Glycemic Monitoring Research Articles

HFpEF and glycemic variability: GHIDD Trial

Abstract Background Recently the guidelines of European Association of Preventive Cardiology reported that the prevalence of diabetes mellitus in patients with diastolic heart failure (HFpEF) is around 31%. Glunovo® is a transdermal device capable of detecting and storing the concentration of glucose in the abdominal interstitial fluid 480 times a day for up to 14 consecutive days. Purpose In our study we evaluated the non diabetic patients with HFpEF with Glunovo to evaluate the glycaemic variability in this population Methods 100 patients with HFpEF admitted to cardiology units of 4 Italian centres on the major islands were enrolled consecutively. Glunovo® was applied to each enrolled patient for 7 days. At the end of the glycaemic monitoring were calculated for each patient the glycaemic variability and the incidence of hyperglycaemia and hypoglycaemia. Glycaemic variability refers to a blood glucose value of ≥ 200 mg / dL or ≤ 59 mg / dL detected more than 3 times in a day for at least 4 days. The inclusion criterion was the presence of diastolic heart failure while the only exclusion criterion was the presence of diabetes diagnosis. Overall, 43 males and 57 females were enrolled with a mean age of 69.3 years (39-87 years). All patients underwent a timely glucose measurement at admission which excluded the presence of hyperglycaemia. No potentially hyperglycaemic drugs were added to the treatment during the hospital stay. Continuous glucose monitoring was performed as an integral part of the hospitalization diagnostic routine. Results In 94 of the 100 patients enrolled it was possible to conclude the analysis, detecting the glycaemic variability, the point glycaemia values and the estimated glycated haemoglobin value. A glycaemia ≥200 mg/dL was found in 53 patients (56%) while a high glycaemic variability was found in 51 patients (54%). A blood glucose value <59 mg / dl was found in 48 patients (51%). Only 5 times the estimated glycated Hb values were> 7%. 32 of the patients who had at least 3 punctual glucose values ≥200 mg/dL were prescribed an oral glucose load curve, which in 100% of cases confirmed the diagnosis of diabetes.No statistically significant differences were found based on age group or sex. In the control group, consisting of 10 patients without DHF undergoing continuous glucose monitoring at one of the participating cardiology units, an unknown hyperglycaemia was found in only 1 patient (10%) and a glycaemic variability in only 1 patient (10%). Conclusions Our experience suggests an incidence of hyperglycaemia and glycaemic variability more then 65% in patients affected by HFpEF. If our data were reproducible on a large scale, a so high prevalence of diabetes in patients with HFpEF cold explain the efficacy of SGLT-2 inhibitor and GLP-1 Agonist in this class of patients.

The Contribution of Postprandial Glucose Levels to Hyperglycemia in Type 2 Diabetes Calculated from Continuous Glucose Monitoring Data: Real World Evidence from the DIALECT-2 Cohort.

Traditional glycemic monitoring in type 2 diabetes is limited, whereas continuous glucose monitoring (CGM) offers better insights into glucose fluctuations. This study aimed to determine the correlations and relative contributions of fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels to hyperglycemia. We utilized CGM and recorded carbohydrate intake data from lifestyle diaries of 59 patients enrolled in the Diabetes and Lifestyle Cohort Twente (DIALECT-2). Correlations between FPG and the glucose management indicator (GMI), FPG and Time Above Range (TAR), PPG and GMI, and PPG and TAR were conducted. Daily and mealtime relative contributions of PPG and FPG to glycated hemoglobin (HbA1c) and GMI were determined, considering two ranges: on target (<7.0%, 53 mmol/mol) and not on target (≥7.0%, 53 mmol/mol). Correlations between mealtime PPG and carbohydrate consumption were examined. FPG and PPG correlated with GMI (r = 0.82 and 0.41, respectively, p < 0.05). The relative contribution of PPG in patients with HbA1c, GMI, and TAR values not on target was lower than in patients with HbA1c, GMI, and TAR values on target. When analyzing different mealtimes, patients with target GMI values had a higher PPG (73 ± 21%) than FPG after breakfast (27 ± 21%, p < 0.001). Individuals with elevated GMI levels had lower PPG after lunch (30 ± 20%), dinner (36 ± 23%), and snacks (34 ± 23%) than FPG. PPG after breakfast positively correlated (r = 0.41, p < 0.01) with breakfast carbohydrate intake. Both PPG and FPG contribute to hyperglycemia, with PPG playing a larger role in patients with better glycemic control, especially after breakfast. Targeting PPG may be crucial for optimizing glucose management.

Nerve conduction velocity studies in diabetic peripheral neuropathy involving sural nerve—A meta-analysis

ABSTRACT Introduction: Diabetes mellitus (DM) poses a significant health burden globally, impacting millions due to its metabolic disruptions. Among its complications, diabetic peripheral neuropathy (DPN) is a prevalent concern, affecting sensory and motor nerves. While various diagnostic methods exist, discrepancies persist in prevalence estimates of DPN among diabetic populations. Objective: This meta-analysis aimed to assess the prevalence of DPN in individuals with DM, focusing on sural nerve conduction velocity (NCV) measurements. Additionally, the study explored how different evaluation techniques influenced prevalence estimates. Methods: A systematic literature search was conducted following PRISMA guidelines across multiple databases. Studies reporting sural nerve NCV measurements in diabetic patients were included. Data extraction, quality assessment, and statistical analyses were performed to synthesize findings. Results: Twenty-six studies met the inclusion criteria, providing insights into sural nerve NCV among diabetic individuals. Pooled analysis revealed a mean sural nerve NCV of 42.12 m/s (95% CI: 39.87-44.36), indicative of reduced conduction velocity in diabetic populations. Furthermore, sural nerve amplitude was significantly lower in diabetic individuals, with a pooled mean of 4.68 μV (95% CI: 3.11-6.25). Conclusion: Individuals with type 2 DM exhibit impaired sural nerve function, as evidenced by reduced NCV and amplitude measurements. Timely NCV assessment, alongside glycemic monitoring, is crucial for identifying and managing DPN to prevent further complications. Interventions addressing glycemic control, dietary regulation, and lifestyle modifications are recommended to mitigate the progression of neuropathy in diabetic populations.

Harnessing cellular therapeutics for type 1 diabetes mellitus: progress, challenges, and the road ahead.

Type 1 diabetes mellitus (T1DM) is a growing global health concern that affects approximately 8.5 million individuals worldwide. T1DM is characterized by an autoimmune destruction of pancreatic β cells, leading to a disruption in glucose homeostasis. Therapeutic intervention for T1DM requires a complex regimen of glycaemic monitoring and the administration of exogenous insulin to regulate blood glucose levels. Advances in continuous glucose monitoring and algorithm-driven insulin delivery devices have improved the quality of life of patients. Despite this, mimicking islet function and complex physiological feedback remains challenging. Pancreatic islet transplantation represents a potential functional cure for T1DM but is hindered by donor scarcity, variability in harvested cells, aggressive immunosuppressive regimens and suboptimal clinical outcomes. Current research is directed towards generating alternative cell sources, improving transplantation methods, and enhancing cell survival without chronic immunosuppression. This Review maps the progress in cell replacement therapies for T1DM and outlines the remaining challenges and future directions. We explore the state-of-the-art strategies for generating replenishable β cells, cell delivery technologies and local targeted immune modulation. Finally, we highlight relevant animal models and the regulatory aspects for advancing these technologies towards clinical deployment.

Value of Glycemic Dispersion Index in Predicting Major Adverse Cardiovascular Events in Diabetic Patients with Concomitant Acute Coronary Syndrome.

This investigation aims to assess the predictive value of the glycemic dispersion index (GDI), calculated by incorporating glycated hemoglobin, fasting plasma glucose, and 2-hour postprandial plasma glucose, in predicting major adverse cardiovascular events (MACE) within a 12-month timeframe for diabetic patients with concomitant acute coronary syndrome (ACS). A retrospective study was conducted on 3261 diabetic patients with ACS who were hospitalized in the Department of Cardiology, the Sixth Affiliated Hospital of Kunming Medical University, from January 2016 to July 2022. Based on the inclusion and exclusion criteria, 512 patients were ultimately enrolled in the study. Their general information and laboratory test indicators were collected, and the occurrence of MACE within 12 months after admission was followed up and recorded for the enrolled patients, With the last follow-up having been concluded on July 31, 2023. The enrolled patients were stratified into four groups (Q1, Q2, Q3, Q4) based on their GDI values, from the lowest to the highest. Cox proportional hazards regression analysis and Kaplan-Meier survival analysis were employed to investigate the risk factors associated with MACE occurrence across these groups and to assess the cumulative risk of MACE over time within each group. The percentages of enrolled patients experiencing MACE in groups Q1 to Q4 were 10.16%, 12.50%, 15.63%, and 16.41%, respectively. GDI independently predicted the hazards for MACE in enrolled patients. The cumulative risk of MACE over time was considerably more significant in those with a GDI>4.21 than those with a GDI≤4.21. The elevated GDI is correlated with an augmented risk of MACE in diabetic patients with concomitant ACS, thereby serving as an early indicator for assessing the unfavorable clinical prognosis of patients. This study offers novel insights into glycemic variability monitoring, enhancing prevention and treatment strategies for cardiovascular disease in people with diabetes.

Glycated albumin may have a complementary role to glycated hemoglobin in glucose monitoring in childhood acute leukemia.

Glycated hemoglobin (HbA1c) as a glycemic index may have limited value in pediatric patients with acute leukemia as they often present with anemia and/or pancytopenia. To address this issue, we evaluated the usefulness of glycated albumin (GA) as a glycemic monitoring index in pediatric patients with acute leukemia. Medical records of 25 patients with type 2 diabetes mellitus (T2DM), 63 patients with acute leukemia, and 115 healthy children from Seoul St. Mary's Hospital, The Catholic University of Korea, were retrospectively investigated for serum GA, HbA1c, and fasting blood glucose (FBG) levels, along with demographic data. GA, HbA1c, and FBG levels did not differ between the control and acute leukemia groups. In the T2DM group, positive correlations were observed among GA, HbA1c, and FBG (P<0.01). Although GA level was not associated with the HbA1c level in the control group, GA and HbA1c levels showed a positive correlation in the acute leukemia group (P=0.045). Regression analysis revealed GA and HbA1c levels to be positively correlated in the acute leukemia and T2DM groups even after adjusting for age, sex, and body mass index z-score (P=0.007, P<0.01). GA may be a useful complementary parameter to HbA1c for glycemic monitoring in pediatric patients with acute leukemia, similar to its use in patients with T2DM.

New Onset Diabetes After COVID 19 (NODAC) is predominantly due to exacerbated Insulin Resistance (IR) rather than beta cell dysfunction: Lessons from tertiary care hospital data during confluence of two epidemics.

To investigate determinants of new onset diabetes after COVID-19 (NODAC) and its recovery at 6 months. This was an observational follow up study conducted from August, 2020 to July, 2023, recruiting patients with preexisting DM and COVID 19 patients with no history of DM. Multivariate regression analysis was used to determine the factors responsible for severity of COVID 19 infection in preexisting DM group. Clinical, laboratory and glycometabolic parameters were estimated at baseline and 6 months in NODAC and euglycemic group to determine the factors responsible for NODAC and its persistence at 6 months. Of 1310 patients, 855 (65.3%) COVID 19 patients were further divided based on their glycemic status: preexisting DM (19%), NODAC (8.5%) and euglycemia (72.5%). Older age and male gender were independent risk factors for severe COVID 19 disease in patients with preexisting diabetes. Prevalence of NODAC in present study was 8.5%. Patients with NODAC had higher mean fasting blood glucose (FBG), random blood glucose (RBG) and HbA1c at baseline as compared to COVID with euglycemic group with no difference in serum C-peptide levels. Female gender, family history of DM, signs of insulin resistance, higher BMI, WHR, HbA1c, serum insulin levels, FBG and RBG predicted persistence of NODAC at 6 months. Preexisting DM is a risk factor for severe COVID 19 disease. Patients with NODAC have evidence of persistence insulin resistance on follow up, underscoring the need for long term glycemic monitoring.

CLINICAL SIGNIFICANCE OF FLASH MONITORING GLYCEMIA INDICATORS IN CHILDREN WITH TYPE 1 DIABETES MELLITUS

One of the basic principles of the treatment of type 1 diabetes mellitus, along with insulin therapy and diet therapy, is regular self-monitoring of glycemia. Glucose meters are most often used for daily self-monitoring, and in recent years devices for continuous and flash monitoring of glycemia have been used. The article discusses the clinical aspects of the application of a glycemic monitoring system with periodic scanning (flash monitoring). The principle of operation of the system is described, as well as the main parameters obtained when using this system – time in the target range, time above and below the target range and their sub-ranges, an indicator of glycemic variability and an indicator of glycemic control, their normative levels, as well as their practical significance and relationship with the clinical aspects of the course of diabetes mellitus and the prognosis of chronic complications. The results of major international and domestic studies on the effectiveness of the flash monitoring system in different age groups are presented. The advantages of the second generation of flash glycemia monitoring sensors are described, and the results of clinical studies of the accuracy of this monitoring system in both children and adult patients with diabetes mellitus are presented.

Diabetes Overtreatment and Hypoglycemia in Older Patients With Type 2 Diabetes on Insulin Therapy: Insights From the HYPOAGE Cohort Study.

To assess the accuracy of "diabetes overtreatment" proxy definitions in predicting hypoglycemia in older adults with type 2 diabetes (T2D). Inclusion of patients from HYPOAGE cohort with insulin-treated T2D, aged ≥75 years, and using a continuous glycemic monitoring (CGM) device for 28 days. "Diabetes overtreatment" was defined as HbA1c < 7.0% (fixed proxy definition) or as HbA1c < 7.0%, 7.5% and 8.0% according to patient's health status (individualized proxy definition). The primary outcome was time below range (TBR) ≥ 1%. Of the 134 patients included (81.6 ± 5.4 years, 59% male), 25 (19%) and 53 (40%) were overtreated, based on fixed and individualized proxy definitions, respectively. CGM data showed TBR >1% in nearly all patients regardless of overtreatment status. Both proxy definitions had low sensitivity (20% [14%; 29%] and 41% [32%; 50%]) and accuracy (27% [20%; 35%] and 44% [35%; 53%]) in predicting hypoglycemia. A revised definition of diabetes overtreatment is needed to better manage older insulin-treated patients and protect them from hypoglycemia.

MODY diabetes as an orphan disease: literature review

BACKGROUND. Maturity-onset diabetes of the young (MODY) is the most common form of monogenic diabetes, usually diagnosed before the age of 30 years in non-obese patients with a family history of diabetes mellitus (DM). MODY is relatively rare compared to type 1 and type 2 DM, with various literature estimates affecting only 1-2 % of people with diabetes, but because it is rare, clinicians may misdiagnose it as type 1 or type 2 DM, which happens in most cases. Unlike type 1 DM patients, patients with MODY have preserved pancreatic β-cell function, so lifestyle modification in combination with glucose-lowering therapy, which in some cases may include insulin, may be sufficient interventions as treatment. OBJECTIVE. With the help of literary sources, familiarize yourself with the classification, clinical manifestations, aspects of treatment and prognosis of the main forms of MODY diabetes. MATERIALS AND METHODS. Object: MODY diabetes as an orphan disease. Research method: a review of literary sources. RESULTS. MODY is most often an autosomal dominant disease and is divided into subtypes (MODY1 to MODY14) based on genetic mutation. Subtypes 1-3 are the most common, accounting for 95 % of cases. Treatment usually includes diet, exercise, and, in some cases, insulin or oral hypoglycemic drugs. In general, the prognosis can be quite favorable, provided that carbohydrate metabolism is compensated. CONCLUSIONS. MODY diabetes is a complex genetically determined pathology, and understanding the features of this disease, diagnosis and treatment are of great importance for patients and their families. The development of modern methods of treatment and monitoring of glucose, such as insulin pumps, 24-hour glycemic monitoring and other technologies, may improve the prognosis for patients with MODY. Each patient with MODY diabetes has individual characteristics, which leaves an imprint on the prognosis of the disease and approaches to treatment. The main goal is to maintain a normal level of glucose in the blood to avoid complications.

Glucose evaluation and management in the ICU (GEM-ICU): Protocol for a bi-centre cohort study.

Hyperglycaemia is common in intensive care unit (ICU) patients. Glycaemic monitoring and effective glycaemic control with insulin are crucial in the ICU to improve patient outcomes. However, glycaemic control and insulin use vary between ICU patients and hypo- and hyperglycaemia occurs. Therefore, we aim to provide contemporary data on glycaemic control and management, and associated outcomes, in adult ICU patients. We hypothesise that the occurrence of hypoglycaemia in acutely admitted ICU patients is lower than that of hyperglycaemia. We will conduct a bi-centre cohort study of 300 acutely admitted adult ICU patients. Routine data will be collected retrospectively at baseline (ICU admission) and daily during ICU stay up to a maximum of 30 days. The primary outcome will be the number of patients with hypoglycaemia during their ICU stay. Secondary outcomes will be occurrence of severe hypoglycaemia, occurrence of hyperglycaemia, time below blood glucose target range, time above target range, all-cause mortality at Day 30, number of days alive without life support at Day 30 and number of days alive and out of hospital at Day 30. Process outcomes include the number of in-ICU days, glucose measurements (number of measurements and method) and use of insulin (including route of administration and dosage). All statistical analyses will be descriptive. This cohort study will provide a contemporary overview of glucose evaluation and management practices in adult ICU patients and, thus, highlight potential areas for improvement through future clinical trials in this area.

Analysis of glycemia during olaparib therapy in patients with ovarian cancer.

e17559 Background: Olaparib (poly(ADP-ribose) polymerase inhibitor) is a relatively new anticancer drug and some of its metabolic side effects, such as its effect on blood glucose, are not yet well defined. The aim of the study was a retrospective analysis to investigate olaparib-induced changes in glucose levels in patients with ovarian cancer (OC). Methods: The study was conducted on 32 OC patients with normoglycemia (3.9–5.5 mmol/l) confirmed before olaparib treatment. The fasting glucose (FG) levels were estimated after I (one month), II (two months), and III (three months) courses of olaparib treatment. The severity of hyperglycemia was graded according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Results: During treatment with olaparib, grade 1 hyperglycemia was found in 18 patients (56.2%), therefore hemoglobin A1C level measurement was recommended. The number of patients with impaired fasting glucose (5.6–6.9 mmol/l), characteristic of a pre-diabetic state, was 17 (53.1%), while glycemia indicative of diabetes (≥7.0 mmol/l) were found in 1 patient (3.1%). The statistically significant increase in glycemia was observed after I course of treatment (p&lt; 0.0001), then after the second (p=0.0003), and III course (p=0.0025). Conclusions: During olaparib therapy, hyperglycemia was observed in 56.2% of the analyzed OC patients, implying the need for glycemic monitoring during monthly routine check-ups to implement effective behavioral and therapeutic management.

HFPEF AND GLYCEMIC VARIABILITY: GHIDD TRIAL

Abstract Background Recently the guidelines of European Association of Preventive Cardiology reported that the prevalence of diabetes mellitus in patients with diastolic heart failure (HFpEF) is around 31%. Purpose In our study we evaluated the non diabetic patients with HFpEF with Glunovo® to evaluate the glycaemic variability in this population. Methods 100 patients with HFpEF admitted to cardiology units of 4 Italian centres on the major islands were enrolled consecutively. Glunovo® was applied to each enrolled patient for 7 days, At the end of the glycaemic monitoring were calculated for each patient the glycaemic variability and the incidence of hyperglycaemia and hypoglycaemia. Glycaemic variability refers to a blood glucose value of ≥ 200 mg / dL or ≤ 59 mg / dL detected more than 3 times in a day for at least 4 days. Overall, 43 males and 57 females were enrolled with a mean age of 69.3 years (39–87 years). All patients underwent a timely glucose measurement at admission which excluded the presence of hyperglycaemia. No potentially hyperglycaemic drugs were added to the treatment during the hospital stay. Results In 94 of the 100 patients enrolled it was possible to conclude the analysis, detecting the glycaemic variability, the point glycaemia values and the estimated glycated haemoglobin value. A glycaemia ≥200 mg/dL was found in 53 patients (56%) while a high glycaemic variability was found in 51 patients (54%). A blood glucose value &amp;lt;59 mg / dl was found in 48 patients (51%). Only 5 times the estimated glycated Hb values were&amp;gt; 7%. 32 of the patients who had at least 3 punctual glucose values ≥200 mg/dL were prescribed an oral glucose load curve, which in 100% of cases confirmed the diagnosis of diabetes.No statistically significant differences were found based on age group or sex. In the control group, consisting of 10 patients without DHF undergoing continuous glucose monitoring at one of the participating cardiology units, an unknown hyperglycaemia was found in only 1 patient (10%) and a glycaemic variability in only 1 patient (10%). Conclusions Our experience suggests an incidence of hyperglycaemia and glycaemic variability more then 65% in patients affected by HFpEF. If our data were reproducible on a large scale, a so high prevalence of diabetes in patients with HFpEF cold explain the efficacy of SGLT–2 inhibitor and GLP–1 Agonist in this class of patients.

Effect of COVID-19 lockdown on glycated haemoglobin testing and utilisation in KwaZulu-Natal, South Africa.

Diabetic monitoring and treatment guidelines are easily accessible, but compliance is poor in KwaZulu-Natal. The coronavirus disease 2019 (COVID-19) pandemic had a devastating impact on diabetic healthcare, both directly and through public health interventions. This study aimed to close the gaps in knowledge concerning glycated haemoglobin (HbA1c) test utilisation and how this was affected by the COVID-19 lockdown in KwaZulu-Natal. We reviewed HbA1c test volumes and results from public health facilities in the 11 health districts in KwaZulu-Natal, South Africa. We compared testing trends and glycaemic control between two 10-month study periods before (March 2019 - December 2019) and during (March 2020 - December 2020) the COVID-19 pandemic. The number of HbA1c tests performed decreased 6.1% during the pandemic period, with 173 760 HbA1c tests performed in 2019 and 163 236 HbA1c tests performed in 2020. There was a statistically significant increase in the average HbA1c level during the pandemic (mean HbA1c level in the pre-pandemic period: 70.5 mmol/mol [8.6%] versus mean HbA1c level in the pandemic period: 72.7 mmol/mol [8.8%]; p-value < 0.001). Of patients with suboptimal HbA1c results (83 421 in 2019, 83 259 in 2020), 11 656 (14.0%) in 2019 and 10 086 (12.1%) in 2020 had more than one HbA1c test performed during the study period. The COVID-19 pandemic impacted glycaemic monitoring in KwaZulu-Natal with lower HbA1c test volumes and worse glycaemic control seen during the pandemic. HbA1c testing practices are not in keeping with recommended guidelines. The study demonstrates that the COVID-19 pandemic impacted HbA1c utilisation in KwaZulu-Natal. Importantly, HbA1c testing practices in KwaZulu-Natal are not in keeping with Society for Endocrinology, Metabolism and Diabetes of South Africa guidelines regarding the monitoring of diabetic patients, and this requires more attention for future diabetic healthcare interventions.

Hyperglycaemia in people with diabetes and chronic kidney disease

Assessment and treatment of hyperglycaemia in people with diabetes and chronic kidney disease (CKD) are challenging. In advanced CKD HbA1c can be unreliable, and treatment adjustments should be supported by other glucose measurements (e.g., continuous glucose monitoring (CGM) or blood glucose measurements). Glucose-lowering treatments should be evaluated based on CKD and an individualised assessment of risk factors especially hypoglycaemia. This review aims at providing an overview of the options for glycaemic monitoring and glucose-lowering treatments in people with diabetes and CKD.

A smart device for smart self-monitoring of glycemia in patients with diabetes

A smart device for smart self-monitoring of glycemia in patients with diabetes

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

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

Emerging biosensor probes for glycated hemoglobin (HbA1c) detection.

Glycated hemoglobin (HbA1c), originating from the non-enzymatic glycosylation of βVal1 residues in hemoglobin (Hb), is an essential biomarker indicating average blood glucose levels over a period of 2 to 3 months without external environmental disturbances, thereby serving as the gold standard in the management of diabetes instead of blood glucose testing. The emergence of HbA1c biosensors presents affordable, readily available options for glycemic monitoring, offering significant benefits to small-scale laboratories and clinics. Utilizing nanomaterials coupled with high-specificity probes as integral components for recognition, labeling, and signal transduction, these sensors demonstrate exceptional sensitivity and selectivity in HbA1c detection. This review mainly focuses on the emerging probes and strategies integral to HbA1c sensor development. We discussed the advantages and limitations of various probes in sensor construction as well as recent advances in diverse sensing strategies for HbA1c measurement and their potential clinical applications, highlighting the critical gaps in current technologies and future needs in this evolving field.

Exploring the Impact of Iron Deficiency Anaemia on Glycated Haemoglobin A1c Levels in Pregnant and Non-Pregnant Women: A Systematic Review.

Haemoglobin A1C (HbA1c) is fundamental in monitoring glycaemic control during pregnancy. However, several conditions could affect this test's accuracy, including iron deficiency anaemia (IDA). Hence, this systematic review delves into the underexplored connection between IDA, iron replacement therapy (IRT), and haemoglobin A1C (HbA1c) during pregnancy. An electronic search of the Cochrane, MEDLINE, and Embase databases was conducted by six authors. From a comprehensive search strategy, 968 records were obtained. After applying the inclusion and exclusion criteria, seven studies were included, comprising 365 women selected for analysis. Six studies indicated a positive correlation between IDA and HbA1c levels, while one found no correlation. The average HbA1c level of the included studies in pregnant women was 5.64%. In comparison, it was found that non-pregnant women had lower HbA1c levels. Among the included studies, the mean HbA1c levels decreased from 5.1% to 4.89% after treating pregnant women with IRT. The review emphasises the complexity of interpreting HbA1c levels in pregnant women with IDA, highlighting the influence of pregnancy-induced physiological changes. In addition, this suggests that HbA1c should not be the sole criterion for diabetes management in pregnant women with IDA. Future research should focus on alternative glycaemic monitoring methods unaffected by IDA.

Boronate crosslinking-based ratiometric electrochemical assay of glycated albumin

As a product of nonenzymatic glycation, glycated albumin (GA) is a promising serum marker for the short-term glycemic monitoring in patients with diabetes. On the basis of the boronate crosslinking (BCL)-enabled direct labeling of ferrocene (Fc) tags to the nonenzymatically glycated (NEG) sites, we report herein a novel aptamer-based ratiometric electrochemical (apt-REC) platform for the point-of-care (POC) assay of GA. This apt-REC platform is based on the recognition of GA proteins by the methylene blue (MB)-modified aptamer receptors and the labeling of the Fc tags to the NEG sites via the BCL. Using MB as the reference tag and Fc as the quantification tag, the ratio of the oxidation currents (i.e., IFc/IMB) can serve as the yardstick for the ratiometric assay of GA. Due to the presence of tens of the NEG sites, each GA protein can be labeled with tens of quantification tags, permitting the amplified assay in a simple, time-saving, and low-cost manner. The ratiometric signal exhibited a good linear response over the range from 0.1 to 100 μg/mL, with a detection limit of 45.5 ng/mL. In addition to the superior reproducibility and robustness, this apt-REC platform is highly selective (capable of discriminating GA against human serum albumin (HSA)) and applicable to GA assay in serum samples. Due to its low cost, high reproducibility and robustness, simple operation, and high sensitivity and selectivity, this apt-REC platform holds great promise in the POC assay of GA for diabetes management.