Lower HbA1c Values Research Articles

Impact of Opuntia ficus-indica Juice and Empagliflozin on Glycemic Control in Rats

Diabetes mellitus (DM) is a major global health concern characterized by high blood glucose levels. This study investigates the effects of Opuntia ficus-indica (cactus) juice and empagliflozin, both alone and in combination, on glycated hemoglobin (HbA1c) levels in healthy and streptozotocin-induced diabetic rats. Eighty Wistar albino male rats were divided into eight groups, with four groups being diabetic. Treatment options included cactus juice, empagliflozin, or both. HbA1c levels were measured at baseline and 100 days later using ELISA. In diabetic and non-diabetic rats treated with cactus juice or empagliflozin, HbA1c levels were significantly reduced, but diabetic rats had significantly lower HbA1c values than non-diabetic rats. The combined treatment provided no additional benefits over individual therapies. These findings indicate that cactus juice and empagliflozin effectively lower HbA1c levels, making their use a promising complementary approach to diabetes management. However, the combined treatment of Opuntia ficus-indica juice and empagliflozin did not yield additional reductions in HbA1c levels compared to individual treatments, with no significant synergistic effects observed throughout the study period. More research is needed to better understand the clinical applications and mechanisms in humans.

Genetic architecture of routinely acquired blood tests in a British South Asian cohort

Understanding the genetic basis of routinely-acquired blood tests can provide insights into several aspects of human physiology. We report a genome-wide association study of 42 quantitative blood test traits defined using Electronic Healthcare Records (EHRs) of ~50,000 British Bangladeshi and British Pakistani adults. We demonstrate a causal variant within the PIEZO1 locus which was associated with alterations in red cell traits and glycated haemoglobin. Conditional analysis and within-ancestry fine mapping confirmed that this signal is driven by a missense variant - chr16-88716656-G-TT - which is common in South Asian ancestries (MAF 3.9%) but ultra-rare in other ancestries. Carriers of the T allele had lower mean HbA1c values, lower HbA1c values for a given level of random or fasting glucose, and delayed diagnosis of Type 2 Diabetes Mellitus. Our results shed light on the genetic basis of clinically-relevant traits in an under-represented population, and emphasise the importance of ancestral diversity in genetic studies.

Ductal Intervention in Chronic Pancreatitis: Impact on Glycemic Control and Endocrine Insufficiency Management.

Background and aim Pancreatic endotherapy has been established as a viable and effective modality for the management of pain in chronic pancreatitis (CP). However, its impact on endocrine insufficiency has been rarely reported. In this retrospective study, we aimed to assess the impact of endotherapy on glycemic status and the management of diabetes in these patients. Methods A retrospective review of a prospectively maintained database of patients with CP with pain presenting to the King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India, from December 2021 to May 2023 was done. Detailed clinical, laboratory, imaging, and treatment data were recorded. Endocrine dysfunction was defined as glycosylated hemoglobin (Hba1C) ≥6.5 g/dl. The status of endocrine function (Hba1C values) before and after endotherapy, as well as the requirement of oral hypoglycemic agent (OHA) and/or insulin, was recorded. Results One hundred forty-one patients underwent endoscopic retrograde cholangiopancreatography for the management of pain (mean age: 35 years, 74.5% males). Prior to endotherapy, pathological endocrine dysfunction was seen in 60 patients (42.5%). The mean HbA1c value was 8.46 g/dl (4.5-16.1g/dl). OHAs alone were used in 13/60 (21.6%), and 34/60 (56.6%) required insulin. A combination of OHA and insulin was required in 13/60 (21.6%) of patients. Post-endotherapy, none of the patients were on a combination of OHAs and insulin; 5/13 (38.4%) patients were on OHAs alone, while 8/13 (61.5%) patients were shifted to insulin. Out of the total 47 patients who required insulin, insulin could be stopped in 15/47 (31.9%) of patients. Patients who demonstrated improvement in endocrine dysfunction had significantly lower HbA1c values (6.38 vs. 8.07 g/dl, p < 0.001), a higher proportion of patients with idiopathic pancreatitis (73.3% vs. 22.2%, p = 0.004), and a lower proportion of patients with concomitant exocrine insufficiency (13.3% vs. 53.3%, p = 0.007). Conclusions One-third of the patients had improvements in endocrine dysfunction. Early ductal intervention in a selected subset of patients with CP may have the potential to improve glycemic status.

Differences Between Glycated Hemoglobin and Glucose Management Indicator in Real-Time and Intermittent Scanning Continuous Glucose Monitoring in Adults With Type 1 Diabetes.

This study demonstrates the difference between glucose management indicator (GMI) and glycated hemoglobin (HbA1c) according to sensor mean glucose and HbA1c status using 2 continuous glucose monitoring (CGM) sensors in people with type 1 diabetes. A total of 275 subjects (117 Dexcom G6 [G6] and 158 FreeStyle Libre 1 [FL]) with type 1 diabetes was included. The G6 and FL sensors were used, respectively, over 90 days to analyze 682 and 515 glycemic profiles that coincide with HbA1c. The mean HbA1c was 6.6% in Dexcom G6 and 7.2% in FL profiles. In G6 profiles, GMI was significantly higher than HbA1c irrespective of mean glucose (all P < .001, mean difference: 0.58% ± 0.49%). The GMI was significantly higher than the given HbA1c when HbA1c was below 8.0% (all P < .001). The discordance was the highest at 0.9% for lower HbA1c values (5.0%-5.9%). The proportion of discordance >0.5% improved from 60.1% to 30.9% when using the revised GMI equation in G6 profiles. In FL profile, the overall mean difference between GMI and HbA1c was 0 (P = .966). The GMI was significantly lower by 0.9% than HbA1c of 9.0% to 9.9% and higher by 0.5% in HbA1c of 5.0% to 5.9% (all P < .001). The GMI is overestimated in G6 users, particularly those with well-controlled diabetes, but the GMI and HbA1c discordance improved with a revised equation from the observed data. The FL profile showed greater discordance for lower HbA1c levels or higher HbA1c levels.

Polygenic subtype identified in ACCORD trial displays a favorable type 2 diabetes phenotype in the UKBiobank population

IntroductionWe previously identified a genetic subtype (C4) of type 2 diabetes (T2D), benefitting from intensive glycemia treatment in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Here, we characterized the population of patients that met the C4 criteria in the UKBiobank cohort.Research design and methodsUsing our polygenic score (PS), we identified C4 individuals in the UKBiobank and tested C4 status with risk of developing T2D, cardiovascular disease (CVD) outcomes, and differences in T2D medications.ResultsC4 individuals were less likely to develop T2D, were slightly older at T2D diagnosis, had lower HbA1c values, and were less likely to be prescribed T2D medications (P < .05). Genetic variants in MAS1 and IGF2R, major components of the C4 PS, were associated with fewer overall T2D prescriptions.ConclusionWe have confirmed C4 individuals are a lower risk subpopulation of patients with T2D.

AdultCarbQuiz for the Portuguese population with type 1 diabetes mellitus: translation, cultural adaptation and validation of its metabolic impact.

In type 1 diabetes mellitus (T1DM), functional insulin therapy, based on carbohydrate (CH) counting and individualized insulin-to-carbohydrate ratio, is essential to achieve an adequate metabolic control. However, to date, few tools have been validated to assess patients' knowledge about CH counting, with the AdultCarbQuiz questionnaire having proved to be a reliable method in an American cohort.The aim of this study was to translate, culturally adapt and validate the AdultCarbQuiz questionnaire for the Portuguese population. METHODS: This was a cross-sectional study of patients with T1DM on functional insulin therapy through continuous subcutaneous insulin infusion (CSII). Prior to its application, the AdultCarbQuiz questionnaire was translated and culturally adapted to the Portuguese context. Statistical analyses include descriptive, correlation and intern consistency analysis using IBM® SPSS® Statistics, version 27. One hundred patients were included, 58% of female sex, with a mean age of 31.09 ± 10.77years. Mean disease duration was 15.04 ± 9.23years, and mean CSII usage time was 4.02 ± 3.90years. The average value of glycated haemoglobin (HbA1c), time in range (TIR), time above range (TAR) and time below range was, respectively, 7.32 ± 0.87, 59.75 ± 14.13, 34.38 ± 15.40 and 5.75 ± 6.58%. The average score of the questionnaire was 30.86 points ± 3.58 points, considered high. The Kuder-Richardson 20 coefficient value was 0.63 for the total score, with a Spearman-Brown value for the half-split of 0.63. Individuals with lower HbA1c values scored significantly higher on knowledge about hypoglycaemia prevention and correction (r = - 0.269, p = 0.007) and on the total questionnaire score (r = - 0.205, p = 0.041). A higher TIR and a lower TAR were also associated with a higher total score (r = 0.274, p = 0.007 and r = - 0.274, p = 0.007, respectively). In this study, the AdultCarbQuiz questionnaire, translated and culturally adapted to the Portuguese context, proved to be a useful tool in assessing knowledge about CH counting in patients with T1DM, allowing to optimize, individually, the therapeutic strategy in consultation.

Influence of diet and exercise adherence in diabetic cases and its impact on HbA1c

&lt;p&gt;&lt;span lang="EN-US"&gt;In a current cross-sectional experimental study, it was observed that the impact of diet and exercise on healthy life adherence in mature diabetes cases and their influence on glycated hemoglobin (HbA1c, average glucose) The diabetic patients (male and female) were anatomized in relation to adherence and suggested a diet with exercise plans that control the adverse effect of producing less insulin. A sample of 30 subjects, 30–50 years old, were selected randomly from 3 major hospitals (Jinnah, Mayo, and Services) and some private laboratories. A group of normal control subjects (N = 10) was also selected for further comparison. The HbA1c test has been taken before and after the implementation of the 12-week diet and exercise plan. This study utilized a simple random sampling technique, and normality was checked through the Shapiro-Wilk test. The data was analyzed through SPSS-22, and a paired sample t-test was utilized for further comparison. The lower HbA1c values indicate a better diabetes operation. These results clearly depicted that it controlled the worse effects of sugar patients, which also emphasizes the significance of adherence in achieving optimal glycaemic control. The result also concluded that a balanced diet and a combination of exercises control the glycaemic patients efficiently and effectively.&lt;/span&gt;&lt;/p&gt;

Patterns of metformin use and glycated haemoglobin trends among patients with newly diagnosed type 2 diabetes in Alberta, Canada.

Canadian guidelines recommend metformin as first-line therapy for incident uncomplicated type 2 diabetes and the vast majority of patients are treated accordingly. However, only 54% 65% remain on treatment after 1 year, with the highest discontinuation rates within the first 3 months. The purpose of this study was: (a) to identify individual and clinical factors associated with metformin discontinuation among patients with newly diagnosed uncomplicated type 2 diabetes in Alberta, Canada, and (b) describe glycated haemoglobin (HbA1c) trajectories in the first 12 months after initiation of pharmacotherapy, stratified by metformin usage pattern. We conducted a retrospective cohort study using linked administrative datasets from 2012 to 2017 to define a cohort of individuals with uncomplicated incident type 2 diabetes. Using logistic regression, we determined individual and clinical characteristics associated with metformin discontinuation. We categorized individuals based on patterns of metformin use and then used mean HbA1c measurements over a 12-month follow-up period to determine glycaemic trajectories for each pattern. Characteristics associated with metformin discontinuation were younger age, lower baseline HbA1c and having fewer comorbidities. Sex, income and location (urban/rural) were not significantly associated with metformin discontinuation. Individuals who continued metformin with higher adherence and individuals who discontinued metformin entirely had lowest HbA1c values at 12 months from treatment initiation. Those who changed therapy or had additional therapies added had higher HbA1c values at 12 months. Identifying characteristics associated with discontinuation of metformin and individuals' medication usage patterns provide an opportunity for targeted interventions to support patients' glycaemic management.

Analiza učestalosti i dužine trajanja kliničke remisije u pacijenata sa novootkrivenim tipom 1 dijabetesa

Introduction: Clinical remission (CR) phase, in other words, euglycaemia, in the absence of insulin therapy (complete CR) or with a reduced daily dose of insulin (partial CR) can be achieved in some patients with new-onset type 1 diabetes (T1D) after the introduction of insulin therapy. Unfortunately, there is still not enough information about the factors influencing the induction and duration of remission. Material and methods: This research included 62 patients with the diagnosis of new-onset T1D, who were treated at the Clinic of Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia in 2019 and 2020. Demographic, clinical and laboratory data were acquired from medical records. Descriptive statistical methods, Fisher's exact probability test, Pearson's chi-square test, Student's t test, Mann Whitney U test and Spearman's correlation coefficient were used for statistical analysis. Results: Clinical remission was inducted in 46.8% of patients and its average duration was 11.2 months. Patients with CR had remarkably lower HbA1c values (9.9 ± 2.8 vs 11.8 ± 2.4%; p=0.007) and lost less weight (4 vs 12 kg, p&lt;0.001) compared to patients without CR. Additionally, C peptide levels at the beginning and 6 minutes after the glucagon test were remarkably higher in patients with CR compared to patients without CR (p&lt;0.001). At the same time, remarkably more patients with CR had autoantibodies detected compared to those without CR (GAD 100% vs 72.4% i IA2-2A 81.8% vs 34.5%; p=0.001). The duration of CR was remarkably correlated with the level of C peptide at the beginning and 6 minutes after the glucagon test (p&lt;0.001). Conclusion: Patients with CR (46.8%) had better metabolic control, less weight loss, better endogenous insulin reserve capacity and less frequent presence of autoantibodies to beta cell antigens at disease onset. At the same time, the duration of CR was associated with an initially better, preserved, endogenous insulin reserve.

Cross Sectional Study on Prevalence of Falsely Low HbA1c in Diabetic Patients on Dapsone Therapy

Background : Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels.[1] Objective: The aim of our study was to establish the prevalence of falsely low HbA1c in diabetes patient on dapsone therapy and the possible mechanism behind it. Study design: we conducted a retrospective Cross-sectional study on 30 subjects more than or equal to 18yrs attending the Endocrinology and Dermatology outpatient department (OPD ) ,patients with diabetes mellitus on oral anti diabetic drugs and or insulin therapy on dapsone therapy and patients on documented dapsone therapy for Hansen’s disease or any other skin condition were eligible for enrolment. HbA1c measured by HPLC(high performance liquid chromatography) was compared with expected A1c value suggested by other parameters like fructosamine assay and mean blood glucose. Also other parameters of haemolysis was measured to establish the possible mechanism behind the falsely low A1c. Results: Out of 30 subjects 25 patients were found to have low HbA1c value compared to their fructosamine assay and expected HbA1c. Prevalence of inappropriately low A1c was 25(83.45%) ,16 of them in diabetic group (53.3%) and 9 in non-diabetic group (30.0%).. There were higher number of subjects in discordance group with &gt;2% methaemoglobin with marginally positive correlation .Factors of haemolysis too was higher in more number of subjects [reticulocyte count (18.2%) mcv(90.9)LDH(86.6%)] in discordance Hba1c group compared to cordance HbA1c group but was not statically significant owning to small sample size. Conclusion :The prevalence of falsely low A1c in patient on dapsone therapy was as high as 83.5% and possible reason for this being hemolysis suggesting there are a number of drugs, some of them quite commonly used, which can cause inappropriately high or low HbA1c levels for the degree of glycemia

A-027 The Clinical Indications of Low or Non-reportable HbA1c Results

Abstract Background Hemoglobin A1c (HbA1c) is the major non-enzymatic glycation product of hemoglobin A (HbA) and usually measured as a percentage of total hemoglobin. It is widely used in the screening, diagnosis, and monitoring of diabetes because HbA1c correlates with the average blood glucose level over the past 8–12 weeks in patients with a normal RBC lifespan. However, many factors can cause inaccurate HbA1c measurements or invalidate this correlation. While a high HbA1c raises the concern of inadequate glycemic control, a low or non-reportable HbA1c may also indicate diverse clinical conditions or technical issues. This study analyzes the pathophysiological conditions and technical limits leading to a low or non-reportable HbA1c value and discusses the use of other lab values in HbA1c result interpretation. Methods HbA1c was measured by cation exchange HPLC (Tosoh G8, v5.24F). 37 cases with a low or non-reportable HbA1c (&amp;lt;4.0%) from January 1, 2022 to November 30, 2022 were reviewed. The relevant diagnoses, medical history, medications, and recent (±1 week from the HbA1c test) lab results (CBC, blood glucose, fructosamine, haptoglobin, LDH) were examined to identify the causes of low HbA1c values. The causes were grouped by pathological mechanisms or technical issues to calculate the frequency, and the association with other lab values was also explored. Results Low or non-reportable HbA1c cases accounted for 0.1% of total HbA1c tests (37/42 771), and about 30% (11/37) had been diagnosed with diabetes by the end of the review period. From the chart, 41% (15/37) cases had elevated blood glucose (&amp;gt;109 mg/dL), 73% (27/37) were anemic (Hb &amp;lt; 13.0 or 11.7 g/dL for male or female), and 46% (17/37) showed a high MCV (&amp;gt;96 fL). Among those cases, a minor portion was caused by method-specific technical issues (8%, 3/37) or unknown reasons (5%, 2/37). The majority (86%, 32/37) was attributed to the following mechanisms: intravascular hemolysis (51%, 19/37), hepatosplenic RBC destruction (27%, 10/37), and increased erythropoiesis (8%, 3/37). For those cases with intravascular hemolysis (51%), the causes were categorized as inherited RBC disorders (19%, 7/37, including hemoglobinopathy and G6PD deficiency), acquired hemolytic diseases (19%, 7/37, including autoimmune hemolytic anemia), and adverse effects of medications (13%, 5/37, including dapsone and hydroxychloroquine). For those cases with hepatosplenic RBC destruction (27%), most of them were caused by cirrhosis (19%, 7/37). In addition, increased erythropoiesis (8%) was observed in patients with recent hemorrhage or EPO treatment. Some hemoglobin variants like homozygous HbE resulted in non-reportable HbA1c (8%), which represented a technical limit of the HPLC method. Conclusion Although low or non-reportable HbA1c cases are rare (0.1%), a significant portion (30%) of them are diabetic patients, and their HbA1c results can be misleading. The majority of low HbA1c cases (86%) are associated with clinical conditions causing a shortened RBC lifespan, and the most common causes include inherited RBC diseases (19%), cirrhosis (19%), medication adverse effects (14%), and autoimmune diseases (11%). Because increased RBC destruction and compensatory erythropoiesis are the underlying mechanisms, hemoglobin, MCV, and markers assessing hemolytic anemia (haptoglobin, LDH, reticulocyte%) can aid in HbA1c interpretation.

Achieving Normoglycemia With Tirzepatide: Analysis of SURPASS 1-4 Trials.

Tirzepatide is a novel single-molecule glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist, which demonstrated unprecedented improvements in glycemic control and body weight reduction, in the SURPASS phase 3 program. In this exploratory analysis, we aimed to characterize tirzepatide-treated participants who achieved HbA1c <5.7% and evaluate changes in clinical markers associated with long-term cardiometabolic health. Baseline characteristics and change from baseline to week 40 for several efficacy and safety parameters were analyzed according to HbA1c attainment category (<5.7%, 5.7-6.5%, and >6.5%) using descriptive statistics in participants taking ≥75% of treatment doses, without rescue medication, in the SURPASS 1-4 trials (N = 3,229). Logistic regression models with tirzepatide doses adjusted as a covariate were used to obtain odds ratios and assess the impact of patient characteristics achieving an HbA1c <5.7%. Tirzepatide-treated participants who achieved HbA1c <5.7% were slightly younger, with a shorter duration of diabetes and lower HbA1c value at baseline compared with those who did not achieve HbA1c <5.7%. In addition, they showed greater improvements in HbA1c, body weight, waist circumference, blood pressure, liver enzymes, and lipid parameters without increasing hypoglycemia risk. Normoglycemia was unprecedently achieved in a significant proportion of participants in the SURPASS clinical program, without increasing hypoglycemia risk, and was associated with an overall improvement in metabolic health.

1450-P: Profiles of Glycemic Control in People with Type 1 Diabetes Using CGM—A Clustering Approach in the SFDT1 Study

CGM-derived data are usually analyzed in silos, metric by metric, for diabetes care or therapeutic strategy. Simultaneous analysis of the various dimensions of glycemic control would allow a more comprehensive overview. We analyzed data of people with type 1 diabetes (PWT1D) in the SFDT1 cohort study. A K-means clustering model was developed with HbA1c, coefficient of variation (CV), time in range (TIR), time below 70 mg/dl (TBR), Gold score and Glycemic Risk Index (GRI). We included 618 participants (53% men, age 41±14 years) from 20 centres in France. The optimal model had 3 clusters. The “Euglycemia” cluster (n=280, 45%) was characterized by a high TIR (mean 69.3%); low TBR ​​(4.2%), TAR (time above 180 mg/dl: 26.5%), CV (35.7%), HbA1c (7.0%) and GRI (36.4) values. The “Hyperglycaemia" cluster (n=197, 32%) was characterized by high TAR (56.5%), GRI (71.8) and HbA1c (8.5%) and low TIR (40.3%), TBR (3.2%) and Gold score (2.3). The “Hypoglycemia” cluster (n=141, 23%) was characterized by high TBR (15.8%), CV (46.1%), GRI (69.2) and Gold score (3.0). Participants in the “Hyperglycemia” cluster were younger, socially vulnerable, and had more frequent hypertension than those in the “Euglycemia” cluster. To conclude, we identified three distinct, clinically relevant glycemic control profiles, enabling better characterization of PWT1D and, thus, more personalised management. Disclosure E.Cosson: Board Member; Abbott, Medtronic. G.A.Aguayo: None. L.Sablone: None. M.Huet: None. J.Riveline: Board Member; Abbott Diabetes, Medtronic, Dexcom, Inc., Novo Nordisk, Eli Lilly and Company, Sanofi. G.Fagherazzi: Advisory Panel; Roche Diabetes Care, Consultant; AbbVie Inc., Lilly. Sfdt1 study team: n/a.

Using Patient Profiles for Sustained Diabetes Management Among People With Type 2 Diabetes.

Our objective was to evaluate the association between patient profiles and sustained diabetes management (SDM) among patients with type 2 diabetes. We collected HbA1c values recorded from 2014 through 2020 for 570 patients in a hospital in Taipei, Taiwan, and calculated a standard level based on an HbA1c level less than 7.0% to determine SDM. We used patients' self-reported data on diabetes self-care behaviors to construct profiles. We used 8 survey items to perform a latent profile analysis with 3 groups (poor management, medication adherence, and good management). After adjusting for other determining factors, we used multiple regression analysis to explore the relationship between patient profiles and SDM. The good management group demonstrated better SDM than the poor management group (β = 0.183; P = .003). Using the most recent HbA1c value and the 7-year average of HbA1c values as the outcome, we found lower HbA1c values in the good management group than in the poor management group (β = -0.216 [P = .01] and -0.217 [P = .008], respectively). By using patient profiles, we confirmed a positive relationship between optimal patient behavior in self-care management and SDM. Patients with type 2 diabetes exhibited effective self-care management behavior and engaged in more health care activities, which may have led to better SDM. In promoting patient-centered care, using patient profiles and customized health education materials could improve diabetes care.

Care Continuity, Telehealth Use, and Quality of Diabetes and Hypertension Care in Community Health Centers Before and During the COVID-19 Pandemic: Repeated Cross-sectional Study

Background Community health centers (CHCs) pivoted to remote chronic care services during the COVID-19 pandemic. While care continuity is associated with improved care quality and patients’ experiences, telehealth’s impact on these relationships is unclear. Objective We aimed to examine the association among care continuity, telehealth use, and quality of diabetes or hypertension care in CHCs before and during the COVID-19 pandemic. Methods We collected electronic health record data from a cohort of 20,792 patients with diabetes or hypertension with ≥2 visits per year from March to December 2019 and 2020 among 166 California CHCs in the OCHIN Accelerating Data Value Across a National Community Health Center Network Collaborative. Logistic regression models estimated the association between care continuity (modified, modified continuity index [MMCI]) and telehealth adoption and blood pressure or hemoglobin A1c (HbA1c) testing. Generalized linear regression models for 2019 and 2020 estimated the association between MMCI and blood pressure or HbA1c, exploring telehealth as a mediator. Results Patients experienced reduced care continuity (2019: MMCI=0.71, SD 0.28; 2020: MMCI=0.63, SD 0.36; P&lt;.001) and more blood pressure (99.99% vs 99.75%) and HbA1c (53.38% vs 48.99%) assessments in 2019 vs 2020. Telehealth accounted for 0.33% of 2019’s visits and 9.55% of 2020’s visits. MMCI scores were associated with higher odds of telehealth use in 2020 (odds ratio [OR] 1.96; P&lt;.001). MMCI (2019: OR 1.72, P&lt;.001; 2020: OR 1.66, P&lt;.001) and telehealth use (2019: OR 2.44, P&lt;.001; 2020: OR 6.82, P&lt;.001) were associated with greater HbA1c testing. MMCI was associated with lower HbA1c values in 2020 (–0.40, P=.01) and lower systolic (2019: –1.64, P=.045; 2020: –2.40, P=.001) and diastolic (2019: –1.24, P=.007; 2020: –1.33, P=.001) blood pressure. MMCI and telehealth were not associated with HbA1c values in 2019. In 2020, telehealth mediated the relationship between MMCI and HbA1c testing (percent mediated 59%), but not between MMCI and other study outcomes. Conclusions Care continuity facilitates telehealth use and enables resilient performance on process measures. Elucidating how care continuity influences telehealth adoption may provide insights about implementing patient-centered innovations.

How sweet is your love? Disentangling the role of marital status and quality on average glycemic levels among adults 50 years and older in the English Longitudinal Study of Ageing

IntroductionThe health benefits of marriage have been widely documented and, to a lesser extent, the effects of marital quality. Marital relationships may be particularly relevant to the health of older...

Erectile Dysfunction Severity: The Role of Glycometabolic Compensation and Antihyperglycemic Drugs.

Background: The aim of this study was to evaluate the prevalence of DM among patients with ED and the impact of glycometabolic compensation and antihyperglycemic treatment on ED severity. Methods: In total, 1332 patients with ED were enrolled. The diagnosis was performed through the International-Index-of-Erectile-Function questionnaire. ED severity was considered according to presence/absence of spontaneous erections, maintenance/achievement deficiency and response to PDE5-i. DM patients were clustered according to antihyperglycemic treatment: “metformin”/“insulin”/“old antihyperglycemic drugs”/“new antihyperglycemic drugs”. Results: The prevalence of DM patients was 15.8% (Group A, patients with ED and DM). Among these, the prevalence of spontaneous erections (21.0%) was lower than in the remaining patients (Group B, patients with ED without DM) (32.0%, p < 0.001). The prevalence of poor response to PDE5-i was lower in Group B (10.0%) than in Group A (35.0%, p < 0.001). Patients with good response to PDE5-i therapy showed lower HbA1c values than patients with poor/no response (6.6 ± 1.1% vs. 7.7 ± 1.9%, p = 0.02). The prevalence of absent response to PDE5-i was higher in patients treated with old antidiabetic drugs than in the population treated with new drugs (p = 0.03). Conclusion: The severity of ED and lower response to PDE5-i were higher in DM patients. A better glycometabolic profile, as well as new antihyperglycemic drugs, seem to have a positive effect on ED.

Early glucose metabolism in children at risk for type 1 diabetes based on islet autoantibodies compared to low-risk control groups.

BackgroundAnatomic variation or early differences in glucose metabolism have been linked to the development of type 1 diabetes. We aimed to describe early glucose metabolism based on HbA1c, oral glucose tolerance test (OGTT), and random plasma glucose years before the presentation of type 1 diabetes in five risk groups based on autoantibody combinations. For the first time, we were able to include for comparison children with very low risk of progression to type 1 diabetes.MethodsThe Finnish Diabetes Prediction and Prevention birth cohort study screened newborn infants for HLA susceptibility to type 1 diabetes since 1994. Those carrying a risk genotype were prospectively followed up with islet autoantibody testing. Glucose parameters were obtained starting from the time of seroconversion. By 31 August 2014, 1162 children had developed at least one islet autoantibody and were included in the current study. Type 1 diabetes was diagnosed in 335 children (progressors). In the non-progressor groups, 207 developed multiple (≥2) biochemical islet autoantibodies, 229 a single biochemical autoantibody, 370 ICA only, and 64 transient autoantibodies. Children were divided into five risk groups. Glucose metabolism was evaluated.ResultsWe observed lower HbA1c values in early follow-up 4.5 to 6.0 years before diagnosis in the progressors when compared to the same time in children with a single biochemical autoantibody or low-risk (ICA only and transient) participants, who did not progress to clinical type 1 diabetes. However, no such differences were observed in OGTTs or random plasma glucose. The variation was minimal in glucose values in the low-risk groups.ConclusionWe report the possibility of early alteration in glucose metabolism in future progressors. This could suggest early defects in multiple glucose-regulating hormones.

SPUR: psychometric properties of a patient-reported outcome measure of medication adherence in type 2 diabetes

IntroductionPoor medication adherence is associated with worsening patient health outcomes and increasing healthcare costs. A holistic tool to assess both medication adherence and drivers of adherence behaviour has yet to...

Erythrocyte osmotic fragility is not linked to vitamin C nutriture in adults with well-controlled type 2 diabetes.

Erythrocyte fragility is amplified by oxidative stress and linked to diabetes-specific microvascular disease. Vitamin C supplementation improves glycemic indices in adults with type 2 diabetes (T2D) by improving antioxidant status. This cross-sectional study examined the relationships between vitamin C status and erythrocyte osmotic fragility in adults with or without T2D. Participants provided a fasting blood sample for erythrocyte osmotic fragility testing as a function of hypotonic NaCl concentrations. Additionally, plasma was stabilized with metaphosphoric acid prior to vitamin C analysis using isocratic reverse-phase UV-HPLC separation. Participants were grouped as diagnosed T2D (n = 14; 36% female; 55.5 ± 8.2 y; 31.5 ± 9.0 kg/m2; HbA1c: 7.4 ± 1.9%; plasma vitamin C: 36.0 ± 12.2 μM) or no diabetes (n = 16; 69% female; 38.7 ± 13.5 y; 26.8 ± 6.6 kg/m2; HbA1c: 5.4 ± 0.3%; plasma vitamin C: 34.8 ± 10.9 μM). Participant characteristics differed between groups only for age and hemoglobin A1c (HbA1c; p < 0.05). All hemolysis parameters were in normal ranges for the participants with T2D, and no significant differences in hemolysis parameters were noted between those with or without T2D. However, among participants with T2D, the NaCl concentration eliciting 50% hemolysis was higher for those with low (<7%) vs. high (>7%) HbA1c values (p = 0.037) indicating a slightly higher erythrocyte fragility in the former group. Vitamin C status did not impact any of the hemolysis parameters in adults with or without T2D. Thus, erythrocyte fragility was not elevated in T2D, and vitamin C nutriture was not related to erythrocyte fragility in adults with well-controlled T2D.