Mean Glycosylated Hemoglobin Level Research Articles

Feeding behavior pattern and glycosylated hemoglobin in people with type 2 diabetes at the beginning and end of an educational intervention

ObjectiveTo assess the changes in food consumption pattern and glycosylated hemoglobin levels in patients with type 2 diabetes after an educational intervention. Materials and methodsA descriptive study in people over 18 years of age with type 2 diabetes receiving the educational intervention provided by the health facilities of the Costa Rican Social Security. Sociodemographic, biochemical, and anthropometric variables were collected. Glycemic control was classified as good (≤7%), fair (7.1–8%), and poor (>8%). The usual daily diet record was used to assess the food consumption pattern based on the 11 criteria, divided into the following categories: poor compliance (0–3 criteria), fair compliance (4–7 criteria), and good compliance (8–11 criteria). Data collected were processed using SPSS version 16 software. A Student's t test was used for dependent samples. The impact of the educational intervention on metabolic control and food consumption pattern was determined using a McNemar test with a level of significance of 5% for hypothesis testing. ResultsThe study sample consisted of 702 patients with a mean age of 54.5±11.6 years, 73.8% females. Mean initial glycosylated hemoglobin level was 8.8±2.14%, while final level was 7.8±1.78% (p<0.05). Glycosylated hemoglobin levels less than 7% were found in 23.9% of the population at study start and in 41.3% at study end. As regard the food consumption pattern, the mean number of criteria met was 6±3 at study start and 9±2 at study end (p<0.000). Mean glycosylated hemoglobin level showed at the start of intervention a similar behavior in all 3 categories of the food consumption pattern, and at the end the changes in glycosylated hemoglobin in the poor and fair compliance categories were statistically significant (p<0.022 and p<0.000 respectively), unlike in the good compliance category (p<0.065). At the end of the intervention, of the 75.6% of the population with good compliance, 41.3% had good metabolic control (p<0.0001). The educational intervention was significant (p<0.000) using the McNemar test. ConclusionThe educational intervention approach to nutritional therapy had a positive impact on the food consumption pattern and glycosylated hemoglobin levels, showing that therapeutic education is part of the treatment of diabetes to achieve the objectives.

Prevalence, incidence and outcomes of diabetes in Ontario First Nations children: a longitudinal population-based cohort study.

First Nations people are known to have a higher risk of childhood-onset type 2 diabetes, yet population-level data about diabetes in First Nations children are unavailable. In a partnership between Chiefs of Ontario and academic researchers, we describe the epidemiologic features and outcomes of diabetes in First Nations children in Ontario. We created annual cohorts from 1995/96 to 2014/15 using data from the Registered Persons Database linked with the federal Indian Register. We used the Ontario Diabetes Database to identify children with all types of diabetes and calculated the prevalence and incidence for First Nations children and other children in Ontario. We describe glycemic control in First Nations children and other children in 2014. In 2014/15, there were 254 First Nations children and 10 144 other children with diagnosed diabetes in Ontario. From 1995/96 to 2014/15, the prevalence increased from 0.17 to 0.57 per 100 children, and the annual incidence increased from 37 to 94 per 100 000 per year among First Nations children. In 2014/15, the prevalence of diabetes was 0.62/100 among First Nations girls and 0.36/100 among other girls. The mean glycosylated hemoglobin level among First Nations children was 9.1% (standard deviation 2.7%) and for other children, 8.5% (standard deviation 2.1%). First Nations children have substantially higher rates of diabetes than non-Aboriginal children in Ontario; this is likely driven by an increased incidence of type 2 diabetes and increased risk for diabetes among First Nations girls. There is an urgent need for strategies to address modifiable factors associated with the risk of diabetes, improve access to culturally sensitive diabetes care and improve outcomes for First Nations children.

Comportamiento del patrón de alimentación y de la hemoglobina glicosilada en personas con diabetes tipo 2, al inicio y final de una intervención educativa

ObjectiveTo assess the changes in food consumption pattern and glycosylated hemoglobin levels in patients with type 2 diabetes after an educational intervention. Materials and methodsA descriptive study in people over 18 years of age with type 2 diabetes receiving the educational intervention provided by the health facilities of the Costa Rican Social Security. Sociodemographic, biochemical, and anthropometric variables were collected. Glycemic control was classified as good (≤7%), fair (7.1-8%), and poor (>8%). The usual daily diet record was used to assess the food consumption pattern based on the 11 criteria, divided into the following categories: poor compliance (0-3 criteria), fair compliance (4-7 criteria), and good compliance (8-11 criteria). Data collected were processed using SPSS version 16 software. A Student's t test was used for dependent samples. The impact of the educational intervention on metabolic control and food consumption pattern was determined using a McNemar test with a level of significance of 5% for hypothesis testing. ResultsThe study sample consisted of 702 patients with a mean age of 54.5±11.6 years, 73.8% females. Mean initial glycosylated hemoglobin level was 8.8±2.14%, while final level was 7.8±1.78% (P<.05). Glycosylated hemoglobin levels less than 7% were found in 23.9% of the population at study start and in 41.3% at study end. As regard the food consumption pattern, the mean number of criteria met was 6±3 at study start and 9±2 at study end (P<.000). Mean glycosylated hemoglobin level showed at the start of intervention a similar behavior in all 3 categories of the food consumption pattern, and at the end the changes in glycosylated hemoglobin in the poor and fair compliance categories were statistically significant (P<.022 and P<.000 respectively), unlike in the good compliance category (P<.065). At the end of the intervention, of the 75.6% of the population with good compliance, 41.3% had good metabolic control (P<.0001). The educational intervention was significant (P<.000) using the McNemar test. ConclusionThe educational intervention approach to nutritional therapy had a positive impact on the food consumption pattern and glycosylated hemoglobin levels, showing that therapeutic education is part of the treatment of diabetes to achieve the objectives.

How Adequate are Macro- and Micronutrient Intake in Pregnant Women with Diabetes Mellitus? A Study from South India.

Diabetes is the most common condition in pregnancy with a worldwide prevalence of 16.9%. To determine the adequacy of the nutrient intake of pregnant women with diabetes mellitus. This is a cross-sectional study of 85 pregnant women who met the diagnostic inclusion criteria for diabetes mellitus (gestational and pre-gestational diabetes mellitus) and who were being managed at the outpatient clinic of a tertiary care teaching hospital. Their demography, clinical characteristics (from updated medical records), anthropometric measures (using standard procedures), nutrient intake and meal pattern (obtained using 24h recall, food frequency and their log diaries) were collected. The mean age of the group was 29.9+4.5years, 54% were in the second trimester of pregnancy with a mean glycosylated haemoglobin level of 6.3+1.4%. The mean BMI indicated that 47% of them were in the obese grade 1 category. Insulin was used in one-third of the population. The overall macronutrient and micronutrient intakes of the population were below the recommended daily allowances for Indians (60-70% of RDA). There was a deficit in the intake of calories, fibre, proteins, iron, calcium, carotene, folic acid, thiamine, riboflavin and niacin. Between the two groups, the pre-GDM women had a significantly better nutrient intake and this could be attributed to a greater exposure to nutrition counselling that they have received during the earlier part of their diabetes care. The gestational period should be viewed as a window of opportunity to modify dietary patterns and introduce healthy lifestyle practices for the woman and her family.

Impact of postprandial hyperglycemia at clinic visits on the incidence of cardiovascular events and all-cause mortality in patients with type 2 diabetes.

Aims/IntroductionWe evaluated the impact of postprandial hyperglycemia at clinic visits on the incidence of cardiovascular diseases (CVD) and all‐cause mortality independently of mean glycosylated hemoglobin in type 2 diabetes patients in a real‐world setting.Materials and MethodsThe present retrospective observational cohort study included 646 type 2 diabetes patients. All of the participants had their initial consultations at the Institute for Diabetes Care and Research, Asahi Life Foundation affiliated Marunouchi Hospital, Tokyo, Japan, during the period from 1995 to 1996, visited the clinic ≥4 times, had their 2‐h post‐breakfast blood glucose (2h‐PBBG) levels measured and were followed up for ≥1 year. The 646 patients were followed up for survival. Of the 646 patients, 618 had no history of CVD at the first visit and had measured 2h‐PBBG until the first CVD onset or censorings. These two cohorts were followed up through June 2012, and subsequently questionnaires were mailed. Multivariate Cox proportional hazard models were used to evaluate the risk of CVD incidence and death.Results CVD occurred in 78 patients, and 56 patients died. The median follow‐up periods of the CVD cohort and the mortality cohort were 15.6 and 15.9 years, respectively. The mean 2h‐PBBG is a significant predictor of the CVD incidence and all‐cause mortality after adjusting for the mean glycosylated hemoglobin, the number of 2h‐PBBG measurements, age, sex and classical risk factors.ConclusionsPostprandial hyperglycemia represented by the mean level of 2h‐PBBG at clinic visits is associated with CVD incidence and all‐cause mortality independently of the mean glycosylated hemoglobin level in type 2 diabetes patients. Prospective interventional trials are warranted to confirm the present findings.

Effects of Rebamipide on Gastrointestinal Symptoms in Patients with Type 2 Diabetes Mellitus.

BackgroundGastrointestinal (GI) symptoms are common in patients with type 2 diabetes mellitus (T2DM). Rebamipide is an effective gastric cytoprotective agent, but there are few data on its usefulness in T2DM. The aim of this study is to evaluate the improvement of GI symptoms after rebamipide treatment in patients with T2DM.MethodsPatients with T2DM and atypical GI symptoms were enrolled. They took rebamipide (100 mg thrice daily) for 12 weeks and filled out the diabetes bowel symptom questionnaire (DBSQ) before and after rebamipide treatment. The DBSQ consisted of 10 questions assessing the severity of GI symptoms by a 1 to 6 scoring system. Changes in the DBSQ scores before and after rebamipide treatment were analyzed to evaluate any improvements of GI symptoms.ResultsA total of 107 patients were enrolled, and 84 patients completed the study. The mean age was 65.0±7.8, 26 patients were male (24.8%), the mean duration of T2DM was 14.71±9.12 years, and the mean glycosylated hemoglobin level was 6.97%±0.82%. The total DBSQ score was reduced significantly from 24.9±8.0 to 20.4±7.3 before and after rebamipide treatment (P<0.001). The DBSQ scores associated with reflux symptoms, indigestion, nausea or vomiting, abdominal bloating or distension, peptic ulcer, abdominal pain, and constipation were improved after rebamipide treatment (P<0.05). However, there were no significant changes in symptoms associated with irritable bowel syndrome, diarrhea, and anal incontinence. No severe adverse events were reported throughout the study.ConclusionRebamipide treatment for 12 weeks improved atypical GI symptoms in patients with T2DM.

Severe Hypoglycemia and Cardiovascular or All-Cause Mortality in Patients with Type 2 Diabetes.

BackgroundWe investigated the association between severe hypoglycemia (SH) and the risk of cardiovascular (CV) or all-cause mortality in patients with type 2 diabetes.MethodsThe study included 1,260 patients aged 25 to 75 years with type 2 diabetes from the Vincent Type 2 Diabetes Resgistry (VDR), who consecutively enrolled (n=1,260) from January 2000 to December 2010 and were followed up until May 2015 with a median follow-up time of 10.4 years. Primary outcomes were death from any cause or CV death. We investigated the association between the CV or all-cause mortality and various covariates using Cox proportional hazards regression analysis.ResultsAmong the 906 participants (71.9%) who completed follow-up, 85 patients (9.4%) had at least one episode of SH, and 86 patients (9.5%) died (9.1 per 1,000 patient-years). Patients who had died were older, had a longer duration of diabetes and hypertension, received more insulin, and had more diabetic microvascular complications at baseline, as compared with surviving patients. The experience of SH was significantly associated with an increased risk of all-cause mortality (hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.39 to 5.02; P=0.003) and CV mortality (HR, 6.34; 95% CI, 2.02 to 19.87; P=0.002) after adjusting for sex, age, diabetic duration, hypertension, mean glycosylated hemoglobin levels, diabetic nephropathy, lipid profiles, and insulin use.ConclusionWe found a strong association between SH and increased risk of all-cause and CV mortality in patients with type 2 diabetes.

Diverted sleeve gastrectomy with ileal transposition in overweight, obese, and morbidly obese patients with type 2 diabetes: results of 1-year follow-up

BackgroundBariatric surgery is an effective intervention for morbidly obese individuals, and it normalizes the level of glycemia in the majority of patients with type 2 diabetes mellitus (T2DM). ObjectivesThe primary aim of the study was to examine the efficacy of diverted sleeve gastrectomy with ileal transposition on weight loss and glycemic control in overweight, obese, and morbidly obese T2DM patients. The secondary aim was to examine the relationship between the effect of surgery and body mass index (BMI). SettingMetabolic surgery clinic. MethodsThis study was performed between October 2011 and August 2014, and mean duration of follow-up was 1 year. A total of 131 patients with T2DM were included. Ileal transposition with sleeve gastrectomy were performed in all patients. Each patient received a standard mixed meal tolerance test; plasma glucose, C-peptide, and insulin concentrations were measured before and 1 hour after the test. Postoperative alterations in BMI were noted. ResultsMean BMI decreased from 33.1±.5 to 23.5±.2 kg/m2 at 1 year, with the magnitude of weight loss correlating with baseline weight (P<.0001). There were marked decreases in fasting plasma glucose concentration and mean glycosylated hemoglobin levels at 1 year. Neither the decrease in fasting plasma glucose or glycosylated hemoglobin correlated with the decrease in weight. The homeostasis model assessment index decreased from 9.6±1.2 to 2.2±.2, P<.0001, and the Matsuda index for insulin sensitivity increased from 2.2±.2 to 7.8±.4, P<.0001. Despite the improvement in insulin sensitivity, surgery caused a 4-fold increase in insulin secretion (P<.01). ConclusionDiverted sleeve gastrectomy with ileal transposition is effective in glycemic control in patients with T2DM; however, this was not dependent on preoperative BMI values.

Pancreas Transplantation: Small-Center Experience in Type 1 Diabetes Mellitus in a High-Incidence Region

BackgroundPancreas transplantation (PT) is the best option of care for patients with type I diabetes mellitus (T1DM). MethodsFrom July 2005 to September 2014, we performed 27 PT from deceased donors (24 simultaneous pancreas-kidney transplantations [SPKT] and 3 pancreas transplantations alone) in a region with a high incidence of T1DM. ResultsEnteric drainage and systemic venous derivation were accomplished for all PT. Cold and warm ischemia times were 291 ± 70 minutes and 32 ± 9 minutes, respectively. The rate of early re-operations was 33%, mainly because of bleeding occurrence. Mean donor age was 31 ± 11 years; all patients had ABO compatibility and negative cross-match. With a mean follow-up time of 2.3 years, no death was registered. Graft survival of PT was 96.7%, with 1 graft loss in the SPKT group (3.7%) after acute rejection. Nine patients were submitted successfully to re-operation for no life-threatening complications within 30 post-operative days. No early or late episode of vascular thrombosis, pancreatitis, or pancreatic fistula was observed. All patients with a functioning graft had excellent metabolic control, with mean glycosylated hemoglobin level at last follow-up of 5.5% and median fasting glucose level of 95 ± 13 mg/dL, comparable to that in the non-diabetic population. ConclusionsIn our experience, PT is an excellent therapeutic solution for patients with T1DM. Despite fewer than 5 PT performed per year, graft and patient outcomes were similar to those in high-volume centers.

Impacts of the Great East Japan Earthquake on diabetic patients.

Aims/IntroductionWe investigated impacts of the Great East Japan Earthquake on diabetic patients and characterized those with disaster-susceptible diabetes.Materials and MethodsWe enrolled 497 diabetic patients who had been followed at hospitals in devastated areas. We collected metabolic parameters prospectively, 1 and 3 months after the earthquake, and retrospectively for pre-earthquake time-points. Questionnaire surveys were carried out regarding earthquake-related damage and post-earthquake lifestyle alterations. Available data were analyzed to examine associations with post-earthquake glycosylated hemoglobin alterations.ResultsThe mean glycosylated hemoglobin level of the participants was not elevated at 1 month, and was significantly decreased at 3 months as compared with the pre-earthquake glycosylated hemoglobin. There were no significant differences in earthquake-related damage or lifestyle alterations between the improved and worsened glycemic control groups according to the data obtained from the questionnaire survey. As reported, fasting serum C-peptide levels were significantly lower in the worsened glycemic control group (P < 0.05). Notably, plasma noradrenaline levels were significantly higher in the worsened glycemic control group (P < 0.05). Furthermore, at 1 month after the earthquake, the plasma noradrenaline level was significantly higher in the low C-peptide group (fasting serum C-peptide <1.0 ng/mL) than in the high C-peptide group (fasting serum C-peptide ≥1.0 ng/mL), but this difference had disappeared by 3 months after the earthquake. These findings show that post-earthquake plasma noradrenaline levels were temporarily increased in the low C-peptide group.ConclusionsSympathetic nerve activation might be elicited more easily in subjects with lower endogenous insulin secretory capacity, and could be involved in the mechanism underlying post-earthquake worsening of glycemic control.

Withdrawal of sulfonylureas from patients with type 2 diabetes receiving long-term sulfonylurea and insulin combination therapy results in deterioration of glycemic control: a randomized controlled trial.

BackgroundThe benefit of sulfonylureas (SUs) to patients with type 2 diabetes mellitus receiving long-term insulin treatment is unclear. This study evaluated glycemic control and beta-cell function after SU withdrawal in these patients.MethodsIn this 8-week randomized controlled study, patients with type 2 diabetes who had been treated with insulin for at least 3 years plus moderate to high doses of SUs were randomly assigned to withdrawal (n=16) or continuation (n=16) of SUs. Clinical characteristics, glycemic control, hypoglycemic events, and insulin secretion, including homeostasis model assessment of beta-cell function (HOMA-B) score, C-peptide concentration, and Matsuda index, were evaluated at baseline and after 2 and 8 weeks.ResultsThirty patients (16 in the SU withdrawal group and 14 in the SU continuation group) completed the study. Median duration of diabetes was 17 (range 5–40) years. Baseline clinical characteristics, glycemic control, and HOMA-B were similar in the two groups, but the mean fasting C-peptide concentration was higher in the SU withdrawal group. After 8 weeks, the SU withdrawal group showed a significant increase in mean glycosylated hemoglobin levels from 7.8%±0.5% (62±5 mmol/mol) to 8.6%±1.2% (71±13 mmol/mol; P=0.002), whereas the SU continuation group showed a slight but not significant increase from 7.7%±0.5% (61±5 mmol/mol) to 7.9%±1.2% (63±13 mmol/mol; P=0.37). Insulin secretion, as measured by C-peptide and HOMA-B, decreased by 18% and 36%, respectively, in the SU withdrawal group. Hypoglycemic events were significantly more frequent in the SU continuation group whereas body weight did not change significantly in either group.ConclusionWithdrawal of SU from patients with type 2 diabetes receiving long-term combination treatment with SU and insulin resulted in deterioration of glycemic control and insulin secretion.

Glycosylated hemoglobin levels and lipid profile in children with asthma using low dose and high dose inhaled corticosteroids

Objective: To compare the mean Glycosylated haemoglobin level and lipid profile of children using high dose ICS with that of children using low dose ICS. Study Population: Children between 1-12 years attending asthma clinic using high dose and low dose inhaled corticosteroids. HbA1c levels, Fasting blood sugar and Lipid profile of children in the two groups were measured Results: Children belonging to low dose ICS group were using a mean dose of 206.02 ± 67.13 micrograms per day and high dose group were using a mean dose of 444.61 ± 70.33 micrograms per day. The mean glycosylated haemoglobin level was 6.206 ±1.36% among children using low dose inhaled steroids and 6.013 ± 1.185% among children using high dose inhaled steroids. The mean fasting cholesterol was 180.39 ± 28.66 mg/dl in the low dose ICS group and 179.17 ± 30.21 mg/dl in the high dose ICS group. The mean high density lipoprotein levels were 50.8 3 ±11.05 mg/dl among children using low dose inhaled steroids and 53.37 ± 13.36 mg/dl among children using high dose inhaled steroids. The mean low density lipoprotein levels were 111.78 ± 25.39 mg/dl among children using low dose inhaled steroids and 108.01 ± 30.26 mg/dl among children using high dose inhaled steroids. Conclusions: There was no statistically significant difference between the glycosylated haemoglobin levels, fasting blood glucose levels and fasting lipid profile between children on low dose inhaled corticosteroids and high dose inhaled corticosteroids.

Short-Term Outcomes of Laparoscopic Single Anastomosis Gastric Bypass (LSAGB) for the Treatment of Type 2 Diabetes in Lower BMI (&lt;30 kg/m2) Patients

Bariatric surgery is an efficient procedure for remission of type 2 diabetes (T2DM) in morbid obesity. However, in Asian countries, mean body mass index (BMI) of T2DM patients is about 25 kg/m(2). Various data on patients undergoing gastric bypass surgery showed that control of T2DM after surgery occurs rapidly and somewhat independent to weight loss. We hypothesized that in non-obese patients with T2DM, the glycemic control would be achieved as a consequence of gastric bypass surgery. From September 2009, the 172 patients have had laparoscopic single anastomosis gastric bypass (LSAGB) surgery. Among them, 107 patients have been followed up more than 1 year. We analyzed the dataset of these patients. Values related to diabetes were measured before and 1, 2, and 3 years after the surgery. The mean BMI decreased during the first year after the surgery but plateaued after that. The mean glycosylated hemoglobin level decreased continuously. The mean fasting and postglucose loading plasma glucose level also decreased. After LSAGB surgery in non-obese T2DM patients, the control of T2DM was possible safely and effectively. However, longer follow-up with matched control group is essential.

P44 Does the slow-releasing hydrogen sulfide donor GYY4137 controls inflammation and pruritogen responses in mouse skin?

A growing body of evidence suggests that hydrogen sulphide (H2S) plays a crucial role in both physiological and pathophysiological process, including heart failure, inflammatory lung and articular diseases, erectile dysfunction, diabetes, among others. Poor diabetes control in women (mean glycosylated hemoglobin level The aim of this study is to determine the effectiveness of the slow H2S-releasing donor GYY4137 in reducing itch behaviour and cutaneous inflammation in mouse dorsal skin. The animal protocols were approved by the local ICB-USP Ethics Committee. In order to produce itching behaviour, male BALB/c mice (25–30 g) were anaesthetised with isoflurano and i.d. injected with histamine (1 μmol site−1) alone or co-injected with GYY4137 (0.3–30 nmol site−1; 0.05 ml). Itching behaviour was estimated by measuring the number of scratching bouts over a 40 min period. In a separate set of experiments, animals were pre-treated (−40 min) with the ATP-sensitive K+ (KATP) channel blocker glibenclamide, and then i.d. injected with histamine and Na2S (3 nmol site−1). In addition, we investigated the presence of mRNA for the enzymes cystathionine-β-synthase (CBS), cystathionine-γ-lyase (CSE) and 3-mercaptopyruvate sulfur transferase (3-MST) in the mouse naive skin via qualitative RT-PCR. Data are presented as mean ± SEM and were analyzed by ANOVA followed by the Dunnett test. Values of P The i.d. injection of histamine significantly increased the itching frequency as compared to its vehicle Tyrode. Increasing doses of GYY4137 (1–10 nmol site−1) dose-dependently reduced histamine-induced pruritus but failed to inhibit plasma extravasation evoked by histamine. Suppression of histamine-induced pruritus by the H2S donor was not reversed by glibenclamide. A marked mRNA expression for CBS and 3-MST, but not for CSE, was seen in the mouse naive skin. These findings indicate that low doses of GYY4137 in the skin decrease histamine-induced pruritus without affecting the associated local inflammation. This protective effect does not appear to be mediated by KATP channels activation. Financial support: FAPESP, CAPES and CNPq.

Abstract 3358: Sex Differences in Vascular Risk Factors in a Multi-ethnic, Medically Underserved Stroke Population

Background: Recent nationally representative studies of stroke patients have revealed that vascular risk factors are not as aggressively controlled in women compared to men. Medically underserved minority populations are at particularly high risk for poor control of vascular risk factors; however, little is known about sex differences in this population. Methods: Sex-specific vascular risk factors and admission medications were assessed for 440 consecutive ischemic stroke patients (39% female) admitted to a safety-net public hospital in Los Angeles County. Multivariate logistic regression was used to determine sex differences in vascular risk factors, adjusting for age and race. Results: The mean age was 58.9 (SE 10.6) years, 58% were Hispanic, 7% were white, 13% were black, 20% were Asian, and 1% were Native American. Stroke classification (using modified TOAST) revealed the following distribution: 35% small vessel, 20% large vessel, 7% cardioembolic, 23% cryptogenic, 13% &gt;1 possible etiology, and 3% other mechanisms (e.g. drug use). Women had higher mean glycosylated hemoglobin levels than men (8.0% vs 7.4%, p&lt;0.01) and were more likely than men to have a history of type 2 diabetes (49% vs. 40% male, p=0.04), systolic blood pressure &gt; 140 mm Hg (72% vs. 62%, p=0.03), total cholesterol &gt; 200 mg/dL (46% vs. 36%, p=0.04), and low HDL levels (&lt;40 mg/dL for men and &lt;50 mg/dL for women)(83% vs. 79%, p &lt;0.01). Men were more likely than women to have a previous history of stroke (19% vs. 13%, p = 0.05), smoking (49% vs 19%, p&lt;0.01), and alcohol abuse (28% vs. 7%, p&lt;0.01). After adjustment for race and age, women were more likely than men to have total cholesterol &gt; 200 mg/dL (OR 1.56, 95% CI 1.05-2.31), BMI ≥ 30 kg/m 2 (OR 1.55, 95% CI 1.03-2.34), systolic blood pressure &gt;140 mm Hg (OR 1.46, 95% CI 0.96-2.22), low HDL (1.26, 95% CI 0.76-2.08), and triglyceride level &gt; 150 mg/dL (OR 1.09, 95% CI 0.74-1.63); however, the latter 3 were not significant. After adjustment for race and age, men were more likely than women to have a history of smoking (OR 4.54, 95% CI 2.78-7.14) and alcohol abuse (OR 5.56, 95% CI 2.86-11.11). Conclusions: In this multi-ethnic population with inadequate access to care, women are more likely than men to have obesity, hypertension, and dyslipidemia while men are more likely than women to smoke or abuse alcohol. Larger studies are necessary to validate these findings. In the meantime, interventions aimed at reducing the incidence of metabolic syndrome components among women and smoking and alcohol abuse among men in underserved communities are likely warranted.

Accuracy of the Enlite 6-Day Glucose Sensor with Guardian and Veo Calibration Algorithms

This study investigates the accuracy of a newly developed, next-generation subcutaneous glucose sensor, evaluated for 6-day use. Seventy-nine subjects (53 men, 26 women) with type 1 diabetes and 18 subjects (14 men, four women) with type 2 diabetes completed a three-center, prospective, sensor accuracy study. The mean age for the group was 42.2±15.0 years (mean±SD), ranging from 18 to 71 years, with a mean glycosylated hemoglobin level of 7.6±1.5%, ranging from 5.5% to 14%. Subjects wore Enlite™ sensors (Medtronic Diabetes, Northridge, CA) in the abdominal and buttocks region for two separate 7-day periods and calibrated with a home-use blood glucose meter. Subjects participated in an in-clinic testing day where frequent sampled plasma glucose samples were acquired every 15 min for 10 h. Sensor data was retrospectively processed with Guardian(®) REAL-Time (Medtronic) and Paradigm(®) Veo™ (Medtronic) calibration routines, and accuracy metrics were calculated for each algorithm and sensor location. Physiological time lag for each measurement site was calculated. Based on 6,404 plasma-sensor glucose paired points, the Enlite sensor with Veo calibration algorithm produced a mean absolute relative difference of 13.86% with 97.3% of points within the A+B zones of the Clarke error grid. Threshold-only alarms detected 90.1% of hypoglycemia and 90% of hyperglycemia. Mean time lag measured at the abdominal region was 7.94±6.48 min compared with 11.70±6.71 min (P<0.0001) at the buttocks area. The Enlite sensor accurately measures glucose when compared with gold standard laboratory measurements over its 6-day use. Sensors placed in the buttocks region exhibited greater time lags than sensors placed in the abdomen.

Retinal Video Recording: A New Way to Image and Diagnose Diabetic Retinopathy

To validate the use of retinal video recording for diabetic retinopathy screening by comparing with standard retinal photography and slit-lamp examination. Evaluation of a new diagnostic technique. One hundred patients. All fundus images were captured using standard retinal still photography (FF 450 plus; Carl Zeiss) and retinal video (EyeScan; Ophthalmic Imaging System, Sacramento, CA), followed by a gold standard slit-lamp biomicroscopy examination. All videos and still images were de-identified, randomized, and interpreted by 2 senior consultant ophthalmologists (M.L.T-K. and L.L.). Kappa statistics, sensitivity, and specificity for all the diabetic retinopathy signs and grades were calculated with reference to slit-lamp examination results as the gold standard. Sensitivity and specificity of video recording for detecting diabetic retinopathy signs and grades. The mean age (± standard deviation [SD]) of participants was 52.8 ± 15.1 years, mean duration of diabetes (± SD) was 13.7 ± 9.7 years, and the mean glycosylated hemoglobin level was 8.0 ± 1.7%. Compared with the gold standard slit-lamp examination results, the sensitivity and specificity of video recording for detecting the presence of any diabetic retinopathy was 93.8% and 99.2%, respectively (ophthalmologist 1), and 93.3% and 95.2%, respectively (ophthalmologist 2). In contrast, the sensitivity and specificity of retinal photography was 91.8% and 98.4%, respectively (ophthalmologist 1), and 92.1% and 96.8%, respectively (ophthalmologist 2), for detection of any diabetic retinopathy. Both imaging methods had 100% sensitivity and specificity in detecting sight-threatening diabetic retinopathy. For overall diabetic retinopathy grading by both ophthalmologists, the measurements of agreement (Cohen's κ coefficient) between the overall grading obtained from the retinal video versus slit-lamp examination and retinal photography versus slit-lamp examination were more than 0.90. Technical failure rate for retinal video recording and retinal photography were 7.0% and 5.5%, respectively. This study demonstrated that retinal video recording was equally as effective as retinal photography in the subjects evaluated in this study. It is a novel alternative diabetic retinopathy screening technique that not only offers primary eye care providers the opportunity to view numerous retinal fields within a short period but also is easy to learn by nonexperienced personnel with minimal training. Proprietary or commercial disclosure may be found after the references.

Alogliptin

Alogliptin (Nesina®) is a dipeptidyl peptidase-4 inhibitor that is approved in Japan for the treatment of adult patients with type 2 diabetes mellitus that is inadequately controlled by diet and exercise alone or by diet plus treatment with an α-glucosidase inhibitor. Alogliptin plus diet and exercise is also approved in Japan for use in combination with a thiazolidinedione in patients with type 2 diabetes. In several large (n >250), double-blind, multinational trials of up to 26 weeks' duration, oral alogliptin as monotherapy or in combination with other oral antihyperglycaemic agents (metformin, glibenclamide or pioglitazone) or insulin therapy improved glycaemic control and was generally well tolerated in adult patients with inadequately controlled type 2 diabetes, including elderly patients. Significant improvements in glycaemic control were evident from as early as 1 week in terms of improvements in mean fasting plasma glucose levels and from 4 weeks onwards for improvements in mean glycosylated haemoglobin levels. In general, the incidence of hypoglycaemia was similar to that seen in placebo groups and alogliptin treatment had neutral effects on bodyweight and lipid parameters. The long-term safety of alogliptin therapy remains to be established in clinical studies and with clinical experience. A planned clinical trial evaluating long-term clinical outcomes in patients with acute coronary syndrome and other planned or ongoing short-term trials will help to more definitively determine the position of alogliptin therapy in relation to other available antihyperglycaemic therapies. In the meantime, alogliptin is a promising new option for the treatment of patients with type 2 diabetes, including elderly patients.

Delayed Radionucleotide Gastric Emptying Studies Predict Morbidity in Diabetics With Symptoms of Gastroparesis

The aim of this study was to evaluate the prognostic value of gastric emptying studies on the morbidity associated with diabetic gastroparesis. This was a parallel cohort study of 3 groups. Group A (n = 94) contained diabetic patients (type 1 and type 2) with classic symptoms of gastroparesis (including early satiety, postprandial fullness, bloating, abdominal swelling, nausea, vomiting, and retching) and delay in radionucleotide gastric emptying study. Group B (n = 94) contained diabetic subjects with classic symptoms of gastroparesis but negative scintigraphy. Group C (n = 94) contained diabetic subjects without symptoms of gastroparesis. Data were gathered on the number of days hospitalized and hospitalizations, office visits, emergency department visits, death rate, glycosylated hemoglobin levels, medications, and past medical history. Group A had significantly more hospital days per 1000 patient days (25.5) than both group B (5.1; P < .01) and group C (2.3; P < .01). Group A also had significantly more hospitalizations, office visits, and emergency department visits than both group B and group C. Deaths and mean glycosylated hemoglobin levels did not differ between the groups. Patients in group A were more likely to have cardiovascular disease (19.2% vs 6.4%, A vs C; P < .05), hypertension (63% vs 43%, A vs C; P = .005), and retinopathy (33% vs 11.7%, A vs C; P < .001). A delayed radionucleotide gastric emptying study predicts negative health outcomes in diabetic patients with symptoms of gastroparesis. We identified a correlation between diabetic gastroparesis and cardiovascular disease, hypertension, and retinopathy that may indicate an underlying vascular etiology.

Depression, diabetes, and glycemic control in an American Indian community.

American Indians have a high prevalence of diabetes and its complications, and so it may be clinically important to identify psychiatric risk factors for the development of diabetes and its complications in this population. The objectives of this cross-sectional study were (1) to determine whether depression and diabetes are associated in the Pima Indians and (2) to determine if depression is associated with variables indicating risk for development of diabetes or diabetic complications. Adults (aged >or= 18 years) who attended research examinations in the Gila River Indian Community in Arizona from July 2003 through January 2007 were included. A sample of 2902 individuals (1121 with diabetes, 1781 without diabetes) was evaluated with the depression module of the Patient Health Questionnaire (DSM-IV criteria), physical examination, and laboratory tests. The prevalence of depression was slightly, but not significantly, higher among participants with diabetes than those without diabetes (12.8% vs. 9.4%, p = .053). Among participants with diabetes, mean glycosylated hemoglobin levels were significantly higher among depressed individuals than among those who were not depressed (9.0% vs. 8.4%, p = .02), even when controlling for age, sex, duration of diabetes, and body mass index (p = .03). In participants without diabetes, mean glycosylated hemoglobin levels were similar among depressed and nondepressed participants (5.4% vs. 5.4%, p = .24). Overall, participants with diabetes had a slightly, but not significantly, higher prevalence of depression than those without diabetes. Among those with diabetes, depression was associated with worse glycemic control. Treatment of depression in Pima Indians with diabetes may improve glycemic control and thereby reduce the risk of diabetic complications.