Lower HbA1c Values Research Articles

Effects of Mangifera indica (Careless) on Microcirculation and Glucose Metabolism in Healthy Volunteers.

A commercial Mangifera indica fruit powder (Careless) showed beneficial acute effects on microcirculation in a randomized, double-blind, crossover pilot study. Here, long-term effects on microcirculation and glucose metabolism were investigated in a double-blind, randomized, placebo-controlled, 3-arm parallel-design study in healthy individuals. A daily dose of 100 mg or 300 mg of the fruit powder was compared to placebo after supplementation for 4 weeks. Microcirculation and endothelial function were assessed by the Oxygen-to-see System and pulse amplitude tonometry, respectively. Glucose metabolism was assessed under fasting and postprandial conditions by capillary glucose and HbA1c values.Microcirculatory reactive hyperemia flow increased, especially in the 100 mg group (p = 0.025). The 300 mg of the M.indica fruit preparation reduced postprandial glucose levels by trend if compared to placebo (p = 0.0535) accompanied by significantly lower HbA1c values compared to baseline. Furthermore, 300 mg intake significantly improved postprandial endothelial function in individuals with decreased endothelial function after high-dose glucose intake (p = 0.0408; n = 11).In conclusion, the study suggests moderate beneficial effects of M.indica fruit preparation on microcirculation, endothelial function, and glucose metabolism.

Incidental Detection of a Rare Hemoglobin Variant (Hemoglobin N Seattle) Leading to Undetectable Levels of HbA1c in a Diabetic Female: A Case Report

Glycosylated hemoglobin (GHb) is routinely used to monitor glycemic control over past 2–3 months in diabetics. As per the recommendations of the American Association of Clinical Endocrinologist, 2007 values should be maintained below 7% to prevent the risk of chronic complications. We report a case of a 55-year old female patient with spuriously low HbA1c values by high-performance liquid chromatography. Suspecting the presence of any abnormal hemoglobin, capillary zone electrophoresis was done which identified the presence of Hb variant corresponding to -Hb N Seattle. Our case highlights that clinical laboratories should be aware of limitations of their HbA1c assay methods as well as rule out any possible interfering Hb variants.

Systemic Associations with Residual Subretinal Fluid after Ranibizumab in Diabetic Macular Edema.

Purpose To investigate the impact of systemic diseases on the occurrence of subretinal fluid (SRF) in diabetic macular edema (DME) and prognostic factors for residual SRF following three consecutive monthly intravitreal ranibizumab. Methods Ninety-seven eyes from 68 patients with DME who completed 3 consecutive monthly injections of ranibizumab were enrolled. Systemic parameters mainly included chronic kidney disease (CKD), hypertension, HbA1c, and insulin dependence. Renal parameters for CKD were serum creatinine, estimated glomerular filtration rate (eGFR), and serum albumin. Ocular factors were baseline central macular thickness (CMT), severity of diabetic retinopathy (DR), and status of panretinal photocoagulation (PRP). Results Chronic kidney disease had significant correlation with baseline SRF (R = 0.397, p < 0.001 after partial correlation with adjustment for age and DR severity). As for CKD, lower serum albumin, but not eGFR or serum creatinine, was associated with baseline presence of SRF (p = 0.026, p = 0.08 and p = 0.53, resp., after adjustment for age and DR severity). Overall, lower eGFR and lower HbA1c values, contrary to popular belief, predicted the presence of residual SRF following intravitreal injections (p = 0.016 and p < 0.001, resp.). Conclusions Tight sugar control and poorer baseline kidney function may slow the resorption of SRF after anti-VEGF injections in patients with DME in the short term.

Teenage girls with type 1 diabetes have poorer metabolic control than boys and face more complications in early adulthood

AimsTo compare metabolic control between males and females with type 1 diabetes during adolescence and as young adults, and relate it to microvascular complications. MethodsData concerning 4000 adolescents with type 1 diabetes registered in the Swedish paediatric diabetes quality registry, and above the age of 18years in the Swedish National Diabetes Registry was used. ResultsWhen dividing HbA1c values in three groups; < 7.4% (57mmol/mol), 7.4–9.3% (57–78mmol/mol) and >9.3% (78mmol/mol), there was a higher proportion of females in the highest group during adolescence. In the group with the highest HbA1c values during adolescence and as adults, 51.7% were females, expected value 46.2%; in the group with low HbA1c values in both registries, 34.2% were females, p<0.001. As adults, more females had retinopathy, p<0.05. Females had higher mean HbA1c values at diagnosis, 11.2 vs. 10.9% (99 vs. 96mmol/mol), p<0.03, during adolescence, 8.5 vs. 8.2% (69 vs. 66mmol/mol) p<0.01, but not as young adults. ConclusionsWorse glycaemic control was found in adolescent females, and they had a higher frequency of microvascular complications. Improved paediatric diabetes care is of great importance for increasing the likelihood of lower mortality and morbidity later in life.

Prospective study to correlate the level of glycosylated haemoglobin with wound healing, vasculopathy and neuropathy in diabetic foot patients

Background: Diabetes mellitus is a prevalent global health problem and diabetic foot represents one of its dreadful complications. Early aggressive approach and multidisciplinary intervention prevent limb loss and disease fatality. Glycosylated haemoglobin (HbA1c) reflects long term glycaemic control and helps in prediction of complications as well as response to treatment. Methods: A total of 50 patients with diabetic foot ulcer (Wegner grade 1, 2) made nucleus of this study. Every patient underwent proper clinical, hematological and sonological assessment. Optimum treatment was provided and the effect of improvement in HbA1c value was correlated with duration of wound healing, vasculopathy and neuropathy over a 12 week follow uu. Results: Mean age of presentation was 53.4 years and patients developed diabetic ulcers (Wegner grade 1, 2) at a mean HbA1c value of 6.6. Foot trauma was inciting event in 70% cases. 70% patients had neuropathy and 30% had vasculopathy at presentation. Mean duration of healing was 42.6 days. Healing was faster in the group with lower HbA1c; however there was no improvement in neuropathy or, vasculopathy in 12 weeks duration. Conclusions: Based on the observations of present study it may be submitted that lower HbA1c value contributes to faster wound healing, however it doesn’t improve neuropathy and/or vasculopathy over duration of 12 weeks.

Diferencias en las características clínico-biológicas y prevalencia de complicaciones crónicas en relación con el envejecimiento de pacientes con diabetes tipo 2

Type 2 diabetes mellitus (T2DM) is a chronic, highly prevalent disease that increases with age. Because of this, and due to its chronic complications, T2DM causes high human, social, and financial costs. In addition, the elderly population with T2DM has a marked clinical heterogeneity. Therefore, our main objective was to analyze the relationship of age with the clinical and biological manifestations of the disease and the prevalence of chronic complications in patients with T2DM. Material and methodsA cross-sectional study of a large population with T2DM (n=405) randomly selected from a Diabetes Unit and 2 health care centers (60%). The clinical, anthropometric, and biochemical variables of the subjects were collected using standard methods to assess the effect of age on the clinical and biochemical phenotype of patients with T2DM. ResultsWe have noted that patients with T2DM > 70 years old have a clinical and biochemical phenotype different from younger subjects (<60 years) including longer times since diabetes onset, higher diastolic blood pressure levels, and lower body mass index (BMI) values. As regards to biological variables, these patients have lower triglyceride levels, impaired kidney function, and lower HbA1c values. Prevalence of metabolic syndrome is lower in patients with T2DM > 70 years of age. Age was inversely related to parameters associated to metabolic syndrome (BMI, waist circumference, blood pressure, and triglyceride levels). ConclusionsWe have defined the clinical and biochemical profile of patients with T2DM > 70 years attending health care centers. In addition, the prevalence of stroke, kidney disease, and distal symmetrical polyneuropathy is higher in patients with T2DM >70 years as compared to younger patients (<60 years).

Rates of Deintensification of Blood Pressure and Glycemic Medication Treatment Based on Levels of Control and Life Expectancy in Older Patients With Diabetes Mellitus.

Older patients with diabetes mellitus receiving medical treatment whose blood pressure (BP) or blood glucose level are potentially dangerously low are rarely deintensified. Given the established risks of low blood pressure and blood glucose, this is a major opportunity to decrease medication harm. To examine the rate of BP- and blood glucose-lowering medicine deintensification among older patients with type 1 or 2 diabetes mellitus who potentially receive overtreatment. Retrospective cohort study conducted using data from the US Veterans Health Administration. Participants included 211 667 patients older than 70 years with diabetes mellitus who were receiving active treatment (defined as BP-lowering medications other than angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, or glucose-lowering medications other than metformin hydrochloride) from January 1 to December 31, 2012. Data analysis was performed December 10, 2013, to July 20, 2015. Participants were eligible for deintensification of treatment if they had low BP or a low hemoglobin A1c (HbA1c) level in their last measurement in 2012. We defined very low BP as less than 120/65 mm Hg, moderately low as systolic BP of 120 to 129 mm Hg or diastolic BP (DBP) less than 65 mm Hg, very low HbA1c as less than 6.0%, and moderately low HbA1c as 6.0% to 6.4%. All other values were not considered low. Medication deintensification, defined as discontinuation or dosage decrease within 6 months after the index measurement. The actively treated BP cohort included 211,667 participants, more than half of whom had moderately or very low BP levels. Of 104,486 patients with BP levels that were not low, treatment in 15.1% was deintensified. Of 25,955 patients with moderately low BP levels, treatment in 16.0% was deintensified. Among 81,226 patients with very low BP levels, 18.8% underwent BP medication deintensification. Of patients with very low BP levels whose treatment was not deintensified, only 0.2% had a follow-up BP measurement that was elevated (BP ≥140/90 mm Hg). The actively treated HbA1c cohort included 179,991 participants. Of 143,305 patients with HbA1c levels that were not low, treatment in 17.5% was deintensified. Of 23,769 patients with moderately low HbA1c levels, treatment in 20.9% was deintensified. Among 12,917 patients with very low HbA1c levels, 27.0% underwent medication deintensification. Of patients with very low HbA1c levels whose treatment was not deintensified, fewer than 0.8% had a follow-up HbA1c measurement that was elevated (≥7.5%). Among older patients whose treatment resulted in very low levels of HbA1c or BP, 27% or fewer underwent deintensification, representing a lost opportunity to reduce overtreatment. Low HbA1c or BP values or low life expectancy had little association with deintensification events. Practice guidelines and performance measures should place more focus on reducing overtreatment through deintensification.

Type 1 and type 2 diabetes in children and young people: updated NICE guidance

Type 1 and type 2 diabetes in children and young people: updated <scp>NICE</scp> guidance

A pragmatic and scalable strategy using mobile technology to promote sustained lifestyle changes to prevent type 2 diabetes in India—Outcome of screening

AimsWe describe a two-step screening approach using non-invasive risk assessment and glycated hemoglobin (HbA1c) to identify participants for a diabetes prevention trial. MethodsA total of 6030 non-diabetic persons of 35–55 years were screened using risk assessment for diabetes. Those with three or more risk factors were screened using point of care HbA1c test. For this study, participants in HbA1c categories of 6.0% (42.1mmol/mol)–6.4% (46.4mmol/mol) were selected and their characteristics were analyzed. ResultsAmong 6030 persons, 2835 (47%) had three or more risk factors for diabetes. Among those screened with HbA1c, 43.2% (1225) had HbA1c values of <6.0% (42.1mmol/mol), 46.8% (1327) had HbA1c values between 6.0% (42.1mmol/mol) and ≤6.4% (46.4mmol/mol) and 10% (283) had undiagnosed diabetes with ≥6.5% (47.5mmol/mol). Positive family history was present in 53.2%, 81.7% were obese and 14.8% were overweight. ConclusionsOpportunistic screening using a two-step approach: diabetes risk profile and HbA1c measurement detected a large percentage of individuals with prediabetes. Prediabetic persons recruited to the trial had higher percentage of obesity and presence of positive family history than those who had lower HbA1c values. Outcomes from this trial will enable comparisons with the previous prevention studies that used blood glucose levels as the screening criteria.

A Randomized, Double-Blind, Placebo-Controlled Trial of Adjunctive Metformin Therapy in Overweight/Obese Youth with Type 1 Diabetes.

ContextInsulin resistance has been proposed as one of the causes of poor glycemic control in overweight/obese youth with type 1 diabetes (T1D). However, the role of adjunctive metformin, an insulin sensitizer, on glycemic control in these patients is unclear.ObjectiveTo compare the effect of metformin vs. placebo on hemoglobin A1c (HbA1c), total daily dose (TDD) of insulin, and other parameters in overweight/obese youth with T1D.HypothesisAdjunctive metformin therapy will improve glycemic control in overweight/obese youth with T1D.Design, Setting, and ParticipantsA 9-mo randomized, double-blind, placebo controlled trial of metformin and placebo in 28 subjects (13m/15f) of ages 10-20years (y), with HbA1c >8% (64 mmol/mol), BMI >85%, and T1D > 12 months was conducted at a university outpatient facility. The metformin group consisted of 15 subjects (8 m/ 7f), of age 15.0 ± 2.5 y; while the control group was made up of 13 subjects (5m/ 8f), of age 14.5 ± 3.1y. All participants employed a self-directed treat-to-target insulin regimen based on a titration algorithm of (-2)-0-(+2) units to adjust their long-acting insulin dose every 3rd day from -3 mo through +9 mo to maintain fasting plasma glucose (FPG) between 90–120 mg/dL (5.0–6.7 mmol/L). Pubertal maturation was determined by Tanner stage.ResultsOver the course of the 9 months of observation, the between-treatment differences in HbA1c of 0.4% (9.85% [8.82 to 10.88] for placebo versus 9.46% [8.47 to 10.46] for metformin) was not significant (p = 0.903). There were non-significant reduction in fasting plasma glucose (189.4 mg/dL [133.2 to 245.6] for placebo versus 170.5 mg/dL [114.3 to 226.7] for metformin), (p = 0.927); total daily dose (TDD) of short-acting insulin per kg body weight/day(p = 0.936); and the TDD of long-acting insulin per kg body weight per day (1.15 units/kg/day [0.89 to 1.41] for placebo versus 0.90 units/kg/day [0.64 to 1.16] for metformin) (p = 0.221). There was no difference in the occurrence of hypoglycemia between the groups.ConclusionsThis 9-month RCT of adjunctive metformin therapy in overweight and obese youth with T1D resulted in a 0.4% lower HbA1c value in the metformin group compared to the placebo group.Trial RegistrationClinicalTrial.gov NCT01334125

Factors associated with early beginning of partial remission in young adult patients with newly diagnosed type 1 diabetes

Clinical remission of type 1 diabetes reflects the transient recovery of β-cell function and improvement in insulin sensitivity, occurring after introduction of insulin therapy. The aim of the study was to identify factors associated with early beginning of partial remission phase in patients with newly diagnosed type 1 diabetes. One hundred and sixteen patients (41 women and 75 men), aged 18–34 (mean age 23.8 ± 8.7 years), were included into the study. Mean hospitalization time was 7 ± 2 days. Early remission was defined as reaching total daily insulin dose <0.3 U/kg with correct glycaemia in 24-h (7-point) glycaemic profile before discharge from the hospital, with random serum C-peptide above 0.5 μg/l. In group entering early remission (74 patients), significantly lower HbA1c values (9.6 ± 2.6 vs. 11.5 ± 4.5 %, p < 0.001), higher body mass index (BMI) (21.9 ± 2.9 vs. 20.8 ± 4.2 kg/m2, p < 0.05), less frequent ketonuria (45 vs. 79 %, p < 0.01) and diabetic ketoacidosis (11 vs. 26 %, p = 0.06) were recorded at diagnosis. The results indicate that degree and duration of metabolic disturbances are associated with early beginning of partial remission in young adults with newly diagnosed type 1 diabetes. Early onset of remission is common in this age group.

Initial combination therapy with metformin, pioglitazone and exenatide is more effective than sequential add-on therapy in subjects with new-onset diabetes. Results from the Efficacy and Durability of Initial Combination Therapy for Type 2 Diabetes (EDICT): a randomized trial.

To test our hypothesis that initiating therapy with a combination of agents known to improve insulin secretion and insulin sensitivity in subjects with new-onset diabetes would produce greater, more durable reduction in glycated haemoglobin (HbA1c) levels, while avoiding hypoglycaemia and weight gain, compared with sequential addition of agents that lower plasma glucose but do not correct established pathophysiological abnormalities. Drug-naïve, recently diagnosed subjects with type 2 diabetes mellitus (T2DM) were randomized in an open-fashion design in a single-centre study to metformin/pioglitazone/exenatide (triple therapy; n = 106) or an escalating dose of metformin followed by sequential addition of sulfonylurea and glargine insulin (conventional therapy; n = 115) to maintain HbA1c levels at <6.5% for 2 years. Participants receiving triple therapy experienced a significantly greater reduction in HbA1c level than those receiving conventional therapy (5.95 vs. 6.50%; p < 0.001). Despite lower HbA1c values, participants receiving triple therapy experienced a 7.5-fold lower rate of hypoglycaemia compared with participants receiving conventional therapy. Participants receiving triple therapy experienced a mean weight loss of 1.2 kg versus a mean weight gain of 4.1 kg (p < 0.01) in those receiving conventional therapy. The results of this exploratory study show that combination therapy with metformin/pioglitazone/exenatide in patients with newly diagnosed T2DM is more effective and results in fewer hypoglycaemic events than sequential add-on therapy with metformin, sulfonylurea and then basal insulin.

One center in Brussels has consistently had the lowest HbA1c values in the 4 studies (1994-2009) by the Hvidoere International Study Group on Childhood Diabetes: What are the "recipes"?

The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications (retinopathy, neuropathy, nephropathy, cardiovascular disease, etc.) by maintaining blood glucose concentrations close to normal level. Glycated hemoglobin levels (HbA1c) provide a good criterion of overall glycemic control. The Hvidoere Study Group (HSG) on Childhood Diabetes, founded in 1994, is an international group representing about twenty highly experienced pediatric centers from Europe, North America, Japan and Australia. Four international comparisons of metabolic control (1995, 1998, 2005, 2009) have been performed. The one center that has consistently had the lowest HbA1c values (approximate 7.3% or 56.3 mmol/mol) is my center in Brussels. This is more often obtained with a twice-daily free-mixed regimen with additional supplemental fast insulins ad hoc. The so-called "Dorchy's recipes" are summarized. The conclusion is that the number of daily insulin injections, 2 or ≥ 4, or the use of pumps, by itself does not necessarily give better results. Intensified therapy should not depend upon the number of insulin doses per day, by syringe, pen or pump but rather should be redefined as to intent-to-treat ascertainment (i.e., goals). When there are no mutually agreed upon goals for BG and/or HbA1c, when there is insufficient education and psychosocial support by the medical team or at home, there is likely to be poor outcomes, as shown by the HSG. One of our recipes is not to systematically replace rapid-acting human insulins by fast-acting analogues. Because the multicenter studies of the HSG, performed in developed countries without financial restriction, show that treatment of childhood diabetes is inadequate in general and that levels of HbA1c are very different, diabetes treatment teams should individually explore the reasons for failure, without any prejudice or bias. Any dogmatism must be avoided. Treatment cost vs results must also be taken into account.

Long-term efficacy of insulin pump therapy on glycemic control in adults with type 1 diabetes mellitus.

Continuous subcutaneous insulin infusion (CSII) is an effective method of intensive therapy for patients with type 1 diabetes; however, most studies have not examined long-term glycemic control. We evaluated the long-term efficacy of CSII in a cohort of adult patients with type 1 diabetes. This was a retrospective observational study of 200 patients with type 1 diabetes who initiated CSII at a single outpatient clinic in Kingston, ON, Canada between January 1998 and December 2012. Data were collected from 3 months prior to and up to 15 years after initiation of CSII and included glycated hemoglobin (HbA1c) level and demographic factors potentially associated with glycemic control. Mean age and duration of diabetes at CSII initiation were 35.4 years and 22.4 years, respectively. Mean duration of CSII at the time of analysis was 6 years. Mean HbA1c at initiation of CSII was 8.7% and decreased to a nadir of 7.5% 6 months post-initiation (SD = 1.0) (P < 0.001). This increased over time (range, 7.8-8.2%) but remained lower than the pre-CSII HbA1c (P < 0.001). Shorter duration of diabetes prior to CSII initiation, history of missed appointments, mental illness, and active smoking were predictors of higher HbA1c on CSII. Pre-CSII HbA1c predicted long-term HbA1c on CSII. The data demonstrate that in a clinic setting, patients on CSII maintain lower HbA1c values over a 1-10-year period compared with pre-CSII values. Poor pre-CSII HbA1c, history of missed appointments, mental illness, and active smoking are predictors of those less likely to achieve an HbA1c target of ≤ 7.0%.

Pitfalls of using HbA1cin the diagnosis and monitoring of diabetes

Question What are the pitfalls of using glycated haemoglobin (HbA1c) in the diagnosis and/or monitoring of diabetes?Background HbA1c has become ubiquitous in its use for the diagnosis of diabetes. It is dependent on the glycation of red blood cells over time. Several variables can affect the HbA1c value, leading to a false-positive or false-negative result, which can significantly affect clinical management. Therefore, it is important that clinicians are aware of alternative tests with which to diagnose and monitor diabetes.Setting This is a case study of a patient with sickle cell trait, whose diagnosis of diabetes mellitus was delayed due to a low HbA1c value on laboratory testing. The patient was subsequently diagnosed as having diabetes by capillary blood glucose and the use of the fructosamine assay.Discussion There are several medical conditions that can affect the HbA1c value, including haemoglobinopathies. Awareness of alternate ways of diagnosing and monitoring diabetes is therefore important for...

Predicting non-diabetic renal disease in type 2 diabetic adults: The value of glycated hemoglobin

AimsThe indications for renal biopsy in type 2 diabetes mellitus (T2D) are not well established. We investigated the prevalence, spectrum, and predictors of biopsy-proven non-diabetic renal disease (NDRD) in T2D. MethodsAn observational, single-center, retrospective study of T2D adults who underwent renal biopsies (N=51) over 10years for nephrotic-range proteinuria, microscopic hematuria, or rapidly declining renal function. ResultsThirty-five (68.6%) biopsies were diagnostic of NDRD, and 16 (31.4%) revealed isolated diabetic nephropathy. The most common NDRDs were interstitial nephritis (20%), progressive crescentic glomerulonephritis (14%), membranous nephropathy (11%), and focal segmental glomerulosclerosis (11%). The odds for NDRD declined by 97% in the presence of diabetic retinopathy (P<0.001). The deterioration of HbA1c during the year before biopsy predicted NDRD even after adjusting for diabetic retinopathy (OR, 7.65; 95% CI, 1.36–123.04; P=0.003). A model based on the interaction between the HbA1c values 12months before biopsy and the absolute change in these values during the preceding year predicted NDRD with 73.7% sensitivity and 75% specificity (AUC, 0.77; 95% CI, 0.59–0.94). ConclusionsThis study demonstrated a considerably high prevalence of NDRD in T2D adults undergoing renal biopsy. The absence of diabetic retinopathy, lower HbA1c values 12months before biopsy and greater deterioration in HbA1c prior to biopsy predicted NDRD in T2D. Further studies are needed to validate the findings.

Abstract 11542: Prognostic Significance of Insulin Treatment and Glucose Control Status on Clinical Cardiovascular Outcomes in Diabetic Patients Who Underwent Elective PCI Using Drug-Eluting Stents

Background: The aim of this study was to evaluate prognostic impact of insulin treatment and glucose control status on cardiovascular outcomes in diabetic patients after elective coronary intervention using drug-eluting stents (DES). Methods: A total of 198 consecutive diabetic patients undergoing elective percutaneous coronary intervention (PCI) with DES in Chubu Rosai Hospital from October 2005 to March 2008 were enrolled. The median HbA1c value of the patients was 7.5%. Patients were divided into four groups based on the presence or absence of insulin treatment and the HbA1c value at baseline (&lt;7.5% or ≧7.5%). The endpoint of this study was major adverse cardiac event (MACE) defined as the composite of cardiovascular death, non-fatal myocardial infarction and any revascularization. Results: During the median follow-up of 1454 days, total 87 events occurred. MACE occurred more frequently in insulin-treated group with HbA1c&lt;7.5% (78.9%) than in the other groups (log-rank p &lt; 0.0001). The incidence of cardiac death or non-fatal myocardial infarction (p=0.022) and any revascularization (p=0.025) were significantly increased in insulin-treated group with HbA1c&lt;7.5% than the other groups. In cox analysis, after adjustment for conventional risk factors (age, sex, body mass index, smoking status, hypertention, dyslipidemia) and duration of diabetes, fasting blood glucose, hemodialysis, the hazard ratio for MACE relative to non-insulin-treated group with HbA1c&lt;7.5% was 2.91 (95% confidence interval 1.09 - 7.81, p = 0.034) in insulin-treated group with HbA1c&lt;7.5%. Compared with insulin-treated group with HbA1c≧7.5%, the hazard ratio was 3.83 (95% confidence interval 1.01 - 14.54, p = 0.049) in insulin-treated group with HbA1c&lt;7.5%. Conclusion: Insulin treatment with lower HbA1c value was proven to be an independent predictor of MACE in diabetic patients after PCI using DES.

Type II diabetes and its therapy in clinical practice - results from the standardised non-interventional registry SIRTA.

Modern antidiabetic therapies should achieve low HbA1c values and avoid hypoglycaemic complications. The registry SIRTA included 1522 patients with type II diabetes mellitus (T2DM) from 306 German medical practices. Patients had an HbA1c >6.5% under the maximum tolerated metformin dose. If required, they received combination therapy with other antidiabetics according to the guideline of the German Diabetes Society [Deutsche Diabetes Gesellschaft (DDG)] or usual medical practice. Patients were followed up for 6months. The target criteria included the achievement of HbA1c target values and the emergence of severe hypoglycaemic episodes. Most patients (64.0%) were planned to achieve an HbA1c target <6.5%, the standard target recommended by the 2009 DDG guideline valid throughout the registry. Primarily to reduce the individual risk for hypoglycaemia, 32.4% of patients had a less strict HbA1c-target of 6.5-7.0%. These targets were achieved by 31.3% and 44.3% of patients, respectively. Combination therapies increased from 45% to 56% over the 6months registry. Four patients had severe hypoglycaemias (0.26%). The registry confirms results from other epidemiologic studies on the therapy of T2DM in everyday practice. The treatment strategies applied effectively reduced blood glucose and avoided severe hypoglycaemias. An early therapy of insufficiently controlled patients with T2DM is important, as lower baseline values facilitated achieving HbA1c targets.

Secondary diabetic ketoacidosis and severe hypoglycaemia in patients with established type 1 diabetes mellitus in China: a multicentre registration study

Diabetic ketoacidosis (DKA) and severe hypoglycaemia are common acute complications of type 1 diabetes mellitus (T1DM). This study aimed to determine the incidence of, and risk factors for, these complications in Chinese patients with established T1DM. This cross-sectional study recruited patients with established T1DM from 16 centres in Guangdong Province, China. Incidence rates were expressed as episodes/100 patient-years. Regression models identified risk factors for the occurrence and recurrence of secondary DKA and severe hypoglycaemia. A total of 611 patients with established T1DM (53.7% women) were recruited. The incidence of secondary DKA and severe hypoglycaemia was 26.4 (22.4, 31.0) and 68.8 (62.2, 76.0)/100 patient-years, respectively. Significant risk factors for secondary DKA were female gender [relative risk (RR) = 2.12], medical reimbursement rate <50% (RR = 1.84), uncontrolled diet (RR = 1.76), smoking (RR = 2.18) and poor glycaemic control [glycated haemoglobin A1c (HbA1c)/1.0% increase; RR = 1.15]. Overweight/obesity was a protective factor (RR = 0.57). Significant risk factors for severe hypoglycaemia included male gender (RR = 1.71), medical reimbursement rate < 50% (RR = 1.36), longer duration of T1DM (per 5-year increase, RR = 1.22), underweight (RR = 1.44), uncontrolled diet ('never controlled' or 'sometimes controlled' vs. 'usually controlled', RR = 2.09 or 2.02, respectively), exercise <150 min/week (RR = 1.66), presence of neuropathy (RR = 1.89), smoking (RR = 1.48) and lower HbA1c values (per 1.0% decrease, RR = 1.46). Overweight/obesity was a protective factor (RR = 0.62). Additionally, 34.4% of secondary DKA and 81.1% of severe hypoglycaemia episodes occurred in 3.8% and 16.2% patients with recurrent events (≥two episodes), respectively. The results indicate that secondary DKA and severe hypoglycaemia occur at high rates in Chinese patients with established T1DM and that recurrence is likely to occur in high-risk patients. Comprehensive management of T1DM should include recommendations to control modifiable risk factors.

Regimes terapêuticos e controlo glicémico nos diabéticos tipo 2 de uma unidade de saúde familiar

ObjectivesTo describe the demographic characteristics, metabolic control, comorbidities and pharmacological treatment of diabetic patients followed in a Family Health Unit. Type of studyobservational, cross‐sectional and analytical. Location and Populationall type 2 diabetics of an family health unit were studied. Methodscomputer records of year 2011 were consulted. ResultsThe prevalence of type 2 diabetes mellitus (DM) was 4.58%. It was analyzed the records of 671 diabetic patients, 52.2% men. The mean HbA1c was 6.2±1.1% of which 68.1% had values ≤6.5%. The prevalence of hypertension and dyslipidemia was 76.5%, 46% had overweight and 43.2% obesity. There was a positive association of HbA1c with the duration of diabetes (p<0.001), body mass index (p=0.006), systolic blood pressure (p<0.001) and the number of antidiabetic drugs prescribed (p<0.001). The two most common regimens were associated with lower HbA1c values: biguanide (p<0.001) and biguanide+incretin (p=0.045). Diabetic patients who did not perform pharmacological therapy also were associated with lower HbA1c values (p<0.001). On the other hand, the pharmacological association sulfonylurea+biguanide+incretin (p<0.001) and multiple drug regimens with inclusion of insulin were associated with higher values of HbA1c. DiscussionThe prevalence of type 2 DM in this population was significantly lower compared to what is published and can alert to an underdiagnosis in this health unit. The mean HbA1c in this population probably reflects the commitment on the intervention of this pathology. The results of this study support the recommendations to individualize the target value of HbA1c, emphasizing the importance of a multifactorial approach in the treatment of diabetes, associated with a continuous monitoring.