Levels In Non-diabetic Patients Research Articles

The association of the basal TIMI flow, post-PCI TIMI flow and thrombus grade with HbA1c levels in non-diabetic patients with acute ST segment elevation myocardial infarction undergoing primary PCI

Abstract Objectives The acute phase of ST-segment elevation myocardial infarction (STEMI), as determined by TIMI angiographic criteria, is influenced by various factors that impact the patient’s clinical outcome. However, the modifiable risk factors of impaired TIMI flow (TIMI<3) and its effective treatment are not fully understood. Hyperglycemia may induce a pro thrombotic state and thus affect TIMI flow before or after PCI. This study investigates the correlation between hemoglobin A1c levels, TIMI flow grade, and thrombus grade in infarct-related arteries, assessing its predictive value in non-diabetic patients with STEMI. Methods The 265 patients selected based on the hemoglobin A1c level lower than 6.5 % and were divided into three groups based on HbA1c level. Comparison between three groups in terms of risk factors, troponin level, blood glucose level, lipid profile, kidney function, number of involved vessels, type of MI, left ventricular ejection fraction, TIMI flow before and after primary angioplasty, thrombus burden, complications and hospital mortality was made. Results With the increase in HbA1c level, the prevalence of TIMI 3 flow after primary PCI decreased. The prevalence of TIMI flow 2–3 before angioplasty also decreased with the increase in HbA1c level. Increased hemoglobin A1c was also significantly related to large thrombus burden (p=0.021). Morover, hemoglobin A1c remained an independent predictor of post-PCI TIMI flow and thrombus burden. Conclusions Elevated hemoglobin A1c is a predictor of TIMI flow less than 3 after primary PCI and high thrombus burden, in STEMI patients without a history of diabetes mellitus.

Obeticholic acid's effect on HDL function in MASH varies by diabetic status.

Inflammation and oxidative stress are the key factors in the pathogenesis of both metabolic dysfunction-associated steatohepatitis (MASH) and atherosclerosis. Obeticholic acid (OCA), a farnesoid X receptor (FXR) agonist, improves hepatic inflammation and fibrosis in patients with MASH. However, it also reduces HDL cholesterol, suggesting that OCA may increase cardiovascular disease (CVD) risk in patients with MASH. We assessed HDL cholesterol efflux function, antioxidant (paraoxonase and ceruloplasmin activity), pro-inflammatory index, and particle sizes in a small group of patients with and without diabetes (n = 10/group) at baseline and after 18 months of OCA treatment. Patients on lipid-lowering medications (statins, fibrates) were excluded. At baseline, ferritin levels were higher in patients with MASH without diabetes (336.5 [157.0, 451.0] vs. 83 [36.0, 151.0] ng/mL, p < 0.005). Markers of HDL functions were similar in both groups. OCA therapy significantly improved liver histology and liver enzymes but increased alkaline phosphatase levels in nondiabetic patients with MASH (p < 0.05). However, it did not have any significant effect on cholesterol efflux and the antioxidant paraoxonase functions. In nondiabetics, ceruloplasmin (CP) antioxidant activity decreased (p < 0.005) and the pro-inflammatory index of HDL increased (p < 0.005) due to OCA therapy. In contrast, in diabetics, OCA increased levels of pre-β-HDL-the HDL particles enhanced protective capacity (p = 0.005) with no alteration in HDL functionality. In all patients, serum glucose levels were negatively correlated with OCA-induced change in pro-inflammatory function in HDL (p < 0.001), which was primarily due to diabetes (p = 0.05). These preliminary results suggest a distinct effect of OCA therapy on diabetic and nondiabetic patients with MASH and warrant a future large-scale study.

Effect of Sevoflurane, Isoflurane, and Desflurane on the Random Blood Glucose Levels in Non-diabetic Patients Undergoing General Anesthesia: A Randomized, Single-Blind Study.

Volatile anesthetic agents like sevoflurane, isoflurane, and desflurane are widely used for maintaining general anesthesia (GA). Their effect on the autonomic system is different and can impact the blood sugar homeostasis. This study compares the intraoperative blood glucose levels in non-diabetic patients undergoing non-cardiac surgery under GA with the three volatile agents. A randomized, single-blind, parallel-arm study recruited 105 non-diabetic patients into three groups. GA induction and maintenance were standardized except for the volatile agent. Capillary blood sugar levels were measured at different time points and compared between and within the groups. A p-value of <0.05 was considered significant. Entire participants completed the study, and their baseline characteristics were statistically indifferent. Intraoperative blood glucose rise and variation were the highest in the desflurane group and the lowest in the isoflurane group; the differences were statistically significant at 15, 30, and 45 minutes. The highest blood sugar level was noted at 60 minutes in all groups; after that, the level started falling. However, none of the raises were beyond 140 mg% to categorize them as hyperglycemia. Intraoperative glycemic variation was evident with isoflurane, sevoflurane, and desflurane. The maximum increase from the pre-induction level was noted at 60 minutes. However, none of the readings reached the hyperglycemia level. The rise was significantly higher in desflurane-based anesthesia than in isoflurane. This study was, however, conducted in non-diabetic patients; hence, results might not be extrapolated to diabetic patients.

A study of effect of iron deficiency anemia on glycosylated hemoglobin in non-diabetic patients

Background: Diabetes mellitus is a rapidly increasing global health concern, having a substantial impact on morbidity and mortality. Glycated hemoglobin (HbA1c) is the primary measure of diabetes control, reflecting glycemic levels over the past 3 months. However, hemoglobin (Hb) abnormalities, such as those seen in iron deficiency anemia (IDA), can theoretically affect HbA1c levels. IDA, affecting over 30% of the global population, results from inadequate iron intake, hemorrhage, or poor iron absorption, leading to reduced Hb production. This study aims to evaluate the impact of IDA on HbA1c levels in non-diabetic patients, providing insights into accurate HbA1c interpretation in anemic patients. Aims and Objectives: The study aimed to determine the impact of IDA on HbA1c levels in non-diabetic individuals. Materials and Methods: This cross-sectional study was conducted over 6 months at Trichy SRM Medical College Hospital and Research Center. There were a total of 100 IDA patients and 100 age- and sex-matched healthy controls. Hb levels below 10 g/dL with a microcytic image suggestive of iron deficiency, postprandial blood sugar (PPBS) levels below 140 mg/dL following an oral glucose tolerance test (OGTT), and fasting blood sugar (FBS) levels below 100 mg/dL were the inclusion criteria. Exclusion criteria included Hb levels above 10 g/dL, altered FBS or PPBS values post-OGTT, diagnosed Type 2 diabetes mellitus, individuals younger than 18 years, and those with conditions such as hemoglobinopathies, hemolytic anemia, hypothyroidism, pregnancy, or abnormal renal function tests. Ethical approval and informed consent were obtained. Data collection included demographics, medical history, and laboratory investigations. Statistical analysis was performed using SPSS version 26, with t-tests, mean, and standard deviation (SD) for association analysis, and Chi-square tests for sex comparisons. Correlations were assessed through t-test. The significance level was kept at 0.05. Results: The study confirmed that both groups met the inclusion criteria for non-diabetic status. The control group exhibited normal Hb levels, whereas the study group had Hb levels indicative of IDA. General and systemic examination findings were normal in both groups. Significant differences were observed across all measured parameters, with Hb levels, serum ferritin, mean corpuscular volume, mean corpuscular Hb, mean corpuscular Hb concentration, and red cell distribution width significantly lower in the study group. HbA1c levels were significantly elevated in the study group compared to the control group (5.87 ± 1.25 vs. 4.97 ± 1.59, P &lt; 0.001), supporting the hypothesis that IDA is associated with elevated HbA1c levels in non-diabetic patients. Conclusion: The study’s findings align with previous research indicating that IDA leads to elevated HbA1c levels. The prolonged erythrocyte survival and altered Hb glycation processes in IDA are likely contributors to this elevation. These results emphasize the need to consider anemia status when interpreting HbA1c values to avoid misdiagnosis and inappropriate management of diabetes. Clinicians should ensure comprehensive evaluations, including iron status assessments when encountering unexpectedly high HbA1c levels in non-diabetic individuals.

Effects of Subarachnoid Block vs General Anaesthesia on Intraoperative Blood Glucose Levels in Non Diabetic Patients undergoing Elective Surgeries: A Prospective Interventional Study

Introduction: The inhibition of the pituitary gland, an increase in the production of catabolic hormones, and the stimulation of the sympathetic nervous system culminate in surgical stress. These factors result in elevated hepatic glycogenesis and gluconeogenesis, decreased skeletal muscle glucose uptake and glycogen synthesis, and hyperglycaemia. Aim: To examine the effects of Subarachnoid Block (SAB) and General Anaesthesia (GA) on perioperative Capillary Blood Glucose (CBG) levels in individuals undergoing surgery lasting 1-3 hours. Materials and Methods: This prospective interventional study included 100 non diabetic patients undergoing surgery of 1-3 hours duration with 50 patients in each group (GA and SAB). CBG was checked 30 minutes before the administration of anaesthesia, 30 and 60 minutes after the induction of anaesthesia, and 30 minutes after shifting to the Post Anaesthesia Care Unit (PACU) in both the GA and SAB groups. Differences in participant characteristics, such as age and CBG levels in the two groups (SAB and GA), were examined using the two-tailed Independent samples t-test and the Chi-square/ Fisher’s exact test. Results: The mean CBG levels measured 30 minutes before anaesthesia in the GA group were 105.50±21.13 mg/dL, while in the SAB group they were 99.67±19.04 mg/dL, with a p-value of 0.330. However, CBG levels measured 30 minutes after anaesthesia in the GA group were 125.69±22.95 mg/dL, compared to 104.67±20.94 mg/dL in the SAB group, with a p-value of 0.001. At 60 minutes after anaesthesia, CBG levels in the GA group were 152.41±28.97 mg/dL, while in the SAB group they were 99.65±22.69 mg/dL, with a p-value of 0.003. Finally, 30 minutes after shifting to PACU, CBG levels in the GA group were 147.49±27.20 mg/dL, compared to 92.86±24.35 mg/dL in the SAB group, with a p-value of 0.002. Conclusion: CBG levels significantly increased in individuals receiving GA for surgery. This indicates that the hormonal stress response is greater during GA compared to SAB.

Association between Periodontitis and HbA1c Levels in Non-Diabetic Patients: A Systematic Review and Meta-Analysis.

A high detection rate of diabetes among dental visitors has been reported recently. This systematic review aimed to evaluate the association between periodontitis and glycated hemoglobin (HbA1c) levels among non-diabetic individuals. The EMBASE, MEDLINE, Web of Science, Cochrane Library, PubMed, and Open GREY databases were searched, and observational studies published until 1st June 2023 were identified. A methodological quality assessment was conducted based on the original and modified versions of the Newcastle-Ottawa scale. Cohort, case-control, and cross-sectional studies that performed clinical periodontal examinations and measured HbA1c levels in non-diabetic adults were included. A meta-analysis was conducted to estimate the weighted mean difference (WMD) between individuals with and without periodontitis. In total, 29 case-control and 5 cross-sectional studies were selected from 2583 potentially eligible articles. Among them, sixteen case-control and three cross-sectional studies with moderate to high quality were selected for the meta-analyses. The HbA1c levels in periodontitis patients were significantly higher than those in individuals with healthy periodontal conditions (WMD = 0.16; p < 0.001) among the non-diabetic populations. This study reveals a significant association between periodontitis and HbA1c levels in non-diabetic populations. Thus, HbA1c screening may be recommended to detect potential hyperglycemia in non-diabetic periodontitis patients.

The effect of external counterpulsation on angiopoietin-1 and angiopoietin-2 levels in nondiabetic patients with refractory angina

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health Research and Development of the Ministry of Health of Indonesia. Background External counterpulsation (ECP) is a noninvasive therapy that employs external compression on the lower extremities to augment coronary perfusion pressure. Numerous studies reported that ECP possesses potential benefits in enhancing the angiogenesis process by promoting expressions of several growth factors. Nondiabetic patients are believed to be more reliable in portraying the angiogenesis process. Unfortunately, the effect of ECP on angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) as angiogenesis markers has not been elucidated. Purpose The objective of this study is to evaluate the effect of ECP on Ang-1 and Ang-2 levels in nondiabetic patients with refractory angina. Methods This is a randomised, double-blind, sham-controlled clinical trial. Nondiabetic patients with refractory angina, who were not contraindicated to ECP therapy, were enrolled and randomised into ECP or sham groups. The treatment consisted of optimal medical therapy plus 35 sessions of ECP or sham, with an hour duration for each session. The pressure applied was up to 300 mmHg in the ECP group, while only 75 mmHg in the sham group. Subjective symptoms, laboratory, echocardiographic, and functional capacity parameters were measured before and after 35 sessions of treatment. Appropriate statistical tests were performed and a p-value of &amp;lt;0.05 was considered statistically significant. Results A total of 26 nondiabetic patients with refractory angina were enrolled and randomised into ECP (n=11) and sham (n=15) groups. All patients successfully followed every treatment session until the 35th session. The baseline characteristics were comparable between the two groups (p&amp;gt;0.05). After 35 sessions, there were increases in Ang-1 median levels in both ECP (1663.4 pg/ml versus 891.6 pg/ml, p=0.477) and sham groups (1577.0 pg/ml versus 1295.0 pg/ml, p=0.496). The Ang-2 median levels after the treatments were slightly lower in ECP (2849.5 pg/ml versus 2902.3 pg/ml, p=0.594), while higher in sham groups (2728.3 pg/ml versus 2376.2 pg/ml, p=0.826). Meanwhile, the ECP group also showed an improvement in the Canadian Cardiovascular Society (CCS) angina class from class III to class I/II in 18% (2 out of 11) patients, while in the sham group only 13% (2 out of 15) patients. Interestingly, the ECP group seemed to elicit a noticeable increase in Ang-1 median levels and a decrease in Ang-2 median levels. However, the effects of ECP shown in this study were not statistically significant (p&amp;gt;0.05). Conclusion The ECP group exhibited a higher trend of increase in Ang-1 level compared to the sham group. The Ang-2 level was slightly lowered in the ECP group, while increased in the sham group. Although it was not statistically significant, the increasing trend in the Ang-1 level may provide an additional understanding of the ECP angiogenic effects. Therefore, further studies to validate these results are warranted.

Estimation of L-carnitine levels in diabetic completely edentulous patients for implant diagnosis: A cross-sectional study

Background: Carnitine is effective in preventing the accumulation of end products related to lipid peroxidation due to its anti-inflammatory and antioxidant effects. Carnitine also exerts a significant anti-inflammatory role through the downregulation of the nuclear factor kappa beta pathway, which leads to a decrease in the expression of pro-inflammatory cytokines. The aim of the study was to estimate the L-carnitine (L-C) levels in diabetic completely edentulous patients. Materials and Methods: A cross-sectional study was conducted after the selection of 60 samples based on the inclusion and exclusion criteria. The collected saliva samples were utilized to measure the levels of L-C using the sandwich enzyme-linked immunosorbent assay (ELISA) method. One hundred microliters of sample was applied to a particular row of wells and incubated for an hour as part of the sandwich ELISA procedure. After the wells had been cleaned, a second batch of monoclonal L-C was added, and they were once more incubated for an hour. The horseradish peroxidase substrate was then applied after washing the second batch as well. To allow the blue-to-yellow color transition, the wells were kept steady. Following the observation of the color shift, the OD was measured, and the concentration was determined using the sandwich ELISA kit's standard curve as an intercept. The data were statistically analyzed using the independent t-test (significant level P &lt; 0.05) and were tabulated. Results: The L-C levels have higher levels in nondiabetic patients than in diabetic patients. The difference in the baseline mean value between the groups was statistically significant (P = 0.00). Although it is statistically significant (P = 0.00), the mean value for diabetic individuals is 0.19 as opposed to 0.29 for nondiabetic patients. Conclusion: Based on the findings, it can be concluded that L-C improves insulin sensitivity and glucose disposal in diabetic completely edentulous patients.

Leuko-Glycemic Index in the Prognosis of Acute Myocardial Infarction; a Cohort Study on Coronary Angiography and Angioplasty Registry.

The leuko-glycemic index (LGI), a combined index of patient leukocyte counts and blood glucose levels, has been shown to predict the prognosis of myocardial infarction (MI) patients. Our study aims to investigate the performance of LGI in prediction of outcomes in a population of diabetic and non-diabetic MI patients. This observational registry-based cohort study was performed on acute myocardial infarction (AMI) patients. Participants were sub-grouped according to their diabetes status and the calculated optimal LGI cut-off value. The outcomes of the study were the length of hospital stay, and in-hospital and 30-day mortality. A total of 296 AMI (112 diabetic and 184 non-diabetic) patients were included in the study. The optimal cut-off value of LGI in the diabetic and non-diabetic groups was calculated as 2970.4 mg/dl.mm3 and 2249.4 mg/dl.mm3, respectively. High LGI was associated with increased hospital admission duration in non-diabetic patients (p = 0.017). The area under the curve (AUC) of LGI for prediction of in-hospital mortality was 0.93 (95% CI: 0.87 to 1.00) in the diabetic group and 0.92 (95% CI: 0.85 to 0.99) in the non-diabetic group. LGI had a sensitivity and specificity of 90.00%, and 93.14% in prediction of in-hospital mortality in the diabetic group compared to 77.77% and 90.85% in the non-diabetic group. We observed 4 post-discharge mortalities in our patient group. Our study demonstrated that higher LGI predicts in-hospital mortality in both diabetic and non-diabetic patients, while the length of hospital stay was only predicted by LGI levels in non-diabetic patients.

Effect of sevoflurane versus desflurane on blood glucose level in patients undergoing intracranial neurosurgery: A randomised controlled study.

Anaesthetic agents can affect the neuroendocrine response to surgical stress. Along with affecting other parameters, this can affect blood glucose levels. This study aimed to compare the effect of sevoflurane and desflurane on hourly intraoperative blood glucose levels in non-diabetic patients undergoing intracranial surgery. A total of 70 adults (18-65 years) of American Society of Anesthesiologists physical status I and II undergoing elective intracranial surgery for supratentorial and infratentorial lesions were enroled. Patients were randomised to receive either sevoflurane or desflurane as the maintenance anaesthetic agent. The blood glucose level was measured hourly after induction until the completion of surgery. Parametric tests, non-parametric tests, Friedman test, generalised estimating equations, Chi-square test, and Fisher's exact test were used to analyse the data. In the sevoflurane group, the mean (standard deviation) blood glucose (mg/dL) increased from 93.34 (9.33) at the baseline to a maximum of 102.00 (8.61) at the 9 hours timepoint. This change was statistically significant (P < 0.001). In the desflurane group, the mean blood sugar (mg/dL) increased from 89.34 (9.85) at the baseline to a maximum of 92.37 (9.92) at the 4 hours timepoint and then decreased to 88.50 (0.71) at 9 hours timepoint. Desflurane caused an initial rise followed by a decline, whereas a gradual increase in intraoperative blood glucose level was seen with sevoflurane use in non-diabetic adult patients undergoing elective neurosurgery. The intraoperative change in blood sugar was statistically significant but was within the normal clinical range.

Rethinking the necessity of low glucose intervention for cerebral ischemia/reperfusion injury.

Glucose is the essential and almost exclusive metabolic fuel for the brain. Ischemic stroke caused by a blockage in one or more cerebral arteries quickly leads to a lack of regional cerebral blood supply resulting in severe glucose deprivation with subsequent induction of cellular homeostasis disturbance and eventual neuronal death. To make up ischemia-mediated adenosine 5′-triphosphate depletion, glucose in the ischemic penumbra area rapidly enters anaerobic metabolism to produce glycolytic adenosine 5′-triphosphate for cell survival. It appears that an increase in glucose in the ischemic brain would exert favorable effects. This notion is supported by in vitro studies, but generally denied by most in vivo studies. Clinical studies to manage increased blood glucose levels after stroke also failed to show any benefits or even brought out harmful effects while elevated admission blood glucose concentrations frequently correlated with poor outcomes. Surprisingly, strict glycaemic control in clinical practice also failed to yield any beneficial outcome. These controversial results from glucose management studies during the past three decades remain a challenging question of whether glucose intervention is needed for ischemic stroke care. This review provides a brief overview of the roles of cerebral glucose under normal and ischemic conditions and the results of managing glucose levels in non-diabetic patients. Moreover, the relationship between blood glucose and cerebral glucose during the ischemia/reperfusion processes and the potential benefits of low glucose supplements for non-diabetic patients are discussed.

Effects of dexmedetomidine on glucose-related hormones and lactate in non-diabetic patients under general anesthesia: a randomized controlled trial

The aim of this study was to explore the effects of dexmedetomidine on glucose-related hormones and lactate levels in non-diabetic patients undergoing malignant gastrointestinal tumor radical resection. Groups D<inf>1</inf> and D<inf>2</inf> received dexmedetomidine loading dose 1 µg/kg and maintenance dose 0.25 and 0.5 µg/kg/h, respectively. Group C received saline solution. Glucose, lactate, insulin, glucagon, cortisol, epinephrine, norepinephrine and dopamine levels were measured before dexmedetomidine infusion (T<inf>1</inf>), 1 h after surgery beginning (T<inf>2</inf>), at surgery ending (T<inf>3</inf>), and 1 h after transfer to the postanesthesia care unit (T<inf>4</inf>). Compared with group C, glucose levels increased in group D<inf>2</inf> at T<inf>2</inf> and reduced in groups D<inf>1</inf> and D<inf>2</inf> at T<inf>4</inf>. Lactate levels reduced in groups D<inf>1</inf> and D<inf>2</inf> at T<inf>4</inf>. A positive correlation between glucose and lactate levels was found in all groups. Compared with group C, insulin level reduced in group D<inf>2</inf> at T<inf>2</inf>; glucagon levels reduced in groups D<inf>1</inf> and D<inf>2</inf> at T<inf>4</inf>; cortisol levels reduced in group D<inf>1</inf> at T<inf>4</inf> and in group D<inf>2</inf> at T<inf>3</inf> and T<inf>4</inf>; epinephrine and norepinephrine levels reduced in group D<inf>1</inf> at T<inf>4</inf> and in group D<inf>2</inf> at T<inf>2</inf> and T<inf>4</inf>; and dopamine level reduced in group D<inf>2</inf> at T<inf>4</inf>. Dexmedetomidine loading dose 1 µg/kg and maintenance dose 0.25 µg/kg/h produces a stable insulin level and significant postoperative decreases in glucagon, cortisol, epinephrine and norepinephrine secretion with stable maintenance of intraoperative and postoperative blood glucose levels and decreased postoperative lactate levels in non-diabetic patients under general anesthesia.

Peripheral Insulin Resistance Is Associated with Copeptin in Patients with Chronic Kidney Disease.

Insulin resistance is associated with cardiovascular disease risk and worsened kidney function. Patients with CKD have higher levels of insulin resistance. Elevated levels of copeptin (a surrogate for vasopressin levels) have been associated with an increased incidence and progression of CKD, and with incident diabetes mellitus. The purpose of our study was to examine the relationship between insulin resistance, copeptin, and CKD. We performed a cross-sectional study to investigate if insulin resistance was associated with higher copeptin levels in nondiabetic patients with stage 3-4 CKD versus controls. We measured plasma copeptin levels and used data from 52 patients with stage 3-4 CKD and 85 controls (eGFR ≥60 ml/min per 1.73 m2) enrolled in the Insulin Resistance in Chronic Kidney Disease (IRCKD) study. We then used a multivariable linear-regression model to assess the independent relationship between peripheral or hepatic insulin resistance and copeptin across levels of eGFR. We found that in patients with CKD (eGFR of 30-60 ml/min per 1.73 m2), but not in controls, peripheral insulin resistance was significantly correlated with higher levels of log copeptin (r=-0.21, P=0.04). In patients with CKD, when adjusted for age, sex, BMI, serum osmolality, log IL6, and log leptin/adiponectin ratio, each 1 SD decrease in insulin sensitivity was associated with a 39% increase in serum copeptin levels. The relationship between hepatic insulin resistance, copeptin, and eGFR is similar between controls and patients with reduced eGFR. Peripheral insulin resistance is associated with elevated copeptin levels in nondiabetic patients with stage 3-4 CKD. Further research into how the interaction between peripheral insulin resistance and elevated vasopressin affects CKD progression could be of interest.

POS-400 EFFECT OF ORAL CHOLECALCIFEROL SUPPLEMENTATION ON SERUM LEVEL OF ANGIOGENIC MARKERS IN CHRONIC KIDNEY DISEASE

Vitamin D plays an important role in proliferation and differentiation of cells and deficiency of vitamin D disturbs angiogenic balance. Previous studies in animal models have reported the imbalance between pro- and anti-angiogenic factors due to impaired vitamin D level. There is insufficient evidence about the effect of vitamin D on mediators of angiogenesis in general in patients with CKD. We investigated the effect of cholecalciferol supplementation on serum angiopoietin-2 levels in non-diabetic patients with CKD stage 3-4

HBA1c Levels In Non-Diabetic Patients with ST Elevated Myocardial Infarction &amp; its Correlation with Short Term Mortality

Background: Elevated HBA1C level is predictive for cardiovascular disease and mortality in diabetic &amp; also in non-diabetic patients. Aim of our study was to evaluate correlation between HBA1c on admission and short term mortality in non-diabetic patients with ST elevated myocardial infarction. Methods: 266 non-diabetic patients presenting with STEMI (within 48 hours) were included in our study. Data regarding patient characteristics were collected over 7 months. All-cause mortality data collected prospectively up to 6 months. Results: Mean HBA1C was 5.69±0.65 for the study population. HBA1C quartiles (&lt;5, 5.1-5.5, 5.6-6, 6.1-6.4) has shown increased 6 months mortality (3%, 4.8%, 1.7%, 15.1% respectively P=0.004) with increased values. Multivariate regression analysis has shown HBA1C&gt;6 as an independent predictor of 6 month mortality. Conclusion: A significant correlation exists between HBA1C on admission in non-diabetic patients with STEMI and 6 month all-cause mortality.

Prognostic significance of the hemoglobin A1c level in non-diabetic patients undergoing percutaneous coronary intervention: a meta-analysis.

BackgroundThe predictive value of hemoglobin A1c (HbA1c) levels in non-diabetic patients with myocardial infarction undergoing percutaneous coronary intervention (PCI) is still controversial. This study aimed to evaluate whether HbA1c levels were independently associated with adverse clinical outcomes in non-diabetic patients with coronary artery disease (CAD) who had undergone PCI by performing a meta-analysis of cohort studies.MethodsThis meta-analysis included non-diabetic patients with CAD who had undergone PCI. A systematic search for publications listed in the PubMed, Embase, and Cochrane Library databases from commencement to December 2018 was conducted. Studies evaluating the adverse clinical outcomes according to abnormal HbA1c levels in non-diabetic patients diagnosed with CAD who had undergone PCI were eligible. The primary outcomes were long-term all-cause deaths and long-term major adverse cardiac events, and the secondary outcome was short-term all-cause deaths. The meta-analysis was conducted with RevMan 5.3 and Stata software 14.0. Odds ratios (ORs) were pooled using a random or fixed-effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary.ResultsSix prospective cohort studies involving 10,721 patients met the inclusion criteria. From the pooled analysis, abnormal HbA1c levels were associated with increased risk for long-term all-cause death (OR 1.39, 95% confidence interval [CI] 1.16–1.68, P = 0.001, I2 = 45%). Sub-group analysis suggested that abnormal HbA1c levels between 6.0% and 6.5% predicted higher long-term major adverse cardiac event (including all-cause deaths, non-fatal myocardial infarction, target lesion revascularization, target vessel revascularization, recurrent acute myocardial infarction, heart failure requiring hospitalization, and stent thrombosis) risk (OR 2.05, 95% CI 1.46–2.87, P < 0.001, I2 = 0). Contrarily, elevated HbA1c levels were not associated with increased risk of short-term all-cause death (OR 1.16, 95% CI 0.88–1.54, P = 0.300, I2 = 0).ConclusionsAn abnormal HbA1c level is an independent risk factor for long-term adverse clinical events in non-diabetic patients with CAD after PCI. Strict control of HbA1c levels may improve patient survival. Further studies in different countries and prospective cohort studies with a large sample size are required to verify the association.

Study of Glycosylated Haemoglobin (Hba1c) Levels in Non-Diabetic Patients with Hypothyroidism

Study of Glycosylated Haemoglobin (Hba1c) Levels in Non-Diabetic Patients with Hypothyroidism

SUN-086 EFFECT OF VITAMIN D SUPPLEMENTATION ON SERUM HEPCIDIN LEVELS IN CKD

Vitamin D has been shown to be a regulator of hepcidin-ferroportin axis. Vitamin D deficiency is common in CKD. Whether native vitamin D supplementation favorably affects serum hepcidin in CKD is not known. We investigated the effect of cholecalciferol supplementation on serum hepcidin levels in non-diabetic patients with CKD stage 3-4. In this secondary analysis of our previously published randomized, double-blind, placebo-controlled trial(https://jasn.asnjournals.org/content/28/10/3100), stable patients of either sex, aged 18-70 years, with non-diabetic CKD stage 3-4 and vitamin D deficiency (serum 25-hydroxyvitamin D ≤20 ng/ml) were randomized to receive either two directly observed oral doses of cholecalciferol (300,000 IU) or matching placebo at baseline and 8 weeks. The primary outcome was change in FMD at 16 weeks. Serum level of Hepcidin was analyzed by ELISA (Quantikine®ELISA kit, R&D, Minneapolis, MN, USA). Intra-assay and inter-assay coefficient of variation of this kit was 3.2-4.3% and 6.2-11%, respectively. Changes in serum hepcidin levels between groups over 16 weeks were compared using paired t test. 120 patients were enrolled. Baseline characteristics showed no differences between groups with respect to demographic details and causes of CKD. Supplementation with cholecalciferol led to significant improvement in FMD. Serum 25(OH)D levels were similar in both groups at baseline (13.21±4.78 ng/ml and13.40±4.42ng/ml; P=0.88). At16 weeks, the serum 25(OH)D levels increased in the cholecalciferol group but not in the placebo group(between-group difference in mean change:23.40 ng/ml; 95% CI, 19.76 to27.06; P<0.001). Blood levels of hemoglobin were similar at baseline (12.02±1.94 mg/dl vs 11.97±1.69mg/dl, p=0.947) and there were no significant changes at 16 weeks in either group [between group difference; 0.21 (-0.22 to 0.63), p=0.34]. Serum hepcidin levels were similar at baseline [median (IQR): 33.6 (8.6-77.8) ng/ml vs 24.6 (9.3-70.7) ng/ml, p=0.903] and did not vary between groups at 16 week [median (IQR): 41.5 (10.9-75.0) ng/ml vs34.8(12.3-63.75) ng/ml, p=0.703]. High dose oral cholecalciferol supplementation has no effect on serum hepcidin levels in subjects with non-diabetic CKD stage 3-4.

Effect of non-surgical periodontal treatment on HbA1c levels in non-diabetic patients with chronic periodontitis in an Iranian population.

Background Evidence is limited on the effect of periodontal treatment on improving HbA1c levels in non-diabetic patients with chronic periodontitis. This study aimed to compare HbA1c levels in non-diabetic patients without periodontitis and nondiabetic patients with chronic periodontitis at baseline and to evaluate the effect of non-surgical periodontal treatment on glycemic control in non-diabetic chronic periodontitis patients. Methods In this interventional study, 30 non-diabetics, aged 35‒65 years, were selected and divided into two groups (n=15). Group A consisted of non-diabetics without periodontitis, and group B consisted of non-diabetics with mild to moderate chronic periodontitis. For all the subjects, periodontal parameters, including plaque index, gingival index, periodontal pocket depth, and clinical attachment loss, and laboratory parameters of FBS and HbA1c were measured and recorded. Independentsamples t-test was used to compare periodontal and laboratory parameters between the two groups; paired-samples t-test was used for intra-group comparisons.Results HbA1c level in group B (5.4±0.42%) was significantly higher than that in group A (5.04±0.43%) (P=0.03) at baseline. Three months after treatment, improvements were achieved in all the periodontal parameters in group B, with a significant decrease in HbA1c levels (P=0.006).Conclusion Non-surgical periodontal treatment resulted in a significant decrease in HbA1c levels in non-diabetic patients with chronic periodontitis. Although these levels did not reach the level of non-diabetic patients without periodontitis, it could be concluded that an improvement in the periodontal condition might lead to near-normal glycemic levels.

A Study on Uric Acid Levels in Non Diabetic Patients at a Tertiary Care Hospital

A Study on Uric Acid Levels in Non Diabetic Patients at a Tertiary Care Hospital