Mean HbA1c Values Research Articles

Severe Hypertriglyceridemia in Patients with Type 2 Diabetes Mellitus Participating in the AMD Annals Initiative.

Background: Familial chylomicronemia syndrome (FCS) is a rare inherited condition due to lipoprotein lipase deficiency, characterized by hyperchylomicronemia and severe hypertriglyceridemia. Diagnosis is often delayed, thus increasing the risk of acute pancreatitis and hospitalization. Hypertriglyceridemia is a common finding in patients with type 2 diabetes (T2D), who may harbor FCS among the most severe forms. Aim of the Study: We investigated the prevalence and clinical characteristics associated with severe hypertriglyceridemia in a range indicative of FCS, in a large population of subjects with T2D. Methods: Within the large population of the AMD Annals Initiative, patients with T2D with a lipid profile suggestive of FCS [triglycerides >880 mg/dL and/or high-density lipoprotein (HDL)-cholesterol <22 mg/dL or non-HDL-cholesterol ≤70 mg/dL] and their clinical features have been identified. Results: Overall, 8592 patients had triglyceride values >880 mg/dL in a single examination, 613 in two examinations, and 34 in three or more measurements. Patients with high triglyceride levels were mostly male (80%), with a relatively young age (54 years), short duration of diabetes (6.3 years), and elevated hemoglobin A1c (HbA1c) levels (9.4%). By stratifying this group of patients according to the severity of hypertriglyceridemia, more severe hypertriglyceridemia (triglyceride levels ≥2000 mg/dL) was associated with an even younger age (52 vs. 54 years), even higher mean HbA1c values (10.0% vs. 9.4%), and significantly higher HDL-cholesterol levels (37.9 vs. 32.4 mg/dL; P < 0.0001). Patients with persistently elevated triglyceride levels (n = 34), on three measurements, had a younger age; lower body mass index, HbA1c, and HDL-cholesterol levels; more frequent use of fibrates and insulin; and a higher prevalence of major cardiovascular events. Conclusions: Severe hypertriglyceridemia is a frequent condition in outpatients with T2D participating in the AMD Annals Initiative, and it is associated with male sex, young age, short disease duration, and a worse glycemic profile. Among patients with persistent severe hypertriglyceridemia, hidden FCS may be present.

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

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

Glycaemic control metrics and metabolic dysfunction-associated steatotic liver disease in children and adolescents with type 1 diabetes.

The aim was to examine the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), a risk factor for atherosclerotic cardiovascular disease, and its association with glycaemic control metrics in children and adolescents with type 1 diabetes (T1D). We enrolled 244 children and adolescents with T1D (115 girls, mean age: 16.2 ± 3.2 years). The diagnosis of MASLD was defined by the presence of hepatic steatosis on ultrasonography in combination with at least one of five common cardiometabolic risk factors. Metrics of short-term and long-term glycaemic control, blood pressure, lipids, anthropometric characteristics and three genetic variants strongly related to MASLD susceptibility (rs738409 [patatin-like phospholipase domain-containing 3], rs58542926 [transmembrane 6 superfamily member 2] and rs1260326 [glucokinase regulator]) were assessed. Characteristics of these subjects with and without MASLD were compared using the unpaired Student t test, Mann-Whitney test or χ2 test as appropriate. Logistic regression analyses were performed to determine the main independent predictors of MASLD. The prevalence of MASLD was 27.5% in children and adolescents with T1D. Blood pressure, total cholesterol, low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein cholesterol, HbA1c and time above range (TAR) were significantly higher in subjects with MASLD than in those without MASLD. Mean HbA1c values from diabetes onset (adjusted odds ratio [OR]: 1.703, 95% confidence interval [CI]: 1.040-2.787, p = 0.034), TAR (adjusted OR: 1.028, 95% CI: 1.009-1.047, p = 0.006) and plasma LDL cholesterol (adjusted OR: 1.045, 95% CI: 1.013-1.078, p = 0.004) were independently associated with the presence of MASLD. MASLD is a common condition in children and adolescents with T1D. The mean HbA1c values from diabetes onset, TAR and LDL cholesterol levels were the independent predictors of MASLD.

A Comparative Evaluation of Point-of-Care and Laboratory HbA1c Testing in Diabetes Care: An Indian Perspective.

This study aimed to assess the diagnostic performance of a point-of-care (POC) glycated hemoglobin (HbA1c) device in the Indian population against the standard laboratory (high-performance liquid chromatography {HPLC}) method for the effective management of diabetes in India. This study on the diagnostic accuracy of a POC HbA1c device involved 121 participants. These participants were categorized into two groups according to their HbA1c levels - one group with HbA1c values below 6.5% and another group with HbA1c values equal to or greater than 6.5%. The HbA1c levels in enrolled participants were estimated using both the POC device (HemoCueHbA1c 501; Ängelholm, Sweden: HemoCue AB) and the standard HPLC-based method. The level of agreement and concordance between the two test results were assessed by the Bland-Altman plot and Lin's concordance correlation coefficient. Sensitivity, specificity, diagnostic accuracy, positive likelihood, and negative likelihood ratios of POC-HbA1c device were assessed with a 6.5% HbA1c cut-off. The mean HbA1c values obtained by the two methods showed no statistically significant difference with a minimum effect size (Cohen's d = 0.035), indicating there was a negligible difference between these methods. The Bland-Altman plot revealed that most values were within acceptable limits (95% CI: -0.5 to 0.7) and Lin's concordance correlation coefficient showed strong agreement (p < 0.0001).The POC-HbA1c device demonstrated an area under the curve (AUC) of 0.991 (95% CI: 0.953-1.000) with sensitivity, specificity, diagnostic accuracy, positive likelihood, and negative likelihood ratios of 93.62%, 97.30%, 95.87%, 34.64 and 0.07, respectively, compared to the standard diagnostic assay. The diagnostic accuracy, sensitivity, and specificity demonstrated by the POC-HbA1c device to the standard HPLC method offers a viable and practical solution for diabetes management in India. Its ability to provide rapid and reliable results at the point of care can improve patient outcomes, reduce healthcare costs, and enhance access to diabetes care, especially in primary care, remote areas, and resource-limited settings of developing countries like India.

Elevated HbA1c Levels Are Associated with a Risk of Pancreatic Cancer: A Case-Control Study.

Background: The early diagnosis of pancreatic cancer (ICD-10 C25) can improve the patient's prognosis. The association between pancreatic cancer and type 2 diabetes (T2D) is known, but not yet fully understood. It is, therefore, necessary to investigate the impact of hemoglobin A1c (HbA1c) serum levels on pancreatic cancer development and the potential intervention options. Methods: In the case-control study, patients from the German IQVIATM Disease Analyzer database aged ≥18 years with a diagnosis of pancreatic cancer (ICD-10 C25) and a diagnosis of T2D (ICD-10: E11) were included. The patients' propensity score matched 1:5 with individuals without pancreatic cancer. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CI). Results: An elevated serum HbA1c prior to the index date was found to be significantly associated with an increased risk of a subsequent pancreatic cancer diagnosis for the mean HbA1c values of 6.5-8.4% (OR: 1.38; 95% CI: 1.22-1.57) as well as for mean HbA1c values ≥8.5% (OR: 1.41; 95% CI: 1.16-1.73). The only antihyperglycemic agent negatively associated with the subsequent pancreatic cancer diagnosis was the sodium-glucose cotransporter-2 (SGLT-2) inhibitor, with an odds ratio of 0.80 (95% confidence interval: 0.74-0.87 per year of therapy). This correlation was observed in both age- and sex-stratified subgroups. Conclusions: The data indicate that elevated serum HbA1c levels in patients with T2D are associated with an increased risk of pancreatic cancer development. It is possible that SGLT2 therapy may prove an effective means of reducing the risk of pancreatic cancer, thereby offering a potential avenue for the future reduction in pancreatic cancer incidence in patients with T2D.

Long-Term Glycemic Control Improvement After the Home and Self-Care Program for Patients With Type 1 Diabetes: Real-World-Based Cohort Study.

The prevalence of type 1 diabetes (T1D) is increasing worldwide, with a much higher proportion of adult patients. However, achieving stable glycemic control is difficult in these patients. After periodic implementation of structured education for patients with T1D through the Home and Self-Care Program, a pilot home health care project promoted by the Korean government, we evaluated the program's effects on glycemic control. This study was conducted from April 2020 to March 2023. We analyzed 119 participants with T1D aged >15 years. Nursing and nutrition education were provided separately up to 4 times per year, with physician consultation up to 6 times per year. A distinguishing feature of this study compared with previous ones was the provision of remote support using a general-purpose smartphone communication app offered up to 12 times annually on an as-needed basis to enhance the continuity of in-person education effects. Patients were followed up on at average intervals of 3 months for up to 24 months. The primary end point was the mean difference in glycated hemoglobin (HbA1c) at each follow-up visit from baseline. For continuous glucose monitoring (CGM) users, CGM metrics were also evaluated. The mean HbA1c level of study participants was 8.6% at baseline (mean duration of T1D 10.02, SD 16.10 y). The HbA1c level reduction in participants who received at least 1 structured educational session went from 1.63% (SD 2.03%; P<.001; adjustment model=1.69%, 95% CI 1.24%-2.13% at the first follow-up visit) to 1.23% (SD 1.31%; P=.01; adjustment model=1.28%, 95% CI 0.78%-1.79% at the eighth follow-up visit). In the adjustment model, the actual mean HbA1c values were maintained between a minimum of 7.33% (95% CI 7.20%-7.46% at the first follow-up visit) and a maximum of 7.62% (95% CI 7.41%-7.82% at the sixth follow-up visit). Among CGM users, after at least 1 session, the mean time in the target range was maintained between 61.59% (adjusted model, 95% CI 58.14%-65.03% at the second follow-up visit) and 54.7% (95% CI 50.92%-58.48% at the eighth follow-up visit), consistently staying above 54.7% (corresponding to an HbA1c level of <7.6%). The mean time below the target range (TBR) also gradually improved to the recommended range (≤4% for TBR of <70 mg/dL and ≤1% for TBR of <54 mg/dL). The Home and Self-Care Program protocol for glycemic control in patients with T1D is effective, producing significant improvement immediately and long-term maintenance effects, including on CGM indexes.

Association of Serum Iron Profile among Patients with Type 2 Diabetes Mellitus with or without Diabetic Nephropathy

Background: Diabetes mellitus (DM) is the most significant public health challenges in both developed and developing countries. Diabetic nephropathy (DN) is one of the major causes of morbidity and mortality among patients with DM worldwide. Iron modify glucose metabolism and glucose metabolism impinges on iron. Objective: To evaluate serum iron profile in type 2 diabetic patients with or without diabetic nephropathy. Methods: This cross-sectional study was conducted at Department of Biochemistry and Molecular Biology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorder (BIRDEM), Dhaka, Bangladesh from January 2019 to December 2019. Total 150 participants were enrolled according to the selection criteria and were divided into three groups, 50 patients were with type 2 diabetes mellitus (T2DM), 50 patients were with DN and another 50 respondents were healthy controls. All relevant data were recorded and their serum iron profile was estimated accordingly. Data were analyzed and compared by statistical tests. Results: Male and female were 41.3% and 58.7% respectively and majority (31.3%) was in 51-60 years. The mean value of HbA1C of DN patients was significantly higher among groups (p&lt;0.001). It was found that serum iron and serum ferritin were significantly (p&lt;0.001) higher and total iron binding capacity (TIBC) was significantly (p&lt;0.001) lower in T2DM and DN patients compare with healthy controls. The mean serum creatinine level was significantly (p&lt;0.001) higher and mean value of estimated glomerular filtration rate (eGFR) was significantly (p&lt;0.001) lower in DN patients. There were significant negative correlation of serum iron and significant positive correlation of TIBC with eGFR in patients with DN; but a negative correlation of serum ferritin with eGFR in patients with DN. Conclusion: It was observed that, serum iron, serum ferritin levels were significantly increased and TIBC was significantly decreased ........

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

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

Edukasi Dan Skrining Diabetes Mellitus Tipe 2 Melalui Pemeriksaan HbA1c Pada Kelompok Lanjut Usia

Type 2 diabetes mellitus is a chronic disease characterized by high blood glucose levels due to insulin resistance or inadequate insulin production. In the elderly, diabetes mellitus causes various serious complications such as heart disease, nerve damage, kidney failure and vision problems. Risk factors for diabetes mellitus include family history, obesity, lack of physical activity, a diet high in fat and sugar, and hypertension. This community service activity aims to increase awareness and early detection of type 2 diabetes mellitus through education and HbA1c screening in the elderly. Of the 93 lanjut usiats, 74 were women and 19 were men, with an average age of 74.05 years. The mean HbA1c value was 7.59, with 55.9% in the moderate category and 25.8% in the poor category. Results showed that suboptimal glycemic control was higher in women. This program highlights the need for regular monitoring and appropriate interventions to improve glycemic control and quality of life for older adults through comprehensive education, physical activity and stress management.

Comparative effectiveness of second line oral antidiabetic treatments among people with type 2 diabetes mellitus: emulation of a target trial using routinely collected health data

ObjectiveTo compare the effectiveness of three commonly prescribed oral antidiabetic drugs added to metformin for people with type 2 diabetes mellitus requiring second line treatment in routine clinical practice.DesignCohort study...

Effect of Iron Deficiency Anemia on HbA1c Levels Among Diabetic and Nondiabetic Patients

Abstract Background and Aims: Hemoglobin A1c (HbA1c) is widely used for assessment of glycemic status and diagnosis of diabetes. HbA1c levels are influenced by age, ethnicity, and conditions that alter the red cell turnover or survival. We aimed to assess the effect of iron deficiency anemia (IDA) on HbA1c levels among adult diabetic and nondiabetic patients and correlate HbA1c with iron profile. Materials and Methods: A cross-sectional study was carried out among 150 patients, of whom 50 were diagnosed diabetics with IDA, 50 were nondiabetics with IDA, and 50 were controls. They were investigated for hemogram, renal function test, HbA1c, and iron profile. Results: Mean HbA1c value among controls was 5.03 ± 0.34%, among diabetics with IDA was 8.69 ± 0.92%, and among nondiabetics with IDA was 5.87 ± 0.76% and this difference was statistically significant. Total iron binding capacity (TIBC) was 332.54 ± 58.32 µg/dL among controls, 420.63 ± 119.03 µg/dL among nondiabetics with IDA, and 495.88 ± 126.79 µg/dL among diabetics with IDA. Pearson’s correlation coefficient of HbA1c with serum ferritin was -0.444, with serum iron was -0.357, and with TIBC was 0.476. Conclusion: HbA1c levels are elevated in diabetes with IDA. HBA1c is negatively correlated with serum iron and ferritin and positively correlated with TIBC.

Nutritional status in patients with tuberculosis and diabetes mellitus: A comparative observational study

BackgroundIndia has been estimated to have 14 % of malnourished population and a high TB incidence burden with a 26.9 lakh cases. Malnutrition and diabetes mellitus are major risk factors for tuberculosis infection. Malnutrition in patients with both tuberculosis and diabetes (TB-DM) population worsens the disease severity, treatment outcomes and increases morbidity and mortality risk. ObjectiveTo assess the nutritional status in patients with TB-DM compared with patients with TB and DM alone. MethodRecords from January 2016 to November 2020 for patients admitted to Kasturba Hospital, Manipal were assessed. Data pertaining to glycemic parameters, nutritional parameters, and other relevant laboratory parameters were extracted for assessment. The study population were divided into three groups i.e. patients with TB-DM, TB and DM. The statistical association was carried out with one-way ANOVA method, considering p < 0.05 as statistically significant. ResultsA total of 291 patients were included, with 97 patients in each group; among those, male and female were 86.27 % and 13.73 % respectively. Cardiovascular co-morbidity was predominant in the DM (68.04 %) and TB-DM (26.8 %) group. The mean value of HbA1c (10.47 %) was found to be highest for the TB-DM group. Low levels of albumin were reported by 71.91 % of patients of the TB group, whereas 73.68 % patients in TB-DM group had vitamin D deficiency. Moreover, higher prevalence of low MCV and MCH in the TB-DM group suggest an increased risk of iron-deficiency anemia. ConclusionThe findings of our study reflect the need for implementation of nutritional support in patients with TB-DM.

Retinal Function in Long-Term Type 1 Diabetes without Retinopathy: Insights from Pattern Electroretinogram and Pattern Visual Evoked Potentials Assessments.

To evaluate changes in pattern electroretinogram (pERG) and pattern visual evoked potentials (pVEP) in patients with long-lasting type 1 diabetes without diabetic retinopathy (DR). Prospective study involving 92 eyes divided into two groups. The diabetic group included 46 eyes of 23 patients with type 1 diabetes (T1DM); the control group included 23 age-matched healthy subjects. pERG and pVEP were assessed using the RETI-port/scan21 recording software (version 1021.3.0.0). Mean age was 48 ± 9.77 years for the diabetic group and 51.7 ± 4.75 years for the control group. The mean duration of diabetes was 28.88 ± 8.04 years. The mean HbA1c value was 7.29 ± 0.89%. There were no differences in the age or sex distribution. Regarding the pERG, T1DM patients exhibited a significant decrease in the amplitude of the P50 and N95 waves compared to the control group (p = 0.018 and p = 0.035, respectively), with no differences in the peak time of each component. pVEP showed no significant changes in either peak time or amplitude of the different components. Long-term T1DM patients without DR showed changes in the amplitude of pERG waves with preserved peak times. We did not observe modifications in pVEP. pERG may serve as a subclinical marker of ganglion cell damage in long-term T1DM patients.

Correlations between Retinal Microvascular Parameters and Clinical Parameters in Young Patients with Type 1 Diabetes Mellitus: An Optical Coherence Tomography Angiography Study

Objectives: In the current study, we investigated the correlations between retinal microvascular parameters using optical coherence tomography angiography (OCTA) and clinical parameters for a group of 69 young patients with type 1 diabetes mellitus (T1DM). Materials and Methods: This retrospective, exploratory study enrolled 69 patients between 5 years old and 30 years old who met the inclusion criteria. All the study participants underwent a comprehensive ophthalmic examination and OCTA scans for the evaluation of the retinal microcirculation. The retinal OCTA parameters were correlated with the following clinical parameters: the patient’s age at the onset of the disease, the duration of T1DM, the BMI at the time of enrollment in the study, the HbA1C values at onset, the mean values of HbA1C over the period of monitoring the disease and the degree of DKA at onset. Results: For the study group, the foveal avascular zone (FAZ) area and perimeter correlated positively with the mean value of HbA1C (Pearson correlation, Sig.2-Tailed Area: 0.044; perimeter: 0.049). The total vessel density in the superficial capillary plexus (SCP) correlated negatively with the duration of T1DM, based on the superior and inferior analyzed areas (Spearman correlation, Sig.2-Tailed SCP in total region: 0.002; SCP in the superior region: 0.024; SCP in the inferior region: 0.050). The foveal thickness also correlated negatively with the levels of diabetic ketoacidosis (DKA) at onset (Spearman correlation, Sig.2-Tailed: 0.034) and the levels of HbA1C at onset (Spearman correlation, Sig.2-Tailed: 0.047). Further on, the study patients were distributed into two groups according to the duration of the disease: group 1 included 32 patients with a duration of T1DM of less than 5 years, and group 2 included 37 patients with a duration of T1DM of more than 5 years. Independent t-tests were used to compare the OCTA retinal parameters for the two subgroups. While the FAZ-related parameters did not show significant statistical differences between the two groups, the vessel densities in both the SCP and DCP were significantly lower in group 2. Conclusions: Our data suggest that specific alterations in OCTA imaging biomarkers correlate with various clinical parameters: the FAZ area and perimeter increase with higher mean values of HbA1C, leading to poor metabolic control. Moreover, the SCP total vessel density decreases as the duration of T1DM increases. Regarding the vessel densities in the SCP and the DCP, they decrease with a duration of the disease of more than 5 years.

Impact of Non-Surgical Periodontal Therapy on HbA1c Levels of Type 2 Diabetes at Khyber College of Dentistry, Peshawar: A Quasi-Experimental Study

Background: Diabetes mellitus (DM) constitutes a spectrum of persistent metabolic disorders originating from irregular glucose metabolism due to insufficient insulin production, compromised insulin function, or a combination of the two, leading to elevated blood sugar levels. This study assessed the influence of non-surgical periodontal therapy on glycated hemoglobin (HbA1c) levels in individuals with Type 2 Diabetes. Methods: This quasi-experimental study was conducted at Khyber College of Dentistry, Peshawar, with 40 participants diagnosed with Type 2 diabetes for more than 3 years and suffering from chronic periodontitis. Patients with Type 1 diabetes, pregnant women, and those with other medical complications were excluded. HbA1c levels were assessed at baseline, and non-surgical periodontal therapy was administered. Patients were educated and scheduled for a follow-up after 3 months when HbA1c levels were reassessed. A paired t-test was employed to compare HbA1c levels pre-and post-intervention. Results: In this study, males were 29 (58%) whereas 21 (42%) females. The mean value of HbA1c was less post-treatment with non-surgical periodontal therapy (6.928±0.866%) than pretreatment (9.048±0.73%) and results were statistically significant (p&lt;0.001). After receiving therapy, the HbA1c level was significantly reduced in both genders (p&lt;0.001). Irrespective of smoking status, the reduction of HbA1c level was statistically significant (p=0.01). Conclusion: Non-surgical periodontal treatment significantly reduces HbA1c levels, indicating a potentially positive impact on glycemic control in individuals with diabetes, which has enhanced the dentist’s role as a part of the health team, and timely interventions can significantly improve prognosis.

Diabetes Care: An Online Web-Based Tool for Improving the Health Outcomes of Type 2 Diabetes Mellitus Patients: A Longitudinal Study.

Diabetes is a chronic medical condition with severe complications, mainly caused by unhealthy lifestyles in genetically susceptible individuals. There has been a growing interest in the role of mobile health technologies in achieving better self-efficacy in managing diabetes. This study attempts to assess the impact of a web-based model on improving the diabetes status among Type 2 diabetic patients attending a tertiary care hospital in southern India. A longitudinal study was conducted among patients with type 2 diabetes attending the outpatient department of a tertiary care hospital in Mysuru, southern India, for 6 months. Diabetes Care (https://www.diabetes-care.co.in/), which is an online website that can be used as a risk prediction tool for uncontrolled diabetes and recommends lifestyle changes, was used by 456 diabetes patients for 6 months. We assessed the change in glycosylated haemoglobin levels at the beginning and after 6 months of using the software. The mean HbA1c value at the start of the study was 8.039% ± 1.981. The HbA1c value assessed after 6 months post-intervention showed an improvement of 7.794% ± 1.853 with a mean difference of 0.245. A paired T-test showed a statistically significant association with a P value of 0.049. Evidence from this study suggests that intervention using a web-based model focusing on risk prediction and educational intervention showed an improvement in the diabetic status of the patients with T2DM.

Glycaemic control and its associated factors among adult Omanis with type 1 diabetes mellitus: a cross-sectional survey

ABSTRACT Objectives This study aimed to investigate the relationship between glycemic control and diabetes self-management (DSM) and other associated factors among adult Omanis with Type-1 Diabetes Mellitus (T1DM). Methods A cross-sectional, descriptive design was used to collect data among 210 adult Omanis with T1DM who were conveniently recruited. All tools were self-reported, whereas the HbA1c was collected from the patient’s electronic medical records. Results The HbA1c mean value was 8.6 (SD = 2.5), 30.5% had optimal glycemic control (<7.0). A significant negative relationship between HbA1c and DSM (r = - 0.191, p = 0.006) and diabetes knowledge (r = - 0.153, p = 0.026) was found. Furthermore, the mean HbA1c was significantly lower for persons with a single marital status, have higher education level, have children, are unemployed, were not admitted to the hospital in the last year, and have a health care professional as a family member. Additionally, marital status, level of education, DSM, and social support were significant predictors of glycemic control. Conclusions The results suggested that better glycemic control could be achieved by optimizing DSM, social support, and diabetes knowledge. Sociodemographic factors should be considered when treating individuals with T1DM to reach good glycemic control.

Are We Diagnosing and Managing Diabetes in Patients with Sickle Cell Disorders Accurately?

Introduction: Patients with hemolytic anemias, especially those resulting from severe sickle cell disorders (SCD), may experience increased red blood cell (RBC) turnover, influencing hemoglobin (Hb) glycation rates. The American Diabetes Association (ADA) recommends measuring plasma glucose levels for diabetes mellitus (DM) diagnosis. However, to monitor glycemic control, fructosamine provides a valuable measure of glycated serum protein byproduct, independent of RBC lifespan. It is important to note that G6PD can aggravate anemia and its co-existence with SCDs is reported to vary between 7%-35.83% depending on genotype, ethnicity and location. Despite National Glycohemoglobin Standardization Program's (NSGP) reporting that most chemistry analyzers exhibit no assay interference, Lacy et al. showed that HbA1C systematically underestimated past glycemia in black patients with sickle cell trait. It is hypothesized that numerous SCD patients with DM receive diagnosis and management based on HbA1C. This study seeks to evaluate the management patterns and the correlation between Hb and HbA1C in the context of a hemoglobinopathy, aiming to enhance patient care standards. Methods: We identified 61 adult sickle cell disorder patients who also had a diagnosis of type 2 DM or prediabetes between January 2019 and May 2023. Patients with acute blood loss events (with or without transfusions), iron deficiency, hyperbilirubinemia, liver or renal disease, HIV infection on antiretroviral therapy, and those receiving Vit A/C supplementation were excluded from the study, as these conditions are known to impact the HbA1C levels. HbA1C testing at our institution was formerly done using Siemens Dimension Vista 500/1500 analyzer until it was switched to Abbott Alinity-c in October 2022. According to NGSP, there are no reports of assay interference in patients with Sickle Cell Disease (SCD) for either of these chemistry analyzers. Descriptive statistics were utilized to report data as means and percentages. Pearson correlation coefficient was used to assess the relationship between Hb and HbA1C values. Results: Mean age of the study participants was 52.59 years (SD 15.56) with a female predominance (53/61, 86.89%). All patients were of African American descent. The study included 49/61 (80.33%) patients with sickle cell trait, 3/61 (4.92%) with HbSC, 2/61 (3.28%) with HbSS, and 1/61 (1.64%) with HbS β+thal genotype. None of the patients had documented evidence of G6PD testing. Initially, all 61 patients had been diagnosed with DM or prediabetes via HbA1C. Only 3/61 (4.92%) patients had a fructosamine test documented in chart. The mean and median HbA1c values were 7.57% and 6.70% respectively (SD 2.07%). Among the participants, 53/61 (86.89%) patients were actively undergoing treatment for DM or prediabetes. There was a negative correlation (r = -0.142) between average Hb (at diagnosis) and HbA1C (at diagnosis) values (p = 0.286) (Figure 1). Conclusions: None of the patients in our study had evidence of G6PD testing. All patients with SCD and DM or prediabetes were initially diagnosed and managed using HbA1C. Only 3/61 patients had documentation of a fructosamine test. In the context of SCD, there was a poor correlation between Hb and HbA1C. The HbA1C test can either overpredict or underpredict DM in SCD patients due to assay interference (Siemens DCA Vantage analyzer is known to overpredict and is commonly used for point-of-care testing in an office setting) or hemoglobinopathy, respectively. Marked discrepancies between plasma glucose levels and measured HbA1C should prompt alternate diagnostic testing. It is recommended to use fasting blood glucose or oral glucose tolerance test to diagnose DM and prediabetes in patients with SCD. The reported cost difference between these tests is not significant. Fructosamine levels remain unaffected by hemoglobinopathies and can thus be used to monitor DM in patients with SCD.

Impact of COVID-19 pandemic on care for chronic diseases in deprived and non-deprived neighbourhoods

Abstract Background Due to stringent lock-down measures imposed during COVID-19 pandemic the access to the primary care dropped significantly. This study aims to investigate the impact on GP consultations for diabetes mellitus (DM) and COPD during the pandemic. Methods In an observational study from January 2018-June 2022, anonymized medical records of 379.567 patients in Rotterdam, were analyzed for the impact on DM and COPD consultations during the lockdown (March-May 2020) and after the lockdown (June 2020-June 2022) compared to pre-pandemic levels. Results The study included 34.270 DM and 11.570 COPD patients. Until the COVID-19 pandemic, the patients living in deprived neighborhoods had comparisonly on average a higher number of consultations for DM (RR = 1.81, 95%CI=1.76-1.86) and COPD (RR = 1.48 95%CI=1.39-1.58). During the stringent lock-down there was almost same significant drop in both neighbourhoods in consultations for DM (RR = 0.85, 95%CI=0.79-0.92) and COPD (RR = 0.72, 95%CI=0.61-0.86). After the lockdown, the consultations for DM were higher and the HbA1c measurements were normalized compared to pre-pandemic levels in both neighbourhoods, (RR = 1.11, 95%CI=1.05-1.17) and (RR = 0.96, 95%CI=0.91-1.01) respectively. Conversely, the consultations for COPD and spirometry measurements remained significantly lower after the lockdown compared to pre-pandemic levels, (RR = 0.72, 95%CI=0.65-0.80) and (RR = 0.26, 95%CI=0.20-0.34) respectively. Surprisingly, the mean HbA1c value in the study population was significantly lower in the months after the lock-down (RR = 0.96, 95%CI=0.94-0.98) turning back to higher normal value at the end of 2021. Conclusions The recovery of primary care for chronic diseases after the lockdown phase was much faster for DM than for the COPD patients. The positive effect of lockdown on HbA1c was unfortunately temporary. More research is needed to know whether the decrease in chronic care has led to extra morbidity or mortality after 2 years of pandemic. Key messages • Diabetes mellitus’ care recovered soon for both deprived and non-deprived neighbourhoods after a significant drop during the lockdown. Lockdown seems to have a positive effect on disease management. • The significant delay in chronic care for COPD patients in both deprived and non-deprived neighbourhoods for almost two years, raises questions about the adverse health effects due to this delay.

THU130 Long Term Tracking Of HbA1c Levels Across The Life Span In Type 1 Diabetes: From Infants To Young Adults

Abstract Disclosure: S. Kim: None. K. Song: None. M. Lee: None. J. Seo: None. H. Chae: None. H. Kim: None. A. Kwon: None. Objectives HbA1c is the most important monitoring value and generally used in diabetes. However, HbA1c may change across the life span according to growth and puberty. This study explores the long-term tracking of HbA1c from infants to young adults diagnosed with Type 1 Diabetes mellitus (T1DM) and analyzes the effects of HbA1c according to life span on complications. Method This retrospective study, included 289 patients (M, 43.0%; mean first visit age, 7.39±3.94 years old; mean followed up periods, 4.32±3.15 years) diagnosed with T1DM. The total of 6368 HbA1c values were analyzed. The distribution of HbA1c values according to age and life period was evaluated. In addition, the differences in mean HbA1c values according to sex and the use of continuous glucose monitoring (CGM) were analyzed. Furthermore, it was analyzed which HbA1c of life period has the most influence on occurrence of complications. Result The level of HbA1c was relatively high at the age of 1- to 2-years, and then decreased between 4 to 5-years. After 5 years of age, HbA1C gradually escalated and peaked at the age of 12- to 15-years, during puberty. Especially for girls, HbA1c increased dramatically during puberty between the age of 10- to 13-years, which was consistent with the physiologic insulin resistance. During in childhood to young adulthood, the mean HbA1c of CGM users was lower than that of non-users. The higher mean HbA1c during all ages affected the occurrence of complications. Intriguingly, the HbA1c level during adolescence was important for the occurrence of diabetic retinopathy. Conclusion HbA1c level change across life span, and peaked at pubertal stage, which consistent with physiologic insulin resistance during puberty. In addition, good glycemic control in adolescence may reduce the occurrence of diabetic retinopathy. Therefore, using CGM in adolescence may be helpful for glycemic control and prevention of diabetic complications. Presentation: Thursday, June 15, 2023