Monitoring Of Glycemic Control Research Articles

Educational Model and Prevention on Prediabetes: A Systematic Review.

Prediabetes is a reversible condition before the onset of Type 2 Diabetes Mellitus. Untreated condition of prediabetes will develop into diabetes and its complications. The prevalence of prediabetes has been emerging worldwide and has a considerable socioeconomic impact. The current study reviews the roles of early detection, educational models, life modification, and prophylaxis of individuals with prediabetes in preventing the progression of prediabetes into Type 2 Diabetes Mellitus and complications in the future. This study included published articles from several electronic databases. The obtained articles were limited to March 2023. Articles that were not open access and not in Indonesian or English were excluded. The protocol for this study used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020. Of 39627 articles, 39601 were excluded due to duplication and did not meet the eligibility criteria. At the final, there were 26 articles that were eligible for systematic review. Prevention of the development of prediabetes into diabetes is essential. A comprehensive understanding and training on intensive lifestyle modification protocols from local and national experts in diabetes prevention through digital-based education models and linguistically and culturally approach can be considered. Intensive lifestyle modification and pharmacological approaches may improve the outcome. Regular monitoring of glycemic control is also important for early diagnosis of diabetes, especially in patients with special conditions.

HbA1c and Pulsatility Index in Middle Cerebral Artery of Patients with Acute Thrombotic Stroke

Highlights:1. The findings of this study indicate that clinicians should remain vigilant, as effective glycemic control, reflected by optimal HbA1c levels, does not necessarily correlate with favorable distal cerebrovascular resistance, as measured by pulsatility index (PI).2. This study recommends that patients with acute thrombotic stroke undergo a comprehensive examination to ensure an accurate diagnosis and appropriate treatment. Abstract Stroke is the second leading cause of death and disability in the world. Diabetes mellitus is a risk factor for stroke with an increase in blood viscosity associated with hyperglycemia, and HbA1c is a well-established biomarker primarily used for the long-term monitoring of glycemic control in patients with diabetes mellitus. The Pulsatility index (PI) parameter of Trans Cranial Doppler (TCD) can measure blood vessel resistance. This study was to prove the correlation between HbA1c and PI in Middle Cerebral Artery (MCA) of acute thrombotic stroke patients. A cross-sectional study was conducted to thrombotic stroke patients treated at the neurological ward of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia from March 2019 to April 2020 who met the inclusion and exclusion criteria. Data were obtained from medical records. Statistical analysis was performed using Spearman test for numerical data and Chi-square for categorical data with a significant value of p <0.05. There were 32 subjects who met the inclusion and exclusion criteria. A total of 24 subjects (75%) were males and 8 (25%) females with a mean age of 56.41±13.22 years. PI MCA results were abnormal in 14 subjects (43.75%) with an average of 1.8±0.97 and PI MCA was normal in 18 subjects (56.25%) with an average of 0.87±0.15. The average HbA1c was 6.55±1.9%. There was no statistically significant association observed between HbA1c and PI in MCA examination (r=0.07; p=0.73). In conclusion, the findings of this study indicate the lack of correlation between pulsatility index and HbA1c in patients with acute ischemic stroke. This underscores the importance of comprehensive cerebrovascular evaluation regardless of HbA1c status.

Glycated Haemoglobin A1c in Contrast to Conventional and Novel Biomarkers in the Diagnosis of Diabetes and Monitoring of Glycemic Control: A Review

Glycated Haemoglobin A1c in Contrast to Conventional and Novel Biomarkers in the Diagnosis of Diabetes and Monitoring of Glycemic Control: A Review

Fructosamine and HbA1c: A Correlational Study in a Southeast Asian Population.

Fructosamine correlates well with glycated haemoglobin (HbA1c) in Caucasians. This study investigates this correlation and whether fructosamine can reliably estimate glycated haemoglobin in Southeast Asians. We recruited 193 participants based on 4 HbA1c bands (<6.0%; 6.0 - 7.9%; 8.0- 9.9%; ≥10%) from a secondary hospital in Singapore between August 2017 and December 2021. Blood samples for fructosamine, glycated haemoglobin, albumin, haemoglobin, thyroid stimulating hormone and creatinine were drawn in a single setting for all participants. Scatter plot was used to explore correlation between fructosamine and glycated haemoglobin. Strength of linear correlation was reported using Pearson's correlation coefficient. Simple linear regression was used to examine the relationship between fructosamine and glycated haemoglobin. We performed simple linear regression to study the relationship between fructosamine and HbA1c in the research participants (R2 = 0.756, p<0.01). Further analysis with natural logarithmic transformation of fructosamine demonstrated a stronger correlation between HbA1c and fructosamine (R2 = 0.792, p<0.01). Fructosamine is reliably correlated with HbA1c for the monitoring of glycaemic control in Southeast Asians.

Comparison of Glycated Hemoglobin (Hba1c%) between High Performance Liquid Chromatography (HPLC) and Non-HPLC Methodology

Background: Glycated hemoglobin (HbA1c) serves as a pivotal marker for the long-term management of glucose levels in patients with diabetes. Accurate measurement of HbA1c is crucial for effective diabetes management and prevention of associated complications. While High-Performance Liquid Chromatography (HPLC) is widely used, non-HPLC methods have also gained popularity due to their simplicity and cost-effectiveness. Discrepancies in measurement between these methods have been a concern, impacting clinical decisions. Objective: The objective of this study was to compare the measurement of HbA1c% using HPLC and non-HPLC methods in a cohort of diabetic patients, evaluating the consistency and reliability of these methodologies. Methods: A cross-sectional study was conducted at Hayatabad Medical Complex, MTI, Peshawar from November 2023 to March 2024. A total of 65 diabetic patients aged between 18 and 70 years were enrolled. Participants were excluded if they had conditions known to affect HbA1c measurement. HbA1c levels were measured using both HPLC and non-HPLC methods. Statistical analysis was performed using SPSS version 25, employing t-tests to compare the mean HbA1c levels and Bland-Altman analysis to assess agreement between the two methods. Results: The HPLC method showed a mean HbA1c% of 8.2 (SD = 1.4) while the non-HPLC method showed a mean HbA1c% of 7.6 (SD = 1.3). The Bland-Altman analysis indicated that 91.5% of the values fell within the limits of agreement, suggesting substantial agreement between the methods. The mean difference in HbA1c% between methods was 0.6%, with limits of agreement from -0.3 to 1.5. Conclusion: Both HPLC and non-HPLC methods provided reliable HbA1c measurements, with a high degree of agreement. Despite minor discrepancies in mean values, both methodologies are suitable for the clinical monitoring of glycemic control in diabetic patients. Further studies with larger sample sizes and multiple centers are recommended to validate these findings.

Predictors of glycemic control monitoring in diabetic pregnant women from 449 patients

Predictors of glycemic control monitoring in diabetic pregnant women from 449 patients

Effects of Dietary Carbohydrate Concentration and Glycemic Index on Blood Glucose Variability and Free Fatty Acids in Individuals with Type 1 Diabetes.

Monitoring glycemic control status is the cornerstone of diabetes management. This study aimed to reveal whether moderate-carbohydrate (CHO) diets increase the risk of free fatty acid (FFA) levels, and it presents the short-term effects of four different diet models on blood sugar, glycemic variability (GV), and FFA levels. This crossover study included 17 patients with type 1 diabetes mellitus to identify the effects of four diets with different CHO contents and glycemic index (GI) on GV and plasma FFA levels. Diet 1 (D1) contained 40% CHO with a low GI, diet 2 (D2) contained 40% CHO with a high GI, diet 3 (D3) contained 60% CHO with a low GI, and diet 4 (D4) contained 60% CHO with a high GI. Interventions were performed with sensor monitoring in four-day periods and completed in four weeks. No statistical difference was observed among the groups in terms of blood glucose area under the curve (p = 0.78), mean blood glucose levels (p = 0.28), GV (p = 0.59), and time in range (p = 0.567). FFA and total triglyceride levels were higher in the D1 group (p < 0.014 and p = 0.002, respectively). Different diets may increase the risk of cardiovascular diseases by affecting GI, FFA, and blood glucose levels.

Glycemic Trends in Patients with Thyroid Eye Disease Treated with Teprotumumab in 3 Clinical Trials

ObjectiveAssess incidence, severity, and outcomes of serum glucose excursions in patients with thyroid eye disease who received the insulin-like growth factor-1 receptor inhibitor, teprotumumab, during pivotal clinical trials. DesignAnalysis of pooled glycemic data and longitudinal trends. Subjectsphase 2 and phase 3 (OPTIC) pooled analysis: 170 patients (84 teprotumumab, 86 placebo); OPTIC-X: 51 patients from OPTIC. MethodsTeprotumumab administered as 8 intravenous infusions over 21 weeks. In the phase 2 trial, serum glucose was measured at weeks 1, 4, 15, and 21, with fasting blood collections weeks 1 and 4. In OPTIC and OPTIC-X, serum glucose was measured at each study visit, with fasting draws weeks 1 and 4 (non-diabetic patients) or all visits (diabetic patients). In all studies, hemoglobin A1c (HbA1c) was measured at baseline, 12, and 24 weeks plus weeks 36 and 48 of OPTIC-X. Main Outcome MeasuresSerum glucose and HbA1c over time. ResultsIn the pooled analysis, 9 hyperglycemic episodes were reported in 8 teprotumumab patients; mean HbA1c in teprotumumab patients increased 0.22% from baseline to week 24 (to 5.8%, range 5.0%–7.9%) versus 0.04% in placebo patients (to 5.6%, range 4.6%–8.1%). At study end, 78% of teprotumumab and 87% of placebo patients were normoglycemic. Normoglycemia was maintained from baseline to week 24 in 84% (57/68) of teprotumumab and 93% (64/69) of placebo patients. Of prediabetic patients, 43% (3/7) remained prediabetic in both groups and 29% (2/7) of teprotumumab and 14% (1/7) of placebo patients were diabetic at week 24. OPTIC-X showed a trend toward increased fasting glucose and HbA1c during teprotumumab retreatment and initial therapy (placebo patients from OPTIC). Fasting glucose commonly rose following the first 2-3 infusions and stabilized over subsequent infusions. Most hyperglycemic incidents occurred in patients with baseline prediabetes or diabetes and were controlled with medication. There was no evidence of progression or increased incidence of hyperglycemia with subsequent doses. ConclusionsSerious glycemic excursions are uncommon in patients who are normoglycemic before teprotumumab therapy. Patients with controlled diabetes or impaired glucose tolerance can be treated safely if baseline screening, regular monitoring of glycemic control, and treatment of hyperglycemia are ensured.

A-163 Abnormal HbA1c Results Lead to an Unexpected Chronic Myeloid Leukemia Diagnosis

Abstract Background Hemoglobin A1c (HbA1c) is used to assess and monitor glycemic control, as it reflects average levels of blood glucose over the previous two to three months. HbA1c can be measured by capillary electrophoresis (CE) which calculates percent HbA1c from the HbA1c and HbA peaks in the electropherogram. CE is a prominent method in reference labs as it provides complete automation with fast separation and less interference than what can be observed with other assay formats. The high-resolution capability of CE allows the quantification of HbA1c, even in the presence of labile HbA1c, carbamylated and acetylated hemoglobins, and major hemoglobin variants. These variants are commonly recognized as causes of interference in HbA1c measurements. Case presentation A 70-year-old male with a history of type 2 diabetes mellitus presented to an outpatient laboratory for routine venipuncture to evaluate glycemic management and cardiovascular disease risk. HbA1c analysis by CE resulted with a flag for an atypical profile in the electropherogram and no HbA1c value was reported. HbA1c measurements throughout the past year demonstrated HbA1c values ≥6.5% yet trending downward, consistent with his diagnosis and treatment of diabetes mellitus. HbA1c was repeated with a different instrument and fresh specimen collected at a different phlebotomy location and showed similar inconclusive results. Unusual shifts in hemoglobin peak migration times were observed upon close review of the electropherogram, suggesting a potential analytical interference of the HbA1c measurement. Results Because atypical peak migration times due to elevated leukocyte counts or increased viscosity are documented by the manufacturer, a follow up complete blood count (CBC) was recommended for this patient. CBC results revealed a highly elevated leukocyte count of 175.80 k/μL (reference interval: 4.30–11.30 k/μL), suggesting the abnormal HbA1c migration profile was possibly due to leukocytosis. The elevated leukocyte count led the patient to visit an oncology clinic where leukemia/lymphoma phenotyping, ancillary studies, and cytogenic testing, confirmed a diagnosis of chronic myeloid leukemia. The diagnosis was completely unexpected, as the patient’s only complaint was feeling fatigued over the last few weeks. The patient began chemotherapy treatment immediately. Conclusion The present case is an example of how leukocytosis and hyperviscosity can interfere with HbA1c measurement by CE. Although this specific clinical situation is uncommon, clinicians and laboratorians should be aware of these potential interferences, as they have not been discussed in detail in the literature. Further, these interferences warrant recognition in the cancer patient population, as this population may be directly impacted by elevated leukocyte count and hyperviscosity in their specimens, which may impact glycemic control monitoring during treatment. The incidence of diabetes in cancer patients is six times greater than in the general population, making glycemic control monitoring key for cancer patients. Many diabetic patients undergoing chemotherapy will prioritize their cancer treatment over management of their diabetes, which increases their risk for poor glycemic control. These patients should be carefully monitored to ensure HbA1c results are accurate as poor glycemic control can lead to increased risk for infections and hospitalizations, which may decrease survivorship.

Endocrinology for the hepatologist.

Endocrinology for the hepatologist.

#4126 LONG-TERM VISIT TO VISIT VARIABILITY IN HBA1C AND KIDNEY RELATED OUTCOMES IN PERSONS WITH DIABETES

Abstract Background and Aims Glycated hemoglobin (HbA1c) is central to the routine monitoring of glycemic control in persons with diabetes, and poor glycemic control is an established contributor to the occurrence and progression of CKD, but whether long-term visit-to-visit variability in glycemic control predicts kidney outcomes is not well studied. Method We included all adults with type 1 or type 2 diabetes in Stockholm, Sweden, during 2006–2019, who had at least one annual outpatient HbA1c test in three consecutive years. We evaluated associations between baseline and time-varying HbA1c variability score (HVS, the percentage of total HbA1c measures that vary by &amp;gt;0.5% [5.5 mmol/mol] during a 3-year window), with the risk of CKD progression (composite of &amp;gt;30% eGFR decline and kidney failure), acute kidney injury (AKI, by clinical diagnosis or increase in creatinine ≥0.3 mg/dL over 48 h or 1.5 times creatinine over 7 days), and worsening of albuminuria. Results We included 93,598 adults with diabetes undergoing 891,536 routine HbA1c tests (median 8 tests per person) during a median follow-up of 5.2 years. Compared with persons showing low HbA1c variability (HVS 0–20%), any increase in variability was associated with a higher risk of adverse kidney outcomes. For example, for patients with a baseline HbA1c variability of 81–100%, the adjusted HR was 1.47 (95% CI, 1.38-1.56) for CKD progression, 1.27 [1.19-1.36] for AKI, and 1.28 [1.21-1.36] for worsening of albuminuria. Results were robust across subgroups (diabetes subtypes, baseline eGFR or albuminuria categories) and in sensitivity analyses including time-weighted average HbA1c or alternative metrics of variability. Conclusion A higher long-term visit-to-visit HbA1c variability is robustly associated with the risks of CKD progression, AKI and worsening of albuminuria.

Atherosclerosis: risk assessment and the role of aiming for optimal glycaemic control in young patients with type 1 diabetes.

Compared with healthy children, peers with type 1 diabetes mellitus (DM1) have an increased risk of developing advanced atherosclerosis and cardiovascular disease (CVD). Glycaemic control is the most important modifiable risk factor for CVD in DM1. Currently, monitoring of glycaemic control relies on glycosylated haemoglobin levels (HbA1c), self-monitoring of blood glucose (SMBG), and the use of continuous glucose monitoring (CGM) systems. The flow-mediated dilatation (FMD), pulse wave velocity (PWV), ankle-brachial index (ABI), and carotid intima-media thickness (cIMT) may be used to assess the risk of CVD, by estimating the process of atherosclerosis in peripheral vessels. Aim of the study: To summarize the current literature on the correlation of metabolic control in young people with DM1, assessed by key metrics from CGM reports, and the development of atherosclerosis and the incidence of CVD. Conclusions: Chronic hyperglycaemia is an independent risk factor for vascular changes. The effect of glycaemic control - assessed on the basis of parameters obtained from CGM reports - on the risk of CVD in DM1 has been analysed in few studies, especially in the paediatric population.

Advances in Nanomaterial-Based Biosensors for Determination of Glycated Hemoglobin.

Diabetes is a major public health burden whose prevalence has been steadily increasing over the past decades. Glycated hemoglobin (HbA1c) is currently the gold standard for diagnostics and monitoring glycemic control in diabetes patients. HbA1c biosensors are often considered to be cost-effective alternatives for smaller testing laboratories or clinics unable to access other reference methods. Many of these sensors deploy nanomaterials as recognition elements, detection labels, and/or transducers for achieving sensitive and selective detection of HbA1c. Nanomaterials have emerged as important sensor components due to their excellent optical and electrical properties, tunable morphologies, and easy integration into multiple sensing platforms. In this review, we discuss the advantages of using nanomaterials to construct HbA1c sensors and various sensing strategies for HbA1c measurements. Key gaps between the current technologies with what is needed moving forward are also summarized.

Analytical performances of a glycated albumin assay that is traceable to standard reference materials and reference range determination.

BackgroundGlycated albumin (GA) is an intermediate‐term marker for monitoring glycemic control (preceding 2–3 weeks) in patients with diabetes mellitus. We evaluated the performance of Lucica Glycated Albumin‐L, a new GA assay that is traceable to standard reference materials and determined the reference range in healthy subjects without diabetes.MethodsThe performance and reference range studies were conducted in accordance with Clinical and Laboratory Standards Institute (CLSI) Guidelines. The traceability was established using reference material recommended by the Japan Society of Clinical Chemistry (JSCC).ResultsThe coefficient of variation (CV) of overall repeatability, within‐laboratory precision, and overall reproducibility values of GA values were not more than 2.6%, 3.3%, and 1.6%, respectively, among laboratories. The GA values showed good linearity from 173 to 979 mmol/mol (9.4%–54.9%) across the assay range. The GA reference range in 262 healthy subjects was between 183 and 259 mmol/mol (9.9%–14.2%) while that of subjects with diabetes was 217–585 mmol/mol (11.8–32.6%). The reagent was stable for 2 months on the bench at room temperature. The limits of blank, detection, and qualification were 6.9, 7.9, and 9.7 μmol/L for GA concentration, and 3.8, 7.0, and 21.8 μmol/L for albumin concentration, respectively. Hemoglobin slightly affected the assay, while other classical interfering substances had no significant impact.ConclusionsThe present GA assay shows comparable performance to current clinical assays and could be used for intermediate‐term monitoring of glycemic control in diabetes patients.

Improving Emotional Well‐Being and Cardio‐Metabolic Health with Continuous Glucose Monitoring

Continuous glucose monitoring (CGM) is extensively used in diabetic populations but understudied in non‐diabetic patients. Glycemic variability is a risk factor for cardiovascular disease, and emerging evidence suggests close monitoring of glycemic control may have a positive impact on chronic disease. CGM increases awareness of glycemic dysregulation and empowers patients to create sustainable changes in eating behaviors. The purpose of this study (ClinicalTrials.gov Identifier: NCT04920058) was to determine if access to continuous blood glucose data using a CGM‐Levels software system improves cardiometabolic health, sleep quality, and emotional well‐being in nondiabetic patients undergoing a comprehensive wellness program.In this 12‐week randomized clinical trial, patients enrolled in a low carbohydrate‐based wellness program were randomly assigned to monitor glucose using a CGM with Levels software (CGM, N=14) or classic glucometer (Ctrl, N=11). Weight, BMI, waist circumference, liver fat (via abdominal ultrasound), and a cardiometabolic blood panel were measured pre‐and post‐program. Ketones were tested weekly, and glucose tested daily using a glucometer in both groups (CGM and Ctrl). Psychological measures of emotional well‐being, depression, anxiety and sleep quality were performed with a subjective well‐being survey, Patient Health Questionnaire‐9 (PHQ9), generalized anxiety disorder‐7 (GAD‐7) and Pittsburgh Sleep Quality Index (PSQI), respectively, pre‐program, week 6, and post‐program.Differences were observed between the groups for liver fat which decreased over time in the CGM but not Ctrl group (p&lt;0.05). Other cardio‐metabolic biomarkers improved in both groups over the course of the study, including weight loss, BMI, waist circumference, triglycerides, VLDL, and fasting insulin, but no differences between groups were observed. Total cholesterol, Non‐HDL, LDL, and HDL ratio increased in both groups over time, but did not differ between groups. Assessments of emotional well‐being, depression, anxiety, and sleep quality also improved in both groups over time, again with no intergroup differences.In a non‐diabetic population, a 12‐week comprehensive wellness program inclusive of glycemic monitoring using CGM was effective at improving liver fat while several biomarkers of cardio‐metabolic health, sleep quality, and emotional well‐being improved regardless of the type of glycemic monitor used. CGM was endorsed by patients to be more comfortable and easier to use than finger stick glucometers, and its use did not impair trial results compared to Ctrl. Thus, CGM with Levels software appears to be a viable and effective method for monitoring glycemic variability in a non‐diabetic population seeking to improve cardio‐metabolic health.

Fructosamine as an Index of Short-Term Glycemic Control in Pregnant Women with Diabetes: Before, During and After Ramadan

PurposeImpact of ramadan fasting on healthy and women with diabetes is already known. However, there is a scarcity of data on impact of fasting on pregnant women with diabetes. Moreover, religious and medical recommendations advise pregnant women against fasting as it is unsafe. Despite being exempted, many pregnant Muslim women with diabetes still choose to fast during ramadan. This study investigated different glycemic marker as an indicator for diabetes control in fasting pregnant women.Patients and MethodsThis is a prospective observational study. A total of 89 pregnant diabetes women were recruited. Blood glucose was self-monitored in all the pregnant women using glucose monitoring device at home. We measure the fructosamine, HbA1c levels before, during and after ramadan.ResultsPregnant women with type 1 diabetes were 14 (25%), type 2 diabetes were 21 (37.5%), and gestational diabetes were 21 (37.5%). The mean fructosamine level decreased during and after ramadan in gestation diabetes pregnant women compared to type 2 diabetes and type 1 diabetes pregnant women subjects (p = 0.009).ConclusionThe present study indicates that pregnant women with diabetes were able to fast during ramadan and there fructosamine level reduced during fasting. Utilization of fructosamine for short-term monitoring of glycemic control in addition to home glucose monitoring in pregnant women with diabetes will provide a good index of glycemic control.RecommendationReligious and medical recommendations advise pregnant women against fasting as it is unsafe, and they are under high risk. However, if they insist to do fast, they must do under strict medical supervision and fructosamine can be used as a glycemic control marker.

Glycated haemoglobin (HbA1c) use and glycaemic control in patients living with diabetes mellitus attending public healthcare facilities in KwaZulu-Natal Province, South Africa.

Ideal control of diabetes mellitus (DM) remains a global goal, which has not yet been reached. As part of an integrated public healthcare strategy, data with subsequent analysis of diabetes control achieved in patients living with DM (PLWD) need to be available. Diabetes control data from KwaZulu-Natal (KZN) Province, South Africa, are scarce. Smaller studies conducted in public and private healthcare sectors of KZN have shown suboptimal DM control. To identify the percentage of glycated haemoglobin (HbA1c) tests done in KZN public healthcare facilities, and to provide a glimpse into diabetes control being achieved in each KZN district municipality. Data regarding the number of HbA1c tests performed, number of patients with an HbA1c ≤7% and number of diabetes visits were accessed from the KZN Department of Health Information Systems and analysed. The majority of HbA1c tests were performed in the metro municipality of eThekwini (p&lt;0.001). Approximately two-thirds (64.5%) of PLWD in whom HbA1c tests had been performed, were suboptimally controlled. In 5 of the 11 KZN district municipalities more than two-thirds of PLWD had an HbA1c &gt;7%. Most of the patients in 9 of the 11 district municipalities showed suboptimal control of their DM. The total number of HbA1c tests performed in KZN represents approximately one-tenth of the total number of diabetes treatment visits. This trend was prevalent in all 11 district municipalities, where the incidence of DM was on an upward trajectory. Our study demonstrated that the majority of PLWD visiting public healthcare facilities in KZN have suboptimal glycaemic control. They are at increased risk of developing diabetes-related complications, further burdening the healthcare fiscus of low- to middle-income countries. We also showed that the number of HbA1c tests being performed, in the presence of suboptimal control, was well below par. This finding serves to emphasise the need for strategies to be implemented to increase awareness of HbA1c testing for the monitoring of glycaemic control, and for making point-of-care HbA1c testing readily available in these healthcare facilities.

Glycated Albumin as Marker for Early Hyperglycemia Detection in Adolescent with β Thalassemia Major

BACKGROUND: Hyperglycemia is one of the most common endocrine complications in children with β thalassemia major. Though the current diagnostic marker either requires fasting, has low reproducibility, or it is not an accurate for thalassemia patients. Glycated albumin (GA) is a quick and easy alternative marker for hyperglycemia detection and monitoring of glycemic control. However to date, no studies have analyzed the role of GA value in detection of hyperglycemia in children with thalassemia major. This study analyzed the value of GA as an alternative screening marker for hyperglycemia detection in children with β thalassemia major.METHODS: A single-blind prospective diagnostic test was conducted in 9 to 18 years old children with β thalassemia major and who were treated at the Dr. Moewardi Regional General Hospital between October 1, 2018 and December 31, 2019. In a single, fasted study visit, height, weight, fasting blood glucose (FPG), GA, oral glucose tolerance test (OGTT) were measured. The area under a receiver operating characteristic curve (AUC) was used to determine the cut-off value at which hyperglycemia prediction (OGTT ≥140 mg/dL) display optimal sensitivity and specificity. RESULTS: Among the 53 children with β thalassemia major, 1 (1.9%) had diabetes mellitus and 4 (7.5%) had prediabetes based on their OGTT values. The median GA value in this study was 10.9% (range: 7.6–12.4%). GA had a low AUC (0.646, p=0.287) for hyperglycemia detection in pediatric patients with β thalassemia major. At a cut-off of 11.45%, GA demonstrated 60% sensitivity and 60.4% specificity.CONCLUSION: GA cannot be used as an alternative marker for hyperglycemia detection in children with β thalassemia major.KEYWORDS: hyperglycemia, diabetes mellitus, prediabetes, β thalassemia major, glycated albumin

Management of diabetes mellitus in patients with cirrhosis: An overview and joint statement

Type 2 diabetes mellitus (T2DM) is a frequent comorbidity in patients with cirrhosis that is projected to rise in prevalence due to the worldwide burden of obesity, insulin-resistance and non-alcoholic fatty liver disease. The management of T2DM in patients with cirrhosis is complex given the requirement for accurate adaptation according to the level of liver function impairment, with lack of summary of the little evidence available in the literature. Here, we summarise the data available with respect to the epidemiology and the impact of T2DM in patients with cirrhosis, as well as those on the management of T2DM in these patients. We provide guidance for the diagnosis of T2DM and the monitoring of glycaemic control in patients with cirrhosis, and for the management of nutrition and pharmacological treatments in relation to the level of liver dysfunction.

IMPACT India

India has the second largest population with diabetes mellitus in the world. Long-term, uncontrolled diabetes is associated with increased microvascular and macrovascular (commonly cardiovascular) complications and death. The large burden of uncontrolled diabetes in India could be because of lack of treatment adherence, limited access to laboratory testing, lack of physical activity, and poor dietary habits. This creates a compelling need for a greater involvement of healthcare professionals (HCPs) in improving societal awareness and regular monitoring of glycemic control, which is limited in patient outreach programs. IMPACT India, launched in November 2018, is a diabetes control program with a three-pronged approach aimed at creating an impact at the level of HCPs, society, and individuals living with diabetes. The India Diabetes Care Index (iDCI®), a quarterly aggregate index of glycated hemoglobin, fasting plasma glucose (FPG), and postprandial plasma glucose (PPG), forms the backbone of IMPACT India. The program uses iDCI® to evaluate glycemic control at periodic intervals, sensitize HCPs about the glycemic control status, and optimize diabetes care by escalating pharmacotherapy including insulin whenever required. Societal awareness will be created by social media to achieve actionable awareness based on the iDCI® reports. At baseline (January 2018 to June 2018), the database (2.39 million) revealed an average glycated hemoglobin of 8.56%, FPG of 172 mg/dL, and PPG of 253 mg/dL. Also, 74% of the patients had HbA1c &gt;7% and FPG &gt;130 mg/dL and &gt;83% of the patients had PPG &gt;160 mg/dL. The IMPACT India program aims to positively impact diabetes care in India by achieving at least 1% glycated hemoglobin reduction in 1000 days.