Lower HbA1c Values Research Articles

Racial and Ethnic Differences in Medication Initiation Among Adults Newly Diagnosed with Type 2 Diabetes.

Given persistent racial/ethnic differences in type 2 diabetes outcomes and the lasting benefits conferred by early glycemic control, we examined racial/ethnic differences in diabetes medication initiation during the year following diagnosis. Among adults newly diagnosed with type 2 diabetes (2005-2016), we examined how glucose-lowering medication initiation differed by race/ethnicity during the year following diagnosis. We specified modified Poisson regression models to estimate the association between race/ethnicity and medication initiation in the entire cohort and within subpopulations defined by HbA1c, BMI, age at diagnosis, comorbidity, and neighborhood deprivation index (a census tract-level socioeconomic indicator). Among the 77,199 newly diagnosed individuals, 47% started a diabetes medication within 12 months of diagnosis. The prevalence of medication initiation ranged from 32% among Chinese individuals to 58% among individuals of Other/Unknown races/ethnicities. Compared to White individuals, medication initiation was less likely among Chinese (relative risk: 0.78 (95% confidence interval 0.72, 0.84)) and Japanese (0.82 (0.75, 0.90)) individuals, but was more likely among Hispanic/Latinx (1.27 (1.24, 1.30)), African American (1.14 (1.11, 1.17)), other Asian (1.13 (1.08, 1.18)), South Asian (1.10 (1.04, 1.17)), Other/Unknown (1.31 (1.24, 1.39)), American Indian or Alaska Native (1.11 (1.04, 1.18)), and Native Hawaiian/Pacific Islander (1.28 (1.19, 1.37)) individuals. Racial/ethnic differences dissipated among individuals with higher HbA1c values. Initiation of glucose-lowering treatment during the year following type 2 diabetes diagnosis differed markedly by race/ethnicity, particularly for those with lower HbA1c values. Future research should examine how patient preferences, provider implicit bias, and shared decision-making contribute to these early treatment differences.

The effect of text messaging intervention on lowering modifiable risk factors for cardiovascular diseases, Riyadh, Saudi Arabia

Objective: To determine whether SMS reduces modifiable cardiovascular risk factors.Methods: From February to July 2018, the authors performed an RCT on primary care patients at King Khaled University Hospital (KKUH). The patients completed a questionnaire with personal data, and E-SEHI was used to evaluate their low-density lipoprotein (LDL), glycated hemoglobin (HBA1C), systolic blood pressure (SBP), diastolic blood pressure (DBP), Body Mass Index (BMI), and smoking status at baseline and 6-month later. Then After six months, the intervention group received four weekly SMS motivating messages that urged them to exercise frequently, quit smoking, eat well, and stick to medications, whereas the control group did not get SMS intervention.Results: Five hundred forty-five participants participated in this study. The intervention group included 202 (37.1%) persons, while the control group had 343 (62.9%). Comparable age and gender distributions were seen in the intervention and control groups.Total cholesterol and LDL dropped in the intervention group. Control group HBA1c and FBS levels improved.SBP and DBP decreased in both intervention and control groups. However, the intervention group's DBP decreased more than the control groups, whereas the control group's SBP decreased less. Those aged 36-60, men, and those with less than a high school degree had lower HBA1c values (p 0.05). Furthermore, the control group decreased more than the intervention group.The intervention group's 36-60-year-olds with less than a high school education lowered their total cholesterol and LDL levels more (p 0.05).DBP in the intervention group decreased across both sexes and low-educated adults (p 0.05).Conclusion: Text messaging has been demonstrated to be a helpful and cost-effective way to modify cardiovascular risk factors. To enhance effectiveness considerably, we advocate delivering patients' interventional massages, which are well designed, interactive audiovisual, automated, focused, and personalized, more frequently and for a longer period.

Measurement of erythrocyte creatine might be useful for diagnosing latent hemolysis

ObjectivesWhereas HbA1c values are low relative to glycemia in patients with hemolytic anemia, including compensatory anemia, low HbA1c levels along with negative results for conventional hemolysis indicators have been reported in patients with latent hemolysis. Conversely, glycated albumin (GA) is a glycemic control indicator unaffected by hemolysis. Erythrocyte creatine (EC) is a hemolysis indicator that reflects the mean age of red blood cells (MRBC). We recently reported a formula for obtaining MRBC based on EC. The present study examined the usefulness of EC measurements and MRBC calculated with EC for diagnosing latent hemolysis. Materials and methodsTwo patients with latent hemolysis and low HbA1c values relative to glycemia were investigated, while controls comprised 214 patients (including patients with hemolysis and/or type 2 diabetes mellitus). HbA1c was expressed in International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) units (iA1c). GA/iA1c ratios, reticulocyte counts, EC, and MRBC in patients with latent hemolysis were compared to non-hemolysis, compensatory hemolysis, and hemolytic anemia patients. ResultsBoth reticulocyte counts and haptoglobin levels were within reference ranges in patients with latent hemolysis. GA/iA1c ratios and EC were higher than reference values in patients with latent hemolysis, and MRBC values were 41.6 and 48.4 days, respectively, shorter than the reference range (49.1–66.8 days). ConclusionsEC measurement and MRBC values calculated on the basis of EC might be useful for diagnosing latent hemolysis.

Sex differences over time for glycemic control, pump use and insulin dose in patients aged 10–40 years with type 1 diabetes: a diabetes registry study

IntroductionTo evaluate sex differences in people with type 1 diabetes concerning changes in glycemic control and trends in insulin pump use and insulin dose over two decades in adolescents and...

Large discrepancy in glycaemic control appropriateness in geriatric patients with type 2 diabetes according to major clinical practice guidelines.

In geriatric patients with type 2 diabetes (T2D), appropriate glycaemic control is crucial to avoid overtreatment and hypoglycaemia. This study compared glycaemic control appropriateness across three major clinical practice guidelines (CPGs). Retrospective study of geriatric older inpatients with T2D and glucose-lowering treatment before admission. Patients were classified as appropriately treated, overtreated or undertreated using CPGs from Diabetes Canada 2018 (DC18), the Endocrine Society 2019 (ES19) and the American Diabetes Association 2021 (ADA21). Of the 318 geriatric patients (median age 84years, 54% women, 66% in poor health), 46%, 25% and 82% were appropriately treated, while 38%, 57% and 0% were overtreated, based on DC18, ES19 and ADA21, respectively. Large discrepancy of glycaemic control appropriateness was detected across these CPGs and concerned mainly overtreatment. This finding relates to the absence in ADA21 of a lower HbA1c value, which may be an obstacle to the prevention of hypoglycaemia.

Diabetic Retinopathy Screening Programme: Attendance, Barriers and Enablers amongst Young People with Diabetes Mellitus Aged 12–26 Years

The study aim is to investigate characteristics, barriers and enablers for attendance at the Diabetic Eye Screening Programme Northern Ireland (DESPNI) among people with diabetes aged 12–26 years. A mixed-methods approach with retrospective analysis and prospective, questionnaire-based data collection was completed. Data were analysed using ordinal logistic regression. A questionnaire collected information on barriers and enablers to attending DESPNI. Age, diabetes duration, attendance at diabetes clinic and lower HbA1c values were significantly associated with better attendance. Those aged 12–15 were more likely to attend screening than 16–26 years, odds ratio (OR) 4.01. Subjects diagnosed less than 5 years were more likely to attend than those with longer diabetes duration (OR = 2.52, p =< 0.001). Subjects who attended diabetes clinics were more likely to attend screening (OR = 1.89, p =< 0.001) and have a lower HbA1c (OR = 1.46, p =< 0.001). Questionnaires revealed major barriers to attendance which included inconvenient appointment times, lack of access and poor communication. While many subjects were aware of the impact of diabetes on the eye, many had little understanding of screening. This study provides pivotal information on potential barriers and enablers for young people attending eye screening. We suggest modest changes such as convenient appointment times, clearer communication and one-stop clinics could improve attendance.

Revisiting Role of HbA1c

With the increasing use of HbA1c as a diagnostic marker, more values at the lower end of the reference range can be observed. As more emphasis has been on decreasing and controlling a rising value of glycated haemoglobin, it is currently uncertain how to interpret low HbA1c values. Various conditions not related to diabetes, but with a fairly common occurrence, influence HbA1c. Alternative indices may have to be used for assessing glycemic control in these cases. It is important that such influencing factors are looked into when evaluating an inappropriately or expectantly low HbA1c value. HbA1c is a biomarker that might have utility beyond just diabetes mellitus. Its role needs to be re-examined as it is a test which is widely available, less amenable to short term physiological variations, and can be easily studied. All that is required is a different perspective or approach to its utility.

Association between Physical Activity and Sport Participation on Hemoglobin A1c Among Children and Adolescents with Type 1 Diabetes

Purpose: To determine associations between physical activity (PA) and sport participation on HbA1c levels in children with type 1 diabetes (T1D). Method: Pediatric patients with T1D were invited to complete a PA and sport participation survey. Data were linked to their medical records for demographic characteristics, diabetes treatment and monitoring plans, and HbA1c levels. Results: Participants consisted of 71 females and 81 males, were 13 ± 3 years old with an average HbA1c level of 8.75 ± 1.81. Children accumulating 60 min of activity 3 days or more a week had significantly lower HbA1c compared to those who accumulated less than 3 days (p < 0.01) of 60 min of activity. However, there was no significant difference in HbA1c values based on sport participation groups. A multiple linear regression model indicated that PA, race, age, duration of diagnosis, and CGM use all significantly predicted HbA1c (p < 0.05). Conclusion: This study demonstrated the significant relationship between daily PA and HbA1c. Those in this sample presented with lower HbA1c values even if accumulating less than the recommended number of days of activity. Further, it was shown that sport participation alone may not be adequate enough to impact HbA1c in a similar manner.

Unexpected Detection of Abnormal Hemoglobin Variants During Routine HbA1c Analysis by HPLC Technique: Challenges and Opportunities in HbA1c Testing

Background: Glycated Hemoglobin A1c (HbA1c) assay is most widely used in diabetic patients for assessing long-term control of glycemia. The presence of hemoglobin variants may be an incidental finding and can interfere with HbA1c measurements. The aim of the present study is to investigate the prevalence and impact of interference of different abnormal hemoglobin variants on HbA1c measurements during routine HbA1c testing. Methods: A total of 12,092 HbA1c samples were collected from January to August 2018. HbA1c quantification was carried out on a Variant II Bio-Rad’s HPLC analyzer. Abnormal chromatograms were further analyzed using the extended-run high-pressure liquid chromatography (HPLC) analysis in the A2/F mode. Results: The samples were examined for presence of abnormal variants. Samples producing abnormal chromatograms were further analyzed in A2/F mode to characterize hemoglobin variants. Abnormal variants were identified in 126 (1%) samples, and 74 (0.59%) sickle cell traits (SCT) were the most common variant in our findings. Moreover, 30 (0.24%) cases were eluted in the variant window in A1c mode, which on further analysis were found to be Hb E &amp; Hb D traits. Furthermore, 3 (0.02%) cases were eluted at a RT &lt;1 min as (unknown) and identified as Hb H. Also,19 (0.15%) samples were eluted in the P3 window at different retention times. Conclusion: Observing each chromatograph after the analysis can help us in identifying silent hemoglobin variants in routine HbA1c testing. Knowledge and awareness of common hemoglobin variants affecting measurement of HbA1c is imperative to avoid reporting of falsely low HbA1c values in diabetic population.

524-P: Diabetes Device Use Linked with Lower Family Conflict in Teens with Type 1 Diabetes

Introduction: Use of hybrid closed-loop insulin delivery systems have been associated with better glycemic control and lower hemoglobin A1c (HbA1c) values, and better glycemic control is linked with less diabetes-specific family conflict among adolescents with type 1 diabetes (T1D). Little is known, however, about how the use of closed-loop systems relates to diabetes family conflict. Methods: Participants included 60 teens ages 13-17 who had been diagnosed with T1D for ≥1 year and who reported at least moderate diabetes distress (M age= 16.15±1.4, 68% white, non-Hispanic 68% female), and their parents (78% white, non-Hispanic, 78% Married, 83% female). As part of baseline data collection of an ongoing two-site trial of a behavioral intervention, parents and teens each reported on diabetes device use and diabetes-related family conflict. HbA1c values were obtained from teens’ medical records or mail-in kits. Nonparametric (Mann-Whitney) tests were conducted to examine differences between parent and teen-reported diabetes family conflict and HbA1c in relation to use of closed-loops systems. Results: Of the participants, 12 teens (20%) were using a closed-loop system. The use of closed-loop systems was associated with lower levels of parent-reported diabetes-related family conflict (z= -2.372, p=0.018). Use of closed-loop systems was also associated with lower HbA1c values (z= -2.865, p=.004). However, teens’ own report of family conflict was not significantly related to use of the closed-loop systems (z= -1.331, .183). Conclusion: Results suggest that the use of closed-loop systems is associated with both lower HbA1c and lower parent perceptions of diabetes-related family conflict. While future studies are needed to replicate these findings in larger samples and over time, our findings further support that closed-loop systems may reduce the burden of diabetes - particularly for parents - and improve both psychosocial and glycemic outcomes in families of youth with T1D. Disclosure H. R. Moore: None. S. S. Jaser: None. R. Streisand: None. H. Inverso: None. T. Morrow: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK121316)

The Burden of Type 2 Diabetes and the Value of Achieving Near Normoglycemia from the Patient Perspective.

IntroductionType 2 diabetes (T2D) is extremely burdensome to people with T2D and associated with impaired health-related quality of life. This study explores the impact of T2D and potentially relevant outcomes for new therapies using a unique approach to in-depth qualitative interviews where people with T2D are asked to think about their future with T2D.MethodsA cross-sectional qualitative interview study among people with T2D from the USA and UK. Interviews explored their treatment journey, perceptions of their future with T2D, and the value of achieving normoglycemia (explored through presentation of two vignettes with hypothetical medications that reduced hemoglobin A1c [HbA1c] levels < 7% and < 5.7%).ResultsPatients with T2D (N = 50; US n = 25; UK n = 25) were 66.0% male, had a mean body mass index (BMI) of 30.8 ± 6.3 kg/m2, and had a mean of 13.0 ± 10.0 years since diagnosis. Current diabetes treatments included diet and exercise only (8.0%), oral medications only (62.0%), oral plus injections (24.0%), and insulin only (6.0%). Despite being treated, participants reported over 25 different unmet needs related to their T2D across a broad range of domains. The most common concerns were diet, diabetes-related complications, weight changes, and psychological and emotional issues. A large majority of participants indicated that achieving lower HbA1c values would change their life. When reflecting on the value of improved glycemic control, patients primarily anticipated physical improvements and improved psychological well-being. When presented with two hypothetical treatments, about 70% of participants preferred the < 5.7% treatment option over the < 7% HbA1c treatment option.ConclusionsPeople with T2D have a high disease burden, a broad range of unmet needs, and extremely varied experiences and expectations on the impacts of T2D on their lives and future. Many patients indicated that achieving near normoglycemia would substantially change their lives primarily in terms of their physical and emotional health.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01054-6.

An Analysis of Medtronic Minimed 670g Insulin Pump Use in Clinical Practice and the Impact on Glycemic Control, Quality of Life, and Compliance

Background: This study evaluated the use of the Medtronic MiniMed 670G system in adults with type 1 diabetes mellitus from a large endocrinology practice and its impact on glycemic control, quality of life (QoL), compliance and safety. Methods: 84 participants completed one site visit for data collection. Percentage of time in range (TIR: 70–180 mg/dL), hyperglycemia (>180 mg/dL), hypoglycemia (<70 mg/dL), HbA1c, average blood glucose (ABG), and other metrics were evaluated at the last visit using the system (LVMM) and compared between the last visit on previous insulin therapy (LVPT). Participants completed three questionnaires to assess QoL. Continuation of the auto mode feature was determined to assess compliance. Results: The mean percentage of TIR at the LVPT was 46.26 ± 18.82% while that at the LVMM was 73.39 ± 12.95%. This represents a significant increase in percentage of TIR of 27.13% (p < 0.001). The mean percentage of time in hyperglycemia at the LVPT was 47.42 ± 20.39% while that at the LVMM was 23.51 ± 11.65%, representing a significant decrease of 23.90% (p < 0.001). The mean percentage of time in hypoglycemia at the LVPT was 6.17 ± 7.91% while that at the LVMM was 2.94 ± 4.72%, representing a significant decrease of 3.22% (p = 0.004). The mean HbA1c at the LVPT was 7.36 ± 1.03% (57 mmol/mol) while that at the LVMM was 7.45 ± 0.85% (58 mmol/mol), representing an increase of 0.09% (p = 0.337). For those with HbA1c greater than or equal to 7.5% at LVPT, the mean HbA1c at the LVPT was 8.49 ± 0.78% (69 mmol/mol) while that at the LVMM was 8.00 ± 0.85% (64 mmol/mol), representing a significant decrease of 0.48% (p = 0.007). For those with HbA1c less than 7.5% at LVPT, the mean HbA1c at the LVPT was 6.78 ± 0.53% (51 mmol/mol) while that at the LVMM was 7.16 ± 0.69% (55 mmol/mol), representing a significant increase of 0.38% (p< 0.001). Patients with LVPT HbA1c less than 7.5% (58 mmol/mol) had a significant reduction in hypoglycemia (<70 mg/dL) from 7.40% to 2.56% (p = 0.001), whereas the reduction in patients with LVPT HbA1c greater than or equal to 7.5% (58 mmol/mol) was from 4.11% to 3.59% (p = 0.758). QoL questionnaires revealed good satisfaction with the system and 86% of participants continued use in auto mode. Conclusions: The use of the Medtronic MiniMed 670G system resulted in a TIR above the recommended target and a significant increase in the percentage of TIR compared to previous insulin therapy. While there was no significant change in HbA1c in the overall population, those with higher HbA1c values at baseline had a reduced percentage of time in hyperglycemia, while those with lower HbA1c values had a reduced percentage of time in hypoglycemia, indicating improvement in parameters specific to each subgroup. The system may be a reasonable choice for patients struggling with significant amounts of hypoglycemia. Use of the system resulted in a high degree of patient satisfaction and excellent compliance in the use of the system.

Marginal Bone Loss of Dental Implants in Patients with Type 2 Diabetes Mellitus with Poorly Controlled HbA1c Values: A Long-Term Retrospective Study.

The objective of this study was to report implant survival rates, marginal bone loss, and the impact of prosthesis type among patients with type 2 diabetes mellitus (DMT2), with high hemoglobin A1C (HbA1c) values. This retrospective study utilized patient medical records from an oral surgeon's office. Patients who had moderately or poorly controlled DMT2 with HbA1c values up to 10% were reviewed. Inclusion criteria were partially or fully edentulous patients diagnosed with DMT2 who were subsequently treated with implant-supported prosthetic restorations. Patients were at least 18 years of age. Exclusion criteria were patients who did not present for annual follow-up visits, patient records with incomplete surgical or restorative data, or nondiagnostic radiographs. All the fixed restorations were cement-retained, and the removable restorations were supported by two to six implants. Marginal bone loss and the consequences of prosthetic type were assessed from the last available radiograph compared with the one taken after the surgical procedure. Data of 357 implants were extracted from the records of 38 patients with HbA1c values (6.9% to 10.0%). The mean follow-up was 7.3 years, with a minimum of 5 years. Six implants failed, yielding a 98.4% overall implant survival rate. The patients were divided into two groups according to the HbA1c values before implant placement. The moderately controlled group included 25 patients with DMT2, with HbA1c values of 6.9% to 8.0%, and the poorly controlled group included 13 patients, with HbA1c values of 8.1% to 10.0%. The overall mean bone loss was 2.02 ± 2.43 mm. In both groups, the maxilla demonstrated more bone loss than the mandible (P < .05). Marginal bone loss in moderately controlled and poorly controlled groups was 1.86 (± 2.21) mm and 2.33 (± 2.85) mm, respectively (P < .05). Removable prostheses also revealed greater bone loss rates compared with fixed prostheses in both groups (P < .05). Patients with high HbA1c values (8.1% to 10.0%) had more marginal bone loss than those with lower HbA1c values. Removable dentures should be reconsidered as a standard treatment option in these patients.

Diabetes Distress and Glycemic Control in Type 2 Diabetes: Mediator and Moderator Analysis of a Peer Support Intervention.

BackgroundHigh levels of psychosocial distress are correlated with worse glycemic control as measured by glycosylated hemoglobin levels (HbA1c). Some interventions specifically targeting diabetes distress have been shown to lead to lower HbA1c values, but the underlying mechanisms mediating this improvement are unknown. In addition, while type 2 diabetes mellitus (T2D) disproportionately affects low-income racial and ethnic minority populations, it is unclear whether interventions targeting distress are differentially effective depending on participants’ baseline characteristics.ObjectiveOur objective was to evaluate the mediators and moderators that would inform interventions for improvements in both glycemic control and diabetes distress.MethodsOur target population included 290 Veterans Affairs patients with T2D enrolled in a comparative effectiveness trial of peer support alone versus technology-enhanced peer support with primary and secondary outcomes including HbA1c and diabetes distress at 6 months. Participants in both arms had significant improvements in both HbA1c and diabetes distress at 6 months, so the arms were pooled for all analyses. Goal setting, perceived competence, intrinsic motivation, and decisional conflict were evaluated as possible mediators of improvements in both diabetes distress and HbA1c. Baseline patient characteristics evaluated as potential moderators included age, race, highest level of education attained, employment status, income, health literacy, duration of diabetes, insulin use, baseline HbA1c, diabetes-specific social support, and depression.ResultsAmong the primarily African American male veterans with T2D, the median age was 63 (SD 10.2) years with a baseline mean HbA1c of 9.1% (SD 1.7%). Improvements in diabetes distress were correlated with improvements in HbA1c in both bivariate and multivariable models adjusted for age, race, health literacy, duration of diabetes, and baseline HbA1c. Improved goal setting and perceived competence were found to mediate both the improvements in diabetes distress and in HbA1c, together accounting for 20% of the effect of diabetes distress on change in HbA1c. Race and insulin use were found to be significant moderators of improvements in diabetes distress and improved HbA1c.ConclusionsPrior studies have demonstrated that some but not all interventions that improve diabetes distress can lead to improved glycemic control. This study found that both improved goal setting and perceived competence over the course of the peer support intervention mediated both improved diabetes distress and improved HbA1c. This suggests that future interventions targeting diabetes distress should also incorporate elements to increase goal setting and perceived competence. The intervention effect of improvements in diabetes distress on glycemic control in peer support may be more pronounced among White and insulin-dependent veterans. Additional research is needed to understand how to better target diabetes distress and glycemic control in other vulnerable populations.

Lower HbA1c targets are associated with better metabolic control.

Previous studies have suggested that clear HbA1c target setting by the diabetes team is associated with HbA1c outcomes in adolescents. The aim of this study was to evaluate whether this finding is consistent in a larger cohort of children from centers participating in the SWEET international diabetes registry. A questionnaire was sent out to 76 SWEET centers, of which responses from 53 pediatric centers were included (70%). Descriptive outcomes were presented as median with lower and upper quartile. The association between the centers' target HbA1c and mean outcome HbA1c was calculated using linear regression adjusted for age, diabetes duration, sex, and gross domestic product. Median age of the children in the studied centers (n = 35,483) was 13.3 [12.6-14.6] years (49% female). Of the 53 centers, 13.2% reported an HbA1c target between 6.0 and 6.5%, 32.1% had a target between ≥ 6.0 and 7.0%, 18.9% between ≥ 7.0 and 7.5%, and 3.8% between ≥ 7.5 and 8.5%. No specific target value was reported by 32.1% of all centers. Median HbA1c across all centers was 7.9 [7.6-8.3] %. Adjusted regression analysis showed a positive association between HbA1c outcome and target HbA1c (p = 0.005).Conclusions: This international study demonstrated that a lower target for HbA1c was associated with better metabolic control. It is unclear whether low target values result in better metabolic control, or lower HbA1c values actually result in more ambitious target values. This target setting could contribute to the differences in HbA1c values between centers and could be an approach for improving metabolic outcomes. What is Known: • Target setting of HbA1c is important in children and adolescents with type 1 diabetes. • The optimal therapeutic approach of children with type 1 diabetes requires a trained multidisciplinary team. What is New: • Lower HbA1c targets are associated with better metabolic control. • No associations between the composition of the diabetes teams and metabolic control could be demonstrated.

Evaluation of type 1 diabetic patients: A single center experience

We evaluated patients diagnosed with type 1 DM who were followed at our clinic by conducting a retrospective chart review. Medical records of a total of 147 patients with type 1 DM (70 females, 77 males) with a mean (±SD) age of 31.2±9.7 years were reviewed retrospectively. The study patients had a mean duration of follow-up of 13.9±9.5 years, mean duration of follow-up of 4±2.6 years at our clinic and a mean HbA1c value of 8.3±2.1%. Microvascular complications were recorded in medical files for 128 patients. There were 48 (37.5%) patients with at least one microvascular complication. Medical records showed that out of 128 patients, 23 (18%) had diabetic neuropathy alone, 4(3%) had diabetic retinopathy alone and 5 (4%) had diabetic nephropathy alone. Ten patients (8%) had both diabetic nephropathy and diabetic retinopathy and 6 (4.7%) patients had all three microvascular complications. No significant difference was observed between patients with or without microvascular complications in terms of HbA1c (HbA1c 8.3% versus 8.1%; p=0.85). A history of diabetic foot ulcer was present in 4 patients in the study sample (4/147=2.7% of all patients).Twenty-two (15%) patients were on insulin pump therapy during follow-up. Insulin pump users had a significantly lower HbA1c value (7.9%) compared to those not using insulin pump (8.5%) (p=0.02). At our clinic, special efforts are being made to ensure type 1 diabetic individuals have regular outpatient examinations. Despite all these measures, our patients are still far from reaching their target HbA1c values, suggesting that we have to do much more help patients achieve their glycemic goals.

Communication frequency between visits is associated with improved glycemic control in pediatric diabetes.

Children with diabetes are advised to see their diabetes team every 3months, with interim communication to address insulin dose adjustments. Despite increasing digital accessibility, there is limited data on whether provider-patient communication frequency is associated with glycemic control in pediatric diabetes. We assessed patterns of communication between diabetes clinic visits and whether communication frequency via electronic messaging (EM) and telephone was associated with glycemic control in pediatric diabetes. Retrospective chart review of 267 children with type 1 (T1DM) and type 2 diabetes (T2DM) over a 1-year period (July 2018-June 2019) at an urban academic pediatric diabetes center. Association between frequency of communication (via EM and telephone) and HbA1c was analyzed using regression analysis. Of 267 participants, 224 (84%) had T1DM, 43 (16%) had T2DM, mean age 11.6years (SD 4), mean duration of diabetes 3.5years (SD 3.4), and mean HbA1c 73.8±23mmol/mol (8.9±2.2%). Most participants (82%) communicated with their diabetes team at least once per year, with a mean number of overall communications of 10.3±13.6 times. Communications were via EM (48%), phone (40%), or both (53%). Participants with more frequent communication had lower HbA1c values (p=0.007), even when controlling for age, sex, provider, and number of clinic visits per year. We determined that a threshold of three communications per year was associated with a lower HbA1c (p=0.006). More frequent communication with the diabetes team between visits is associated with improved glycemic control. Initiatives to contact diabetes patients between clinic visits may impact their overall glycemic control.

Experience of point-of-care HbA1c testing in the English National Health Service Diabetes Prevention Programme: an observational study

IntroductionTo report the observations of point-of-care (POC) glycated hemoglobin (HbA1c) testing in people with non-diabetic hyperglycemia (NDH; HbA1c 42–47 mmol/mol (6.0%–6.4%)), applied in community settings, within the English National Health...

The importance of low HbA1c during childhood on glycaemic control in adulthood and the risk of late complications.

To evaluate whether a very low glycated haemoglobin A (HbA1c) (<48mmol/mol, 6.5%) during childhood compared to higher HbA1c values further decreases the risk for microvascular complications. Data were included from the 5116 patients with type 1 diabetes transferred from the Swedish paediatric diabetes quality registry to the Swedish National Diabetes Register (NDR), until 2014. All HbA1c values ever registered in the paediatric registry were used to divide patients into six groups based on the mean HbA1c. Values were compared with HbA1c registered in 2013 and 2014 in NDR, together with data on retinopathy, micro- and macroalbuminuria, age at onset and duration of diabetes. The group with lowest mean-HbA1c during childhood had also the lowest mean as young adults during 2013 and 2014. The most common complication as young adults was retinopathy. The proportion with macroalbuminuria was 3% in the lowest HbA1c group during childhood and 3.9% in the highest group, and lower in the groups in between. Microalbuminuria had the same pattern. Retinopathy increased with each HbA1c group. Children with the lowest HbA1c values had the lowest HbA1c values as adults. HbA1c was associated with retinopathy but the relationship with albuminuria was not obvious.

Relationship between previous HbA1c value and subsequent severe hypoglycaemia in patients with coronary artery disease and type 2 diabetes. Data from the DMP in North Rhine, Germany

Abstract Background and purpose Based on the documentation data of DMP type 2 diabetes in North Rhine from 2018, it was examined to what extent the HbA1c value from 2012 influenced the emergence of severe hypoglycaemia from 2013 in patients with coronary artery disease (CAD). Methods The predictors were determined in separate logistic regression models. The database was the last follow-up documentation of 2018. For all patients it was determined which HbA1c value was available in 2012 and whether severe hypoglycaemia has been documented for the first time since 2013. Results Within a group of a total of 98,950 patients, 2,520 new cases of severe hypoglycaemia have been documented since 2013. Treatment with insulin (odds ratio OR 7.00; 95-%-CI 5.80–8.44), HbA1c over 8.5% in 2012 (OR 1.66; 1.43–1.93), and the presence of diabetic complications (OR 1.37; 1.23–1.52) were the greatest risk factors, adjusted for age, gender, duration of DMP care and blood pressure. When the up to 70-year-old patients were analyzed separately, the two main predictors turned out to be somewhat weaker (insulin OR 5.40; 3.76–7.76; HbA1c &amp;gt;8.5% OR 1.61; 1.23–2, 11), on the other hand, they were somewhat more pronounced for patients over 70 years of age (insulin OR 7.58; 6.09–9.44; HbA1c &amp;gt;8.5% OR 1.72; 1.42–2.07). The influence of comorbidity was comparably high in both subgroups (≤70 years, OR 1.45; 1.16–1.79; &amp;gt;70 years OR 1.34; 1.19–1.51). Conclusion In patients with CAD and type 2 diabetes, the insulin prescription, a previously high HbA1c value and comorbidity are significant predictors for the later recurrence of severe hypoglycaemia; these influences are somewhat weaker in younger patients and somewhat more pronounced in older patients. A association between low HbA1c values and an increased risk of new onset of severe hypoglycaemia could not be demonstrated even in older patients with CAD and T2D. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Joint Establishment Disease Management Programs North Rhine