Mean HbA1c Of Patients Research Articles

Abstract 110: Prevalence of asymptomatic bacteriuria in patients with type 2 diabetes mellitus

Introduction: A Recent meta-analysis showed higher prevalence of asymptomatic bacteriuria (ASB) in diabetics compared to healthy controls (12.2% vs 4.5%). Especially women with type 2 diabetes mellitus (T2DM) are prone to develop asymptomatic bacteriuria. A recent study done in northern India estimated the prevalence of ASB as 17.5% in diabetics. In addition, an association between poor glycemic control and higher prevalence of ASB has been reported.Materials and Methods: This is a retrospective cross-sectional study including 2843 patients with T2DM who had visited Endocrinology out-patient services from June 2018 to May 2020 and underwent diabetic medical health check which includes urine chemistry and microscopy.Results: A total of 11.3% (322/2843) of patients were found to have ASB with a higher prevalence among women than men (20% vs 6.9%, p<0.0001). The mean HbA1c of patients with ASB was significantly higher than those without ASB in the total study population (8.64 vs 8.23%, p= 0.003), men (9.02 vs 8.28%; p= 0.0001) but not in women (8.38 vs 8.12%; p=0.168).Conclusion: Prevalence of ASB was higher in women than men with T2DM. However, the association of ASB with poor glycemic control was observed only men with T2DM.

Relationship of Central Corneal Thickness with the Status of Diabetic Retinopathy and Level of HbA1C in Diabetic Patients

Study Objectives: To determine the relationship of central corneal thickness with the status of diabetic retinopathy and level of HbA1c in diabetic patients. Study Design and Settings: Department of Ophthalmology, Allied Hospital/DHQ Hospital, Faisalabad Pakistan from Jan 2021 to June 2021. Patients and Methods: Out of the patients visiting OPD, 100 patients with clinically diagnosed type 2 DM which satisfied the range of selected standards and offered written informed agreement were involved in the research with the use of simple random sampling. Snellen’s visual acuity chart for distance vision and Jaeger’s chart for near vision were used to determine the best-corrected visual acuity. Wet Refraction and axial length was measured using A-scan. Goldmann applanation tonometry was used to measure the intraocular pressure. Results of the Study: In this research sixty two percent of the patients were men and thirty eight percent patients were women. Total 84 patients had type 2 DM of duration 5-10 years, and the remaining 16 patients had diabetes for over 10 years. Total 35 patients had HbA1c between 4-5.6%, 31 patients had HbA1c between 5.7- 6.5% and 34 patients had HbA1c ≥ 6.5%. From 100 patients with Diabetes Mellitus Type 2, 21 patients had no diabetic retinopathy, 28 patients had very minor and minor NPDR, 25 patients had average NPDR, 19 patients had critical and very acute NPDR and 7 patients had PDR. The mean HbA1c in patients with no diabetic retinopathy was 5.05%. The mean HbA1c in patients having minor and very little NPDR remained 5.64%. The mean HbA1c in patients with moderate NPDR was 6.36%. The mean HbA1c in patients with critical and very acute NPDR was 8.26%. The mean HbA1c in patients with severe PDR was 9.86%. This was a statistically significant survey (P-value = 0.01). Conclusion: This study showed a strong correlation between the central corneal thickness to the severity of diabetic retinopathy and HbA1c levels emphasizes the importance of evaluation of corneal endothelial morphology in the early screening and diagnosis of microvascular complications of DM Keywords: Central Corneal Thickness, Diabetic Retinopathy, HbA1c

929-P: A Population-Based Study of Long-Term HbA1c Associated with Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Western Australian Children

Background: In addition to the acute illness associated with DKA at diagnosis of T1D in children, there is some evidence of its association with poor long-term glycaemic outcomes, increasing risk of complications. With growing global interest in screening for pre-diabetes in children, long-term outcomes are an important consideration in terms of economic viability but there is limited high quality data. This population-based study helps to address this gap. Methods: All children &amp;lt;16 years presenting to Perth Children’s Hospital with new onset T1D 2000-2019 were included and followed up for ≤ 14 years. Moderate-severe DKA at diagnosis was defined as serum pH &amp;lt;7.2 or bicarb &amp;lt;15mmol/l in the presence of hyperglycaemia and ketosis. HbA1c was recorded at each clinic visit, ~3 monthly from diagnosis. A linear mixed model, adjusted for sex, diagnosis age, socioeconomic status and metro/regional area of residence, was used to examine long-term HbA1c associated with DKA at diagnosis at each year of duration. Results: The population-based cohort included 2063 patients and median [IQR] follow-up time was 5.4 [3.0-8.4] years. The incidence of DKA at diagnosis was 25%. Patients presenting with DKA had a higher mean HbA1c at diagnosis as expected but from 2 to 7 years post-diagnosis there was no difference between the two groups. Mean HbA1c of patients presenting with DKA increased relative to the remainder from 7 years. The only comparable study, conducted in Colorado in 2017, reported an immediate and sustained relationship between DKA severity at onset and HbA1c over 15 years. Conclusion: The difference in findings for similar cohorts in Australia and the US raises questions regarding the variables that influence long-term glycaemic outcomes in children diagnosed with T1D. Further studies are required to explore the association between DKA at diagnosis and HbA1c over time and to understand the importance of sociodemographic, physiological and other factors. Disclosure H. Clapin: None. G. J. Smith: None. S. Vijayanand: None. T. Jones: None. E. A. Davis: None. A. Haynes: None.

Outpatient Diabetic Outcome During the Covid-19 Pandemic: A Retrospective Single Center Analysis

Background: Previous studies have shown that telemedicine is an effective alternative method for health care delivery. The COVID-19 pandemic has acutely stimulated expansion of telemedicine across the country. This study aimed to determine characteristics of telehealth visit and short term HbA1c outcome in patients with diabetes mellitus in endocrinology clinic during the COVID-19 pandemic. Methods: A single center retrospective chart review was conducted in all patients seen in endocrinology clinic for diabetes mellitus between 5/27/2020–7/20/2020. Data were extracted from electronic medical record. The primary research question is percentage of patients who achieved HbA1C ≤ 8% at 3 month follow up. Secondary research questions are characteristic of patients and clinic visits, diabetic technology usage, 3 month follow up mean HbA1c and HbA1c change. This project was approved by the institutional review boards. Results: Two hundred and six diabetic patients were seen: 72 (35%) in person, 49 (24%) phone visit, and 85 (41%) VDO visit. Mean age for patients adopted in person visit was 57 (SD 15) years, phone visit was 68 (SD 13) years and VDO visit was 54 (SD 18) years, p <0.001. Male percentage for in person, phone and VDO visit was 44%, 59% and 61% respectively, p 0.09. New consult visit percentage for in person, phone and VDO visit was 7%, 2% and 5% respectively, p 0.46. Percentage of patients using insulin pump or continuous glucose monitoring for in person, phone and VDO visit was 33%, 43% and 54%, respectively, p 0.03. Baseline HbA1c was done in 89% (64/72) in person, 45% (22/49) phone and 52% (44/85) VDO visit. Among patients who had baseline HbA1c, average HbA1c was 8.6% (SD 1.8) for in person visit, 8.0% (SD 1.1) for phone visit and 8.1% (SD 1.8) for VDO visit, p 0.25. At 3 months, HbA1c was done in 38% of patients who had in person visit, 36% phone visit, and 43% VDO visit. Among patients who had 3 month follow up HbA1c, HbA1c ≤ 8% was achieved in 50%, 61% and 69% for in person, phone and VDO respectively, p 0.56. Mean 3 month follow up HbA1c was 8.1% (SD 1.3), 7.7% (SD 0.9) and 7.8% (SD 1.6) for in-person, phone and VDO visit respectively, p 0.47. Comparing mean HbA1c in patients who had both baseline and 3 month follow up HbA1c, changes were significant for in person visit 9.1% to 8.1% (p 0.01) and VDO visit 8.7% to 7.6% (p 0.01). No significant change in 3 month follow up HbA1c was observed in phone visit, 7.7% to 7.6% (p 0.88). Conclusions: This retrospective study showed that during the COVID-19 pandemic, no differences in short term HbA1c outcome (3 month follow up mean HbA1c and percentage of patients who achieved HbA1c ≤ 8%) were observed among patients who adopted in-person and telehealth visit. Patients who adopted phone visit appeared to be older; and there was more diabetic technology usage (insulin pump or continuous glucose monitoring) among patients who adopted telehealth (phone and VDO) compared to in person visit.

Prevalence of Thyroid Disorders in Patients with Type 2 Diabetes Mellitus

Background and Objectives: Thyroid disorders are very common in the general population, and it is second only to diabetes as the most common condition to affect the endocrine system. In this study, we try to observe the prevalence of the type of thyroid dysfunction in patients with type 2 diabetes mellitus (T2DM). and its effect on glycemic parameters and the prevalence of autoimmune thyroid disorder in patients with T2DM. Settings and Design: This study included adults having T2DM. Patients were explained about the nature of the study and consent was obtained. Materials and Methods: Clearance was taken from the ethics committee. All participants who met the inclusion criteria were subjected to detailed clinical examination and relevant investigation. Statistical Analysis: Chi-square test was used for the analysis. Results: Two hundred and thirty-four patients (112 males and 122 females) were included in the study. The mean body mass index was high (26.21 ± 3.13 kg/m2). The mean hemoglobin (Hb) A1c was 8.81% ± 1.96%, whereas mean HbA1c in patients with both T2DM and thyroid dysfunction was 9.68% ± 1.35%. Thyroid dysfunction was found in 84 cases (35.8%), out of which the most common thyroid abnormality was overt hypothyroidism (61.9%) followed by subclinical hypothyroidism (27.3%). Out of 84 cases with thyroid dysfunction anti-thyroid peroxidase (TPO) was found positive in 45 cases (53.5%), and the most common thyroid dysfunction associated with positive anti-TPO was subclinical hypothyroidism (44%). Conclusions: The study shows a high prevalence of thyroid dysfunction among patients with T2DM and its association with poor glycemic control. The study also shows the prevalence of anti-TPO among patients and its significant correlation with thyroid dysfunction.

19-OR: Glycemic Control Differences between Individuals with Accurately and Inaccurately Provider-Perceived Literacy and Numeracy

Little is known about provider accuracy in assessing health literacy and numeracy of individuals with diabetes and the effect of incorrect assessment on patient outcomes. We conducted a clinic-based study (121 patients, 12 providers) to explore whether there was a discrepancy between patient-actual and provider-perceived literacy and numeracy levels among those (≥18yrs) with type 1 (n=59), type 2 (n=57), and unknown (n=5) diabetes, and to test whether this discrepancy was associated with worse HbA1c. We used multiple linear regression to compare mean HbA1c of patients whose providers overestimated, underestimated, and correctly estimated literacy and numeracy. Literacy was assessed by The Rapid Estimate of Adult Literacy in Medicine-Short Form and numeracy by the Diabetes Numeracy Test. Based on a directed acyclic graph and comparison of precision and bias of multiple models, the final models were adjusted for insurance (public/private), race (white/other), and education (≤high school/≥some undergraduate/≥some postgraduate). Providers incorrectly identified 33.3% of patients’ literacy and 55.5% of numeracy. Providers overestimated 15.7% of patients’ literacy and 47.1% of numeracy. Providers underestimated 2.5% of literacy and 15.7% of numeracy. Mean Hb1Ac was 8.1%. Patients whose provider incorrectly perceived their literacy and numeracy score had, respectively, an HbA1c that was on average 0.9% (p=0.01) and 0.6% (p=0.05) higher than those whose scores were correctly perceived. Further, patients with overestimated numeracy had a 0.9% higher HbA1c than those whose high numeracy was correctly identified (p=0.001). These findings suggest providers might benefit from accurate knowledge of patients’ numeracy and literacy so that appropriate information can be communicated. Future research is needed to test effects of changing provider communication to minimize overestimation of patient numeracy and literacy levels. Disclosure R. Logendran: None. A. Cristello: None. J. DuBois: None. B.S. Friedman: None. E.J. Mayer-Davis: None.

Management of diabetes during Ramadan fasting: applications of international recommendations in clinical practice

Le jeûne n’est pas sans risques chez les patients diabétiques. L’objectif de notre étude est d’évaluer l’impact du jeûne chez une cohorte de patients diabétiques ayant bénéficié d’une préparation au jeûne avec ajustement des traitements selon les recommandations de l’association américaine du diabète (ADA) en 2010. Il s’agit d’une étude prospective de cohorte menée en 2014, incluant des patients diabétiques désirants jeûneer au cours du mois de Ramadan consentant pour participer à l’étude. Nous avons exclu les patients considérés comme à très haut risque selon la classification de l’ADA. Les patients ont bénéficié d’une consultation avant le mois du Ramadan (J0) comprenant éducation et ajustement du traitement, suivi d’une consultation au cours du Ramadan (J7) puis à J30 et à J60. Notre étude a inclus 34 patients, dont 60% sont des femmes, d’âge moyen de 50,4 ans avec une ancienneté moyenne du diabète de 6,2 ans et un index de masse corporelle (IMC) moyen de 27,83 kg/m2. Les ajustements thérapeutiques réalisés (J0) étaient une diminution de la dose de sulfamides hypoglycémiants (SH) et la mise sous gliptine chez les patients à risque hypoglycémique, ainsi qu’une répartition de la dose de metformine. Au cours de la première semaine (J7), deux patients ont présenté une glycémie inférieure à 0,7g/l avant la rupture du jeûne, 38% de l’échantillon ont présenté une glycémie >2g/l après la rupture du jeûne. Nous avons noté des erreurs diététiques chez 15% des patients. L’ajustement à (J7) a consisté à adapter la dose du SH ou à ajouter une gliptine. Aucun patient n’a présenté d’hyperglycémie majeure, de cétose ou d’hypoglycémie grave. Une patiente a présenté une arythmie complète par fibrillation atriale (ACFA) sur cardiopathie ischémique méconnu avec arrêt du jeûne. Trois patients ont arrêté le jeûne entre J15 et J20 devant une asthénie intense sans déséquilibre glycémique. La moyenne d’HBA1C chez les patients après le jeûne était de 7,10 versus 6,8% avant le jeûne (p=0.42). Les facteurs significativement associés au déséquilibre glycémique après le jeûne avec des HBA1C > à 8% étaient principalement les taux d’HBA1C de départ (p=0.002), l’absence d’autosurveillance (p=0.01), et l’ancienneté du diabète (p=0.06). Une bonne évaluation du niveau de risque du patient, une éducation thérapeutique, une autosurveillance glycémique et un ajustement du traitement selon les recommandations internationales, permettent aux patients diabétiques musulmans de diminuer le risque lié au jeûne. Néanmoins une consultation au cours du Ramadan (J7) permet une correction des erreurs diététiques et un ajustement thérapeutique si cela est nécessaire.

A Study of Prevalence of Thyroid Disorders in Patients with Type 2 Diabetes Mellitus

Context: Thyroid disorders are very common in the general population and it is second only to diabetes as the most common condition to affect the endocrine system. In this study we try to observe the prevalence of type of thyroid dysfunction in patients with T2DM. Aims: Prevalence of thyroid dysfunction in patients with T2DM and its effect on glycemic parameters. Prevalence of autoimmune thyroid disorder in patients with T2DM. Settings and Design: This study included adults having Type 2 DM. Patients were explained about the nature of study and consent was taken. Methods and Material: Clearance was taken from the ethics committee. All participants who met the inclusion criteria were subjected to detailed clinical examination and relevant investigation. Statistical analysis: Chi-square test Results: 234 patients, 112 male and 122 female were included in the study. The mean BMI was high (26.21 ± 3.13 kg/m2). The mean HbA1c was 8.81 ± 1.96%, while mean HbA1c in patients with both T2DM and thyroid dysfunction was 9.68±1.35%. Thyroid dysfunction was found in 84 cases (35.8%) out of which most common thyroid abnormality was Overt Hypothyroidism (61.9%) followed by Sub-clinical hypothyroidism (27.3%). Out of 84 cases with thyroid dysfunction Anti-TPO was found positive in 45 cases (53.5%) and the most common thyroid dysfunction associated with positive Anti-TPO was subclinical hypothyroidism (44%). Conclusion: The study shows high prevalence of thyroid dysfunction among patients with T2DM and its association with poor glycemic control. The study also shows the prevalence of Anti-TPO among patients and its significant correlation with thyroid dysfunction.

Relationship between Hemoglobin A1c Level and Severity of Coronary Artery Disease Among The Hospitalized Patients with Acute Coronary Syndrome

Background : Diabetes mellitus is one of the important risk factors for coronary artery disease. The hemoglobin A1c is used for evaluating glycemic control in diabetic patients. Here, we conducted the study to evaluate the relationship between HbA1c level and severity of coronary artery disease among the hospitalized patients with ACS.&#x0D; Materials &amp; Methods : This cross sectional study was conducted in the department of Cardiology, Ibrahim Cardiac Hospital &amp; Research Institute, Dhaka, Bangladesh from September 2015 to December 2015. Total of one hundred patients were studied and they were grouped on the basis of their glycaemic status. One hundred patients with acute coronary syndrome were enrolled in this study. Out of them fifty were diabetic (HbA1c&gt;6.5%) and rest of were nondiabetics (HbA1c&lt;6.5%) ( group-A and B).&#x0D; Results: Out of one hundred patients fifty eight were male and fourty two were female. Mean age of patients in group-A was 58.54±10.22 years and mean age of patients in group-B was 54.52±13.69 years. Mean age of male and female was 57.72±11.48 years and 54.0±13.08 years respectively. Mean HbA1c of patients in group-A was 11.43±1.43% and group-B was 6.34±0.915%. 38% of group-A and 22% of group-B had triple vessel disease, 26% of group-A and 20% of group- B had double vessel disease and 28% of group-A and 18% of group-B had single vessel disease, and 8% of group-A and 40% of group-B had normal coronary arteries. 48% patients of age group 46-50 in group-A had more incidence in coronary artery disease than other age group which was statistically significant ( p=0.035). 61-75 years age group in group-B patients had coronary artery disease than other age groups which was statistically not significant(p=0.084). Patients of group-A was significantly relation with coronary artery disease (p&gt;.001) and six times greater coronary artery disease than patients of group-B (OR= 6.15, 95% CI for OR =2.074 -18.289).&#x0D; Conclusions: In this way the importance of appropriate glycaemic control has been emphasized in diabetic patients. This study showed the relation between HbA1c levels and the severity of CAD in patient with type-II diabetes mellitus .Our findings demonstrate that elevated HbA1c level was risk factor for severity of coronary artery disease in ACS patients.&#x0D; Bangladesh Heart Journal 2018; 33(2) : 80-84

Visit-to-visit HbA1c variability is inversely related to baroreflex sensitivity independently of HbA1c value in type 2 diabetes

BackgroundThe relationship between long-term glycemic variability (GV) represented by visit-to-visit HbA1c variability and baroreflex sensitivity (BRS) in type 2 diabetes mellitus (T2DM) has not been clarified by previous literature. The present study is the first to examine the relationships between visit-to-visit HbA1c variability and BRS.MethodsThis retrospective study initially analyzed data on 94 patients with T2DM. Visit-to-visit HbA1c variability was evaluated using the intrapersonal coefficient of variation (CV), standard deviation (SD), and adjusted SD of 8 or more serial measurements of HbA1c during a 2-year period. The BRS was analyzed using the sequence method. Short-term GV was assessed by measuring the glucose CV during 24-h continuous glucose monitoring (CGM). The primary objective was to determine if there was a relationship between visit-to-visit HbA1c variability (HbA1c CV) and BRS. Secondary objectives were to examine the relationship between other variables and BRS and the respective and combined effects of long-term GV (HbA1c CV) and short-term GV (CGM CV) on BRS.ResultsA total of 57 patients (mean age 67.2 ± 7.7 years, mean HbA1c 7.3 ± 1.0%) who met this study’s inclusion criteria were finally analyzed. In the univariate analysis, HbA1c CV (r = − 0.354, p = 0.007), HbA1c SD (r = − 0.384, p = 0.003), and adjusted HbA1c SD (r = − 0.391, p = 0.003) were significantly related to low levels of BRS. Multiple regression analysis showed that HbA1c CV, HbA1c SD, and adjusted HbA1c SD were inversely related to BRS. Furthermore, although the increase in either long-term GV (HbA1c CV) or short-term GV (CGM CV) as determined by 24-h CGM was inversely correlated with BRS, additional reductions in BRS were not shown in participants with both HbA1c CV and CGM CV values above the median.ConclusionsVisit-to-visit HbA1c variability was inversely related to BRS independently of the mean HbA1c in patients with T2DM. Therefore, visit-to-visit HbA1c variability might be a marker of reduced BRS in T2DM.

Temporal Change in Profile of Association between Diabetes, Obesity, and Age of Onset in Urban India: A Brief Report and Review of Literature.

Context:Indian population is known to develop diabetes at lower body mass index (BMI) and younger age than their western counterparts. However, data on the prevalence of overweight/obesity in people with diabetes have not been well documented in the Indian literature. The current study also establishes time trends for the age of onset of diabetes mellitus type 2 in Urban India.Aims:The aim of this study was to analyze the current trend in the presentation of people with diabetes in a metropolitan city (Urban residents) in context to age, sex, and BMI.Settings and Design:Retrospective cross-sectional study.Subjects and Methods:Data captured in clinic electronic medical records from May 2015 to March 2017 are analyzed. The profile of newly diagnosed diabetes is also presented.Statistical Analysis Used:Data were analyzed descriptively and for statistical analysis, SPSS software was used.Results:A total of 1473 patients with age 52.6 ± 12.7 (mean ± standard deviation) and BMI of 27.86 ± 4.83 kg/m2 were analyzed. About 17.6% were overweight; 71.5% were obese. The significant higher proportion of females was overweight/obese (91.2% vs. 82% of males; P < 0.0001). Females had significantly higher mean BMI than males (29.19 ± 4.99 vs. 26.93 ± 4.83; P ≤ 0.001). Overall, mean HbA1c of patients was 7.84% ±1.61% with no significant difference between genders. However, there was no difference in mean HbA1c based on either gender or BMI category. Among people with new-onset diabetes, there was even higher proportion of people with BMI ≥23 kg/m2 (overall 89.1%, males 87.6%, and females 91.6%). About 43.8% of people presented at <40 years age. Totally, 49.5% of males presented at age <40 years as compared to 33.9% of females.Conclusions:The prevalence of obesity among people with diabetes in Indian setting is now as high as in western studies. Indians are now presenting with diabetes at even earlier age with higher BMI.

Macular changes in diabetic patients using optical coherence tomography and fundus photography

Aim: To identify and compare macular changes in patients with diabetic mellitus (DM) using optical coherence tomography (OCT) and fundus photography (FP). Setting and Design: This prospective comparative study was conducted at a tertiary care center. Materials and Methods: We examined 200 eyes of 107 diabetic patients with slit-lamp biomicroscopy, color FP using TOPCON fundus camera, and cirrus OCT. Fasting blood sugar (FBS), postprandial blood sugar (PPBS), and hemoglobin A1c (HbA1c) were measured. The clinical diabetic retinopathy (DR) and OCT findings were compared. Statistical Analysis: SPSS version 20, using Pearson’s Chi-square test, Student’s t-test, and analysis of variance. Results: Mean age of patients was 53.59 ± 10.8 years, with 68.2% males. Only six (5.5%) patients had type 1 DM. Mean FBS, PPBS, and HbA1c were 137.08 ± 34.4 mg/dL, 218.13 ± 70.5 mg/dL, and 6.65% ± 2.8%, respectively. The mean HbA1c of patients with OCT changes (7.08% ± 2.9%) was higher than those with normal OCT (5.52 ± 2.18) (P value

Exenatide treatment causes suppression of serum fasting ghrelin levels in patients with type 2 diabetes mellitus.

AimIn the present study, we investigated the long-term effects of exenatide treatment on serum fasting ghrelin levels in patients with type 2 diabetes mellitus.MethodsType 2 diabetic patients, who were using metformin with and without the other antihyperglycemic drugs on a stable dose for at least 3 months, were enrolled in the study. BMI>35 kg/m2 and HbA1c>7.0% were the additional inclusion criteria. Oral antihyperglycemic drugs, other than metformin, were stopped, and metformin treatment was continued at 2000 mg per day. Exenatide treatment was initiated at 5 µg per dose subcutaneously (sc) twice daily, and after one month, the dose of exenatide was increased to 10 µg twice daily. Changes in anthropometric variables, glycemic control, lipid parameters and total ghrelin levels were evaluated at baseline and following 12 weeks of treatment.ResultsThirty-eight patients (male/female = 7/31) entered the study. The mean age of patients was 50.5 ± 8.8 years with a mean diabetes duration of 8.5 ± 4.9 years. The mean BMI was 41.6 ± 6.3 kg/m2 and the mean HbA1c of patients was 8.9 ± 1.4%. The mean change in the weight of patients was −5.6 kg and the percentage change in weight was −5.2 ± 3.7% following 12 weeks of treatment. BMI, fasting plasma glucose and HbA1c levels of patients were decreased significantly (P < 0.001 and P < 0.001; respectively), while there was no change in lipid parameters. Serum fasting ghrelin levels were significantly suppressed following 12 weeks of exenatide treatment compared with baseline values (328.4 ± 166.8 vs 245.3 ± 164.8 pg/mL) (P = 0.024).ConclusionThese results suggest that the effects of exenatide on weight loss may be related with the suppression of serum fasting ghrelin levels, which is an orexigenic peptide.

To study the impact of glycemic control over cardiac autonomic neuropathy in type 1 and type 2 diabetics patients using bedside tests at a tertiary care hospital

Background: Cardiac autonomic neuropathy a serious complication of diabetes and is often overlooked. It is associated with higher cardiovascular mortality and poor quality of life in diabetic individuals. The Glycemic control has been well established as the risk factor for all the diabetes related microvascular and macrovascular complications. This stresses importance of role of glycemic control over CAN in Type 1 and Type 2 Diabetics in order to stop further progression to advanced and irreversible stages. The objective was to study the impact of various demographic and other clinical factors over prevalence of CAN in type 1 and type 2 diabetic patients who are asymptomatic for CAN using bedside testsMethods: A case control comparative clinical study was undertaken comprising of 100 diabetic patients, both type 1 and type 2 with duration from 5-10 years and &gt;10 years. The tests which were performed are deep breathing test, heart rate response to standing, hand grip test, cold pressor test, BP response to standing. Depending on these tests, patients were categorised as patients with cardiac autonomic neuropathy and without cardiac autonomic neuropathy.Results: The prevalence of cardiac dysautonomia was 68%. Type 2 diabetics had higher prevalence of cardiac dysautonomia than type 1 diabetics (p=0.025). Significant correlation was observed between cardiac autonomic neuropathy and poor glycemic status (type 1 p&lt;0.001; type 2 p&lt;0.001). The mean HbA1c in patients with and without CAN in type 1DM was 9.16+0.81 and 7.21+0.56 and in type 2 DM was 9.15+1.72 and 7.15+0.53 respectively. Similarly, presence of other microvascular complications increased the prevalence of CAN in both types of diabetes mellitus.Conclusions: Cardiac autonomic neuropathy is a common complication in long standing diabetes. Present results suggest that glycemic status of the diabetics is undoubtedly an important factor for the onset of cardiac dysautonomia which in turn account for high prevalence of cardiac mortality in diabetic patients. All asymptomatic diabetic patients should be evaluated for the presence of autonomic neuropathy and glycemic status should be controlled to prevent the further progression of CAN.

Exenatide treatment causes suppression of serum fasting ghrelin levels in patients with type 2 diabetes Mellitus

AIM In the present study, we investigated the long-term effects of exenatide treatment on serum fasting ghrelin levels in patients with type 2 diabetes mellitus. METHODS Type 2 diabetic patients, who were using metformin with and without the other antihyperglycemic drugs on a stable dose for at least 3 months, were enrolled in the study. BMI>35 kg/m2 and HbA1c>7.0% were the additional inclusion criteria. Oral antihyperglycemic drugs, other than metformin, were stopped, and metformin treatment was continued at 2000 mg per day. Exenatide treatment was initiated at 5 µg per dose subcutaneously (sc) twice daily, and after one month, the dose of exenatide was increased to 10 µg twice daily. Changes in anthropometric variables, glycemic control, lipid parameters and total ghrelin levels were evaluated at baseline and following 12 weeks of treatment. RESULTS Thirty-eight patients (male/female = 7/31) entered the study. The mean age of patients was 50.5 ± 8.8 years with a mean diabetes duration of 8.5 ± 4.9 years. The mean BMI was 41.6 ± 6.3 kg/m2 and the mean HbA1c of patients was 8.9 ± 1.4%. The mean change in the weight of patients was -5.6 kg and the percentage change in weight was -5.2 ± 3.7% following 12 weeks of treatment. BMI, fasting plasma glucose and HbA1c levels of patients were decreased significantly (P < 0.001 and P < 0.001; respectively), while there was no change in lipid parameters. Serum fasting ghrelin levels were significantly suppressed following 12 weeks of exenatide treatment compared with baseline values (328.4 ± 166.8 vs 245.3 ± 164.8 pg/mL) (P = 0.024). CONCLUSION These results suggest that the effects of exenatide on weight loss may be related with the suppression of serum fasting ghrelin levels, which is an orexigenic peptide.

Incidence of infections in hospitalized subjects with diabetes mellitus

Background: The risk of infection is higher in patients with diabetes mellitus (DM) compared to those without DM and significantly affects morbidity and mortality when these patients are admitted to a hospital. Hence, this study was undertaken to determine the type of infections, presentation of illness and to correlate with the severity of diabetes. Method: We studied 115 patients with DM (60 males) admitted in acute medical ward of our Institute with subacute, acute and chronic illnesses in all of them. Blood glucose and glycosylated haemoglobin were (HbA1c) determined by the standard methods. The type of organisms isolated from blood/urine/ pus /sputum and drug sensitivity pattern was determined. Results: Coronary artery disease (CAD) was seen in 22.6%, retinopathy in 2.6% and nephropathy in 9.6% of cases. Eighty six of the 115 patients (75%) had infections. Of these, acute, subacute and chronic presentation were seen in 67, 12 and 7 patients respectively; 76 had community acquired infections and nosocomial infection were seen in 10 cases. Pulmonary infections were most common (29.1%) followed by urinary tract infection (26.7%). Of the 86 patients with infection 9 had HbA1c 10%. The mean HbA1c in patients with sepsis/multiorgan dysfunction syndrome (MoDS) was 11.3 ±2.8% as against 8.4% ± in the non sepsis group. Conclusion: We observed that infections were a common cause of hospital admissions in patients with uncontrolled DM.

PDB8 - Iatrogenic Hypoglycaemia in the Elderly: An Analysis of Diabetic Medication Usage Patterns According to Age

We performed a retrospective data analysis to examine the use of medications that can cause hypoglycaemia in elderly diabetes mellitus patients in Malaysia. We utilised data from the National Diabetes Registry from 2012 containing data from diabetes patients followed up in Malaysian public sector primary care clinics. Medications analysed were anti-diabetic (metformin, sulphonylurea, acarbose, insulin) and anti-hypertensive drugs classes (ACE-inhibitors, beta-blockers) which were widely used in the study population. Descriptive and univariate analyses were performed to examine the use of these medications across various age groups. A total of 130,246 patients with T2DM were included in the study. The patients were divided into 4 age groups, with 8.4% under 45 years old, 58.3% aged between 45–64 years, 29.8% between 65-79 years old and 3.5% over 80 years of age. The mean HbA1c of patients in the <45 years age group was the highest at 8.68% and lowest in the ≥80 years age group at 7.11%. There were significant reductions in the use of metformin (from 83.97% to 68.69% of patients) and insulin (24.70% to 12.03%) with age (all P<0.001). However, sulphonylurea use was similar cross all age groups (52.55% to 57.44%, P=0.500) while use of acarbose was generally higher in older patients (3.12% to 3.94%, P<0.001). In the subset of diabetics with hypertension, use of ACE inhibitors declined with age (64.43% to 49.95%, P<0.001) while use of beta blockers increased with age (20.11% to 35.56%, P<0.001). Despite limitations of our study especially related to reasons for prescribing different drugs, we note that a large proportion of older patients are still prescribed with medications that potentially cause hypoglycaemia, in particular, sulphonylureas and beta-blockers. This finding is to remind doctors to proceed with caution in treating the elderly when treating the elderly with certain medications.

Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes.

BackgroundThe aim of the study was to evaluate the effect of delay in treatment intensification (IT; clinical inertia) in conjunction with glycaemic burden on the risk of macrovascular events (CVE) in type 2 diabetes (T2DM) patients.MethodsA retrospective cohort study was carried out using United Kingdom Clinical Practice Research Datalink, including T2DM patients diagnosed from 1990 with follow-up data available until 2012.ResultsIn the cohort of 105,477 patients mean HbA1c was 8.1% (65 mmol/mol) at diagnosis, 11% had a history of cardiovascular disease, and 7.1% experienced at least one CVE during 5.3 years of median follow-up. In patients with HbA1c consistently above 7/7.5% (53/58 mmol/mol, n = 23,101/11,281) during 2 years post diagnosis, 26/22% never received any IT. Compared to patients with HbA1c <7% (<53 mmol/mol), in patients with HbA1c ≥7% (≥53 mmol/mol), a 1 year delay in receiving IT was associated with significantly increased risk of MI, stroke, HF and composite CVE by 67% (HR CI: 1.39, 2.01), 51% (HR CI: 1.25, 1.83), 64% (HR CI: 1.40, 1.91) and 62% (HR CI: 1.46, 1.80) respectively. One year delay in IT in interaction with HbA1c above 7.5% (58 mmol/mol) was also associated with similar increased risk of CVE.ConclusionsAmong patients with newly diagnosed T2DM, 22% remained under poor glycaemic control over 2 years, and 26% never received IT. Delay in IT by 1 year in conjunction with poor glycaemic control significantly increased the risk of MI, HF, stroke and composite CVE.

Single-centre study of 628 adult, primary kidney transplant recipients showing no unfavourable effect of new-onset diabetes after transplant.

To better understand the implications of new-onset diabetes after transplant (NODAT), we used our prospectively followed cohort of 628 adult primary kidney transplant recipients to determine the prognostic impact of pretransplant diabetes and NODAT. The study cohort consisted of all participants in four randomised immunosuppression trials performed at our centre since May 2000. For each cause-specific hazard analysed, Cox stepwise regression was used to determine a multivariable model of significant baseline predictors; the multivariable influence of having pretransplant diabetes and NODAT (t) (the latter defined as a zero-one, time-dependent covariate) was subsequently tested. Similar analyses of estimated glomerular filtration rate (eGFR) at 36 and 60 months post transplant were performed using stepwise linear regression. Finally, a repeated measures analysis of mean HbA1c as a function of diabetes category (pretransplant diabetes vs NODAT) and randomised trial (first to fourth) was performed. Median follow-up was 56 months post transplant. Patients with pretransplant diabetes comprised 23.4% (147/628), and 22.5% (108/481) of the remaining patients developed NODAT. Pretransplant diabetes had no prognostic influence on first biopsy-proven acute rejection and death-censored graft failure hazard rates, nor on eGFR, but was associated with significantly higher rates of death with a functioning graft (DWFG) (p = 0.003), DWFG due to a cardiovascular event (p = 0.005) and infection that required hospitalisation (p = 0.03). NODAT (t) had no unfavourable impact on any of these hazard rates nor on eGFR, with actuarial freedom from DWFG remaining at over 90% among patients in pre- and post-NODAT states at 72 months post transplant/NODAT. Mean HbA1c for patients in the first to fourth randomised trials, averaged across diabetes category, decreased by trial (7.28%, 6.92%, 6.87% and 6.64% [56.1, 52.1, 51.6 and 49.1 mmol/mol], respectively; p = 0.02). Less-than-expected post-NODAT risk for graft loss and death may exist in the current climate of tighter glucose monitoring post transplant.

Glycemic Control of Type 2 Diabetic Patients Managed in Tertiary Care Internal Medicine Clinics Using HbA1c

Background /Objective: The aim was to assess the glycemic control in patients with type 2 diabetes mellitus using American Diabetes Association HbA1c definition of good control of ≤ 7.0%.&#x0D; Methods: This retrospective study conducted in internal medicine outpatient clinics at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia. All patients with type 2 diabetes mellitus attending the clinic from August 2005 to January 2006 were evaluated. Patients with HbA1c measured regularly and under anti-diabetic therapy were included in the study. Last measured HbA1c was used to evaluate diabetic control.&#x0D; Results: Data for 968 (81.5%) patients out of 1188 were available for analysis. Only 211 (21.8%) patients had their HbA1c within the American Diabetes Association recommended target of HbA1c ≤ 7%. Mean HbA1c was 8.98%. Patients were stratified into groups of good (HbA1c £ 7%), average (HbA1c 7.1% - 9.9%) and poor diabetic control (HbA1c ≥ 10%) included 21.8%, 46.2% and 32.0% of the study population, respectively. Mean HbA1c in patients on diabetic diet only, oral hypoglycemic agents, insulin, and oral hypoglycemic agents plus insulin was 7.62%, 8.67%, 8.92% and 9.70%, respectively.&#x0D; Conclusion: Majority of patients in our study did not meet the American Diabetes Association recommended target HbA1c for type 2 diabetes mellitus. Causes for this failure need to be assessed in Saudi type 2 diabetes mellitus population.