from the UK Biobank. CVD events were identified from through medical and death records. We used multivariable Cox proportional hazards model with a restricted cubic spline to assess the potential non-linear effect of HbA1c on CVD risk.ResultsWe included a total of 6,685 patients (mean age 59.7; 8.1% females) with gout for analyses. During a mean follow-up of 7.3 years, there were 1,095 CVD events documented with an incidence of 2.26 events per 100 person-years (95% confidence interval [CI]: 2.13–2.40). A quasi J-shaped association between HbA1c and risk of CVD was observed, with the potentially lowest risk found at the HbA1c of approximately 5.0% (hazard ratio [HR] = 0.65, 95% CI: 0.53–0.81). When compared with the HbAlc level of 7%, a significantly decreased risk of CVD was found from 5.0 to 6.5%, while an increased risk was observed at 7.5% (HR = 1.05) and 8.0% (HR = 1.09). Subgroup analyses yielded similar results to the main findings in general.ConclusionsBased on data from a nationwide, prospective, population-based cohort, we found a quasi J-shaped relationship between HbA1c and risk of CVD in patients with gout. More high-quality evidence is needed to further clarify the relationship between HbA1c and CVD risk in patients with gout.

The Combination Clinical Value of Plasma Brain Natriuretic Peptide and Serum HbAlc in the Diagnosis of Chronic Pulmonary Heart Disease.

Objective To analyze the combination clinical value of plasma brain natriuretic peptide and serum glycated hemoglobin (HbAlc) in chronic pulmonary heart disease. Methods A total of 200 patients with chronic pulmonary heart disease admitted to our hospital from January 2021 to January 2022 were selected as the observation group, and 200 healthy subjects were selected as the control group during the same period. All subjects were examined by an ECG vector map and plasma BNP, and HbAlc levels were detected to analyze the value and clinical significance of each index in single diagnosis and combined diagnosis. Results Plasma BNP and HbAlc levels in the observation group were significantly higher than those in the control group (P < 0.05). There were 154 BNP positive, 146 HbAlc positive, 164 parallel combined diagnosis positive, and 132 serial combined diagnosis positive. Sensitivity of series combination diagnosis was significantly higher than other indexes (P < 0.05); especially, parallel combination diagnosis was significantly higher than other indexes (P < 0.05). Besides, area under the ROC curve of parallel combination diagnosis and series combination diagnosis was significantly higher than that of each index alone diagnosis (P < 0.05). Conclusion In the diagnosis of chronic pulmonary heart disease, the combination of plasma BNP and HbAlc can effectively improve the diagnostic specificity and sensitivity, as well as improve the area under the ROC curve.

Ponicidin attenuates streptozotocin-induced diabetic nephropathy in rats via modulating hyperlipidemia, oxidative stress, and inflammatory markers.

The present research work was proposed to discover the beneficial roles of ponicidin against the streptozotocin (STZ)-induced diabetic nephropathy (DN)in rats via modulating the oxidative stress and inflammation. The DN was initiated to the Wistar rats via administering 45 mg/kg of STZ and then diabetic animals were supplemented with 50 mg/kg of ponicidin and 150 mg/kg of metformin (standard drug) for 8 weeks. The body weight and food intake of animals were checked every week. The glucose, insulin, and homeostasis model assessment- insulin resistance (HOMA-IR)levels in the serum were assessed using kits. The levels of reactive oxygen species(ROS)accumulation, oxidative stress and antioxidant markers, and pro-inflammatory cytokines were examined using assay kits. The levels of lipid profiles and renal function markers were investigated using respective kits. The renal tissues were analyzed microscopically to detect the histological alterations. The ponicidin treatment effectively decreased the body weight, food intake, HOMA-IR, and HbAlc levels in the DN animals. The levels of ROS and MDA were decreased and superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase (GR) activities were improved by the ponicidin. The ponicidin also reduced the blood urea nitrogen(BUN), creatinine, lactate dehydrogenase(LDH), and kidney injury molecule (KIM-1) levels. The levels of low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), free fatty acid (FFA), and total cholesterol (TC) were decreased and the high-density lipoprotein (HDL) level was improved by the ponicidin treatment to the DN rats. The tumor necrosis factor-alpha(TNF-α), interleukin-1β (IL-1β), nuclear factor-kappa B (NF-κB), and IL-6 levels were appreciably attenuated by the ponicidin. The ponicidin also ameliorated the DM-provoked histological alterations in the renal tissues. In conclusion, this study work evidenced that ponicidin has the therapeutic action in ameliorating the development of DN via averting oxidative stress, inflammation, and renal injury. It could be a promising therapeutic agent to treat DN in the future.

Proximity hybridization-induced competitive rolling circle amplification to construct fluorescent dual-sensor for simultaneous evaluation of glycated and total hemoglobin

The glycated hemoglobin (HbA1c) level, defined as the ratio of HbA1c to total hemoglobin (tHb), has been considered as a standard index for diabetes mellitus diagnosis, avoiding any short-term fluctuation of the blood glucose level. However, it is still a key challenge that some complicated separation procedures are required to detect HbA1c and tHb in a single experiment. Herein, we developed a dual-sensing fluorescent assay for HbA1c and tHb based on proximity hybridization-induced rolling circle amplification (RCA) and T7 exonuclease aided signal cycle to calculate the HbAlc level in one single experiment. Typically, four DNA-tagged probes were used for immunoreactions of anti-HbA1c antibodies (Ab1) and anti-Hb antibodies (Ab2) with HbA1c and Hb, respectively. The RCA1 and RCA2 were induced by the complexes of assistant DNAs and the products of proximity hybridization with anti-HbA1c-DNA1 (2) and anti-Hb-DNA3 (4), respectively. Meanwhile, the tHb in solution could prevent the existing RCA2 based on its competing with Hb-DNA3 for Ab2-DNA4. Thus, RCA1 and RCA2 routes create “signal-on” and “signal-off” readouts, respectively. After the hybridization of signal probes and RCA products, the quenched fluorescence was recovered by the digestion of T7 exonuclease. Under optimized conditions, the method displayed high sensitivity with a limit of detection 2.17 ng/mL and 33.4 ng/mL for HbA1c and tHb, respectively, and the real sample analysis results were found to match well with the theoretical data, holding feasibility for rapid, homogeneous, and easy HbA1c level evaluation and great promise as a potential alternative tool to analyze HbA1c level clinically.

New onset autoimmune diabetes mellitus and hypothyroidism secondary to pembrolizumab in a patient with metastatic lung cancer.

SummaryImmunotherapy has become an important pillar for the management of advanced cancer. Immune-related adverse events including endocrinopathies have been well described with programmed cell death 1 inhibitors such as pembrolizumab. While thyroid dysfunction is the most common endocrinopathy associated with pembrolizumab, new-onset autoimmune diabetes mellitus (DM) is extremely rare. The authors report a case of pembrolizumab-induced primary hypothyroidism and type 1 diabetes mellitus presenting with diabetic ketoacidosis (DKA). A 59-year-old female patient was treated with pembrolizumab for a stage 4 lung adenocarcinoma. She presented to the emergency department with hyperglycaemia-related signs and symptoms, such as polyuria, polydipsia, weight loss, vomiting, asthenia and dehydration, 3 weeks after her first dose of pembrolizumab. Laboratory evaluation revealed hyperglycaemia, hyperketonaemia and high anion gap metabolic acidaemia consistent with DKA. After prompt and adequate treatment of DKA, she transitioned to s.c. basal-bolus insulin. The diagnose of autoimmune DM was established based on the undetectable C-peptide levels and seropositivity for antiglutamic acid decarboxylase antibodies. Additional hormonal parameters revealed overt hypothyroidism and levothyroxine therapy was initiated. This case highlights the importance of blood glucose and thyroid function monitoring as an integral part of cancer treatment protocols for pembrolizumab and other immune checkpoint inhibitors.Learning pointsProgrammed cell death 1 (PD1) inhibitors such as pembrolizumab can cause endocrine immune-related adverse events (irAE), including thyroid dysfunction and type 1 diabetes mellitus (T1DM).Thyroid dysfunction is the most frequent endocrine irAE secondary to PD1 inhibitors.Autoimmune diabetes and possible resultant diabetic ketoacidosis are rare, but life-threatening adverse events associated with pembrolizumab.Pembrolizumab-induced T1DM often present with relatively low HbAlc levels, reflecting the fulminant onset of β-cell destruction.Patients treated with pembrolizumab and other immune checkpoints inhibitors should be monitored regularly for hyperglycaemia and thyroid dysfunction.

Effect Of Nursing Intervention Based on Behavioral Shaping Therapy on Blood Glucose Index, Self-Efficacy and Subjective Well-Being in Elderly Patients with T2DM

Objective: To investigate the effect of nursing intervention based on behavioral shaping therapy on blood glucose index, self-efficacy and subjective well-being in elderly patients with type 2 diabetes mellitus (T2DM). Methods: 100 elderly patients with T2DM admitted to our hospital from February 2019 to January 2020 were selected and divided into control group and observation group according to the random number table method, 50 cases in each group. The control group adopted the nursing method of routine education combined with motivation interview, and the observation group adopted the nursing method of behavior shaping on the basis of the control group. The fasting plasma glucose (FPG), 2h postprandial plasma glucose (2h PG), glycosylated hemoglobin (HbAlc) level, self-management ability score, diabetes management self-efficacy scale (DMSES) score and subjective well-being score were compared between the two groups before and after intervention. Results: The levels of FPG, 2h PG and HbAlc in the two groups were significantly decreased, and those of the observation group were significantly lower than those in the control group (P&lt;0.05). After intervention, the total scores of self-management ability, DMSES and subjective well-being of the two groups were significantly increased, and the observation group was significantly higher than the control group (P&lt;0.05). Conclusion: Behavioral shaping therapy combined with routine education and motivation interview can significantly improve the self-management ability, self-efficacy, blood glucose index and subjective well-being of elderly patients.

Increased hemoglobin A1c level associates with low left atrial appendage flow velocity in patients of atrial fibrillation

Background and aimsHigh hemoglobin A1c (HbAlc) level is associated with increased cardiovascular disease risk and thromboembolic events [1]. The study sought to explored the association between HbAlc and left atrial appendage flow velocity (LAAV) among non-valvular atrial fibrillation (AF) patients. Methods and resultsA total of 249 consecutive non-valvular AF patients who underwent transesophageal echocardiography (TEE) were divided into two subgroups according to the median of LAAV level (<45 cm/s, ≥45 cm/s). Blood samples and other baseline clinical data of all patients were collected and analyzed. The low LAAV group included 126 patients and the high LAAV group included 123 patients. Patients in the low LAAV group were older and had a higher percentage of persistent AF, chronic heart failure, and higher CHA2DS2-VASc score (P < 0.05). HbAlc level in the low LAAV group was significantly higher than the high LAAV group [6.1 (5.7–6.5)% vs 5.9 (5.6–6.2)%, P = 0.010]. The low LAAV group had larger left atrial diameter (LAD), left atrial area (LAA), higher left atrial pressure (LAP), and lower left ventricular ejection fraction (LVEF) (P < 0.05). Spearman rank correlation analysis showed that the HbAlc level was negatively correlated with LAAV (r = −0.211, P = 0.001). Multivariate analysis indicated that female gender (OR = 2.233, 95% CI 1.110–4.492, P = 0.024), persistent AF (OR = 6.610, 95% CI 3.109–14.052, P < 0.001), and HbAlc (OR = 1.903, 95% CI 1.092–3.317, P = 0.023) were independent factors that associated with low LAAV in AF patients. ConclusionIncreased HbAlc level is associated with decreased LAAV and may reflect a low contractile function of the left atrial appendage.