Normal HbA1c Group Research Articles

The Influence of HbA1c and Gestational Weight Gain on Pregnancy Outcomes in Pregnant Women With Gestational Diabetes Mellitus.

BackgroundTo investigate the influence of HbA1c level and GWG on pregnancy outcomes in pregnant women with GDM.MethodsA total of 2,171 pregnant women with GDM were retrospectively included and categorized as follows: (1) normal (HbA1c <6%) and elevated (HbA1c ≥6%) HbA1c groups according to the HbA1c level in the second trimester, and (2) inadequate, appropriate, and excessive GWG groups according to the IOM guidelines.ResultsIn pregnant women with GDM, advanced age and high pre-pregnancy BMI were high-risk factors for elevated HbA1c. Pregnant women with elevated HbA1c had higher OGTT levels than those with normal HbA1c, and the risks of adverse pregnancy outcomes were higher (P < 0.05). The risks of primary cesarean section, hypertensive disorders during pregnancy, and macrosomia in pregnant women with excessive GWG were significantly higher than those with inadequate and appropriate GWG (P < 0.05). When GWG was appropriate, the risk of hypertensive disorders during pregnancy in the elevated HbA1c group was higher than that in the normal HbA1c group. When GWG was excessive, the risks of postpartum hemorrhage, macrosomia, and neonatal asphyxia in the elevated HbA1c group were significantly higher than in the normal HbA1c group (P < 0.05).ConclusionMonitoring and controlling blood glucose levels have shown effectiveness in reducing the adverse pregnancy outcomes in women with GDM, particularly for those who had excessive GWG.

Elevated blood and cerebrospinal fluid glucose levels affect the severity and short-term prognosis of Guillain-Barré syndrome

ABSTRACT Objective This study aimed to explore the correlation of elevated glucose levels in the blood and cerebrospinal fluid with the progression and short-term prognosis of Guillain-Barré syndrome (GBS). Methods The medical records of 982 patients who were diagnosed with GBS in 31 representative tertiary hospitals, located in 14 provinces in southern China, were collected and retrospectively reviewed. Patients were grouped according to the levels of fasting plasma glucose (FPG) and cerebrospinal fluid (CSF) glucose, as well as the concentration of blood hemoglobinAlc (HbA1c). The Hughes grade scale was used to quantify functional outcomes. Results Compared to patients with normal FPG and CSF glucose levels, those in the high FPG and high CSF glucose groups were characterized by a higher proportion of severe patients (HFGS ≥ 3) at admission (58.8 vs. 73.1, P = 0.000; 57.6 vs. 71.2, P = 0.000), at nadir (67.4 vs. 83.0, P = 0.000; 66.2 vs. 80.4, P = 0.000), and at discharge (29.8 vs. 46.3, P = 0.000; 26.4 vs. 45.0, P = 0.000). Patients in the high HbA1c group also had more severe disability at admission (74.6 vs. 56.1, P = 0.005) and at nadir (80.3 vs. 64.3, P = 0.012) compared to the normal HbA1c group. Moreover, elevated levels of FPG and CSF glucose were significantly correlated with more severe disability at admission, at nadir, and at discharge. Conclusions The present study showed that elevated glucose levels in the blood and cerebrospinal fluid were associated with the severity and short-term prognosis of GBS. Trial registration chicTR-RRc-17,014,152. Abbreviations GBS, Guillain-Barré syndrome; FPG, fasting plasma glucose; CSF, cerebrospinal fluid; HFGS, Hughes Functional Grading Scale; HbA1c, hemoglobin A1c. DM, diabetes mellitus; NCS, nerve conduction study; AIDP, acute inflammatory demyelinating polyneuropathy; AMAN, acute motor axonal neuropathy; AMSAN, acute motor sensory axonal neuropathy; MV, mechanical ventilation.

Association between glycated hemoglobin and ambulatory blood pressure or heart rate in hypertensive patients.

To determine the association between glycosylated hemoglobin (HbA1c) and ambulatory blood pressure or heart rate in hypertensive patients. A total of 585 patients, who performed ambulatory blood pressure monitoring (ABPM) from September 2018 to April 2019 in Xiangya Hospital, Central South University, were enrolled and assigned into 2 groups (470 in a hypertensive group and 115 in a normal group). HbA1c levels were compared. According to the HbA1c level, the hypertensive group was divided into 2 subgroups: A high HbA1c group (HbA1c≥6.1%, n=142) and a normal HbA1c group (HbA1c<6.1%, n=328). Whole basic data and ABPM parameter were compared among the groups. Pearson/Spearman correlation analysis was applied to study the association between HbA1c and BPV. Multivariate logistic regression was used to explore the influential factors for HbA1c (≥6.1%) and continuous increase of HbA1c in different hypertensive populations, respectively. The hypertensive group had higher HbA1c level than the normal group [(6.1±1.3)% vs (5.1±1.7)%, P<0.05]. In hypertensive patients, nocturnal systolic blood pressure [(131.1±19.2) mmHg vs (122.5±19.2) mmHg], nocturnal systolic blood pressure load [62.5% (15.5%-100%) vs 28.6% (0-75%)], and daytime heart rate [(74.3±11.6) min-1 vs (71.2±11.4) min-1] of the high HbA1c group were higher than those in the normal HbA1c group (all P<0.05). Pearson/Spearman correlation analysis showed that HbA1c was positively correlated with systolic blood pressure and blood pressure load (both P<0.05). Logistic regression analysis showed that nocturnal systolic pressure load was the risk factor for the increase of HbA1c level (OR=1.025, 95% CI 1.003 to 1.048, P<0.05). Multiple linear regression showed that nocturnal systolic pressure load was still positively correlated with HbA1c in total, tertiary, and hypertensive patients without treatment (β=0.155, β=0.171, β=0.384, respectively, all P<0.05). In hypertensive patients, HbA1c is positively correlated with ambulate blood pressure, blood pressure load, and heart rate, and it has no correlation with blood pressure variability, heart rate variability, or morning blood pressure.

EFFECTS OF GLYCOSYLATED HEMOGLOBIN LEVEL ON BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS

Objective: To investigate the effect of glycosylated hemoglobin (HbA1c) levels on blood pressure variability in hypertensive patients. Design and method: From September 2018 to April 2019, in the Xiangya Hospital of Central South University, 429 case of hypertensive patients with complete basic information, medical records, HbA1c measures and other biochemical indicators, as well as the 24-hour ambulatory blood pressure result were enroll in and divided into two groups (119 in the high HbA1c group with HbA1c more than 6.1 mg/dl and 310 in the normal HbA1c group with HbA1c less than 6.1 mg/dl). The blood variability, night drop rate, and fluctuations were compared between the two groups. Multivariate logistic regression analysis and Pearson correlation analysis were used to explore the relationship between HbA1c level and blood pressure variability. Results: In hypertensive patients, the level of systolic and diastolic pressure during 24-hour, daytime, nighttime and the proportion of non-dipping blood pressure in the high HbA1c group was higher than that in the normal HbA1c group (p &lt; 0.05); There was no significant difference between the two groups in blood pressure load, variability, and nocturnal blood pressure drop rate (p &gt; 0.05).Multivariate logistic regression analysis showed that nocturnal mean systolic blood pressure was a risk factor for increased HbA1c levels, with OR (95% CI) of 1.031 (1.017 to 1.045). Pearson correlation analysis implied that the level of HbA1c was positively correlated with the maximum, the minimum and the average value of 24-hour systolic pressure and mean systolic pressure of daytime and nighttime (r = 0.131, 0.129, 0.155, 0.151, 0.164; p &lt; 0.05). Further analysis of grade 3 hypertensive patients, the high HbA1c group of had the higher value of night systolic pressure load and non-dipping blood pressure ratio. Multivariate logistic regression analysis showed that the mean nocturnal systolic pressure was a risk factor for elevated HbA1c levels, with OR (95% CI) being 3.774 (1.086 to 13.117). Conclusions: HbA1c is closely related to hypertension (especially systolic blood pressure). In the grade 3 hypertensive patients, the elevated HbA1c might increase the value of the nocturnal systolic blood pressure load.

Metabolomics profiles associated with HbA1c levels in patients with type 2 diabetes.

Glycated hemoglobin (HbA1c) is an indicator of the average blood glucose concentration. Failing to control HbA1c levels can accelerate the development of complications in patients with diabetes. Although metabolite profiles associated with HbA1c level in diabetes patients have been characterized using different platforms, more studies using high-throughput technology will be helpful to identify additional metabolites related to diabetes. Type 2 diabetes (T2D) patients were divided into two groups based on the HbA1c level: normal (HbA1c ≤6%) and high (HbA1c ≥9%) in both discovery and replication sets. A targeted metabolomics approach was used to quantify serum metabolites and multivariate logistic regression was used to identify significant differences between groups. The concentrations of 22 metabolites differed significantly between the two groups in the discovery set. In the replication set, the levels of 21 metabolites, including 16 metabolites identified in the discovery set, differed between groups. Among these, concentrations of eleven amino acids and one phosphatidylcholine (PC), lysoPC a C16:1, were higher and four metabolites, including three PCs (PC ae C36:1, PC aa C26:0, PC aa C34:2) and hexose, were lower in the group with normal HbA1c group than in the group with high HbA1c. Metabolites with high concentrations in the normal HbA1c group, such as glycine, valine, and PCs, may contribute to reducing HbA1c levels in patients with T2D. The metabolite signatures identified in this study provide insight into the mechanisms underlying changes in HbA1c levels in T2D.

Glycated Hemoglobin is Associated with Glycemic Control and 6-Month Neurologic Outcome in Cardiac Arrest Survivors Undergoing Therapeutic Hypothermia.

Glucose control status after cardiac arrest depending on chronic glycemic status and the association between chronic glycemic status and outcome in cardiac arrest survivors are not well known. We investigated the association between glycated hemoglobin (HbA1c) and 6-month neurologic outcome in cardiac arrest survivors undergoing therapeutic hypothermia (TH) and whether mean glucose, area under curve (AUC) of glucose during TH, and neuron-specific enolase (NSE) are different between normal and high HbA1c groups. This retrospective single-center study included adult comatose cardiac arrest survivors who underwent TH from September 2011 to December 2017. HbA1c and glucose were measured after return of spontaneous circulation (ROSC), and normal or high HbA1c was defined using cutoff value of 6.4% of HbA1c. Blood glucose was measured at least every 4h and treated with a written protocol to maintain the range of 80-200mg/dL. Hypoglycemia and hyperglycemia were defined with glucose < 70 or > 180mg/dL. Mean glucose during induction and rewarming phase and AUC of glucose during every 6h of maintenance were calculated, and NSE at 48h after cardiac arrest was recorded. The primary outcome was unfavorable neurologic outcome, defined as Glasgow Pittsburgh Cerebral Performance Category scale 3-5 at 6months after cardiac arrest. Of 384 included patients, 81 (21.1%) had high HbA1c and 247 (64.3%) had an unfavorable neurologic outcome. Patients with high HbA1c were more common in the unfavorable group than in favorable group (27.5% vs 9.5%, p < 0.001), and the unfavorable group had significantly higher HbA1c level (5.8% [5.4-6.8%] vs 5.6% [5.3-6.0%], p = 0.007). HbA1c level was independently associated with worse neurologic outcome (odds ratio 1.414; 95% confidence interval 1.051-1.903). High HbA1c group had higher glucose after ROSC, glucose AUC during maintenance, and rewarming phase than normal HbA1c group. High HbA1c group had significantly higher incidence of hyperglycemia throughout the TH, while normal HbA1c group had significantly higher incidence of normoglycemia. However, no glucose parameter remained as an independent predictor of neurologic outcome after adjustment, irrespective of HbA1c level. NSE showed good prognostic performance (area under curve 0.892; cutoff value 26.3ng/mL). Although NSE level was not different between HbA1c groups, high HbA1c group had higher proportion of patient having NSE over cutoff. Higher HbA1c was independently associated with unfavorable neurologic outcome. Glycemic status during TH was different between normal and high HbA1c groups.

HbA1c levels at presentation do not impact the clinical presentation or outcomes in abdominal tuberculosis.

The relationship between diabetes mellitus and tuberculosis (TB) has received increasing attention, and diabetes may be associated with poor outcomes in pulmonary TB. Clinical relevance of HbA1c measurement in abdominal TB is unknown. We did a retrospective study of consecutive patients diagnosed with abdominal TB and treated with antitubercular therapy for 6 months. Patients were categorized as those with normal HbA1c (<5.7%) or those having elevated HbA1c (≥5.7%). The patients' baseline characteristics, their mode of presentation, type of abdominal TB, and their outcomes after treatment were retrieved and compared. Of 84 patients included in the final analysis, the mean age was 35.52 years and 50% were male. While 19 patients had a confirmed diagnosis, 65 patients were diagnosed as probable abdominal TB. Of the 84 patients, 60 patients (71.43%) had a normal HbA1c and 24 patients (28.57%) had an elevated HbA1c. Those with elevated HbA1c were older in age (47.00 ± 13.98 vs. 30.93 ± 13.91; P < 0.001), and there were more males (75.0% vs. 40.0%; P = 0.004) as compared to the normal HbA1c group. However, other parameters such as their presenting features, pattern of abdominal TB, extra-abdominal involvement, outcomes after treatment, and need of intervention (surgery and dilatation) were comparable between both the groups. Presence of prediabetes or diabetes does not seem to impact the clinical presentation or outcomes in patients with abdominal TB.

Effect of Periodontal Treatment on HbA1c among Patients with Prediabetes

Evidence is limited regarding whether periodontal treatment improves hemoglobin A1c (HbA1c) among people with prediabetes and periodontal disease, and it is unknown whether improvement of metabolic status persists >3 mo. In an exploratory post hoc analysis of the multicenter randomized controlled trial “Antibiotika und Parodontitis” (Antibiotics and Periodontitis)—a prospective, stratified, double-blind study—we assessed whether nonsurgical periodontal treatment with or without an adjunctive systemic antibiotic treatment affects HbA1c and high-sensitivity C-reactive protein (hsCRP) levels among periodontitis patients with normal HbA1c (≤5.7%, n = 218), prediabetes (5.7% < HbA1c < 6.5%, n = 101), or unknown diabetes (HbA1c ≥ 6.5%, n = 8) over a period of 27.5 mo. Nonsurgical periodontal treatment reduced mean pocket probing depth by >1 mm in both groups. In the normal HbA1c group, HbA1c values remained unchanged at 5.0% (95% CI, 4.9% to 6.1%) during the observation period. Among periodontitis patients with prediabetes, HbA1c decreased from 5.9% (95% CI, 5.9% to 6.0%) to 5.4% (95% CI, 5.3% to 5.5%) at 15.5 mo and increased to 5.6% (95% CI, 5.4% to 5.7%) after 27.5 mo. At 27.5 mo, 46% of periodontitis patients with prediabetes had normal HbA1c levels, whereas 47.9% remained unchanged and 6.3% progressed to diabetes. Median hsCRP values were reduced in the normal HbA1c and prediabetes groups from 1.2 and 1.4 mg/L to 0.7 and 0.7 mg/L, respectively. Nonsurgical periodontal treatment may improve blood glucose values among periodontitis patients with prediabetes (ClinicalTrials.gov NCT00707369).

Non-culprit plaque characteristics in acute coronary syndrome patients with raised hemoglobinA1c: an intravascular optical coherence tomography study

BackgroundRaised hemoglobinA1c (HbA1c) is an indicator of pre-diabetes, which is associated with increased risk of coronary artery disease. However, the detailed morphological characteristics of non-culprit plaques in acute coronary syndrome (ACS) patients remain largely unknown.MethodsA total of 305 non-culprit plaques from 216 ACS patients were analyzed by intravascular optical coherence tomography. These patients were divided into three groups according to the serum glycosylated hemoglobin level: normal HbA1c (< 5.7%), pre-diabetes with raised HbA1c (5.7–6.4%) and diabetes mellitus (DM).ResultsPlaques in patients with raised HbA1c had a longer lipid length (17.0 ± 8.3 mm vs. 13.9 ± 7.2 mm, P = 0.004) and greater lipid index (2775.0 ± 1694.0 mm° vs. 1592.1 ± 981.2 mm°, P = 0.001) than those with normal HbA1c but were similar to DM. The prevalence of calcification in patients with raised HbA1c was significantly higher (38.7% vs. 26.3%, P = 0.048) than normal HbA1c but was similar to DM. The percentage of macrophage infiltration in the DM group was higher than that in the normal HbA1c group (20.5% vs. 7.4%, P = 0.005).ConclusionsCompared to patients with normal HbA1c, the non-culprit plaques in ACS patients with raised HbA1c had more typical vulnerable features but were similar to DM.

The preoperative HbA1c level is an independent prognostic factor for the postoperative survival after resection of non-small cell lung cancer in elderly patients.

The aim of this study was to investigate the influence of a history of diabetes mellitus (DM) and the glycated hemoglobin (HbA1c) level on the survival in patients who underwent complete resection for non-small cell lung cancer (NSCLC). Of the patients who underwent complete resection for NSCLC between 2007 and 2015, 468 were classified into DM (who were currently taking medication for DM) and no DM groups as well as into high HbA1c (≥ 6.5) and normal HbA1c (< 6.5) groups. The overall survival (OS) did not differ significantly between either pair of groups. Among the elderly patients, the OS did not differ significantly between the DM and no DM groups, but was significantly higher in the normal-HbA1c group than in the high-HbA1c group (5-year survival rate: 84.7 versus 37.2%, respectively, p < 0.01). In the elderly patients, non-adenocarcinoma histology, advanced stage, a high Charlson comorbidity index, and a high preoperative HbA1c level were found to be independent risk factors for the OS. We revealed that a high preoperative HbA1c level was associated with a poor OS in elderly patients who underwent complete resection for NSCLC. This suggests that it is necessary to achieve diabetic control prior to complete resection in NSCLC patients.

An Elevated HbA1c Level Is Associated With Short-Term Adverse Outcomes in Patients With Gastrointestinal Cancer and Type 2 Diabetes Mellitus.

BackgroundAlthough an elevated hemoglobin A1c (HbAc1) level is an independent predictor of worse survival in patients with both digestive cancer and diabetes mellitus, its relationship to short-term prognosis in these patients has not been addressed. This study assessed this relationship in gastrointestinal cancer (GIC) patients with type 2 diabetes mellitus (T2DM).MethodsA retrospective review of patients with GIC with or without T2DM from 2004 to 2014 was performed. Patients with T2DM were grouped according to HbA1c level, either normal (mean < 7.0%) or elevated (mean ≥ 7.0%). Age- and sex-matched GIC patients without T2DM served as controls.ResultsOne hundred and eighteen patients aged 33 - 81 years with T2DM met the study eligibility criteria; 51 were in the normal HbA1c group, and 67 were in the elevated HbA1c group. The 91 patients in the non-T2DM group were randomly selected and matched to the T2DM group in terms of admittance date, age, and sex. There was a trend toward a higher 180-day mortality rate in the T2DM group compared with the non-T2DM group (15.3% vs. 7.7%, P = 0.095) and in the elevated HbA1c group compared with the normal HbA1c group (19.4% vs. 9.8%, P = 0.151); however, the differences were not significant. The duration of the hospital stay was longer in patients with T2DM than in those without T2DM (13.2 vs. 8.9 days, P < 0.05) and in patients with elevated versus normal HbA1c levels (14.5 vs. 11.4 days, P < 0.05). Diabetic GIC patients with elevated HbA1c levels had significantly more total postoperative complications than those with normal HbA1c levels (25.4% vs. 9.8%, P < 0.05). In multivariate regression analyses, short-term adverse outcomes were strongly associated with elevated HbA1c levels (odds ratio (OR): 5.276; 95% confidence level (CI): 1.73 - 16.095; P < 0.05) and no strict antidiabetic treatment (OR: 7.65; 95% CI: 2.49 - 23.54; P < 0.001).ConclusionAn elevated level of HbA1c significantly correlated with and was an independent predictor of short-term adverse outcomes in GIC patients with T2DM.

3. The impact of elevated HbA1c on Surgical Site Infection and other infectious morbidities after isolated coronary artery bypass surgery

Background & Aim of the study Wound infection is an important cause of morbidity and mortality after coronary artery bypass surgery (CABG). Patients with diabetes represent a high risk group for patients undergoing CABG. Glycosylated hemoglobin (HbA1c), a measure of hyperglycemia, is a sensitive and reliable marker of impaired glucose metabolism. The aim of the study is to compare the impact of the elevated (HbA1c), on the post-operative risk of Surgical Site Infection (SSI) and other infectious morbidities and mortality after isolated CABG. Patients & methods Two hundred and fifty patients (190 males, 65 females; mean age 62.69 ± 11.00; range 38–85 years) who underwent coronary artery bypass surgery at our center between January and December 2012 were enrolled in this study. All patients including the non-diabetics were managed with a specialized hospital protocol for glycemic control in the perioperative period. Results Out of the 255 patients, 169 patients (66.3%) had elevated preoperative HbA1c and 183 (71.8%), were diabetics. Surgical Site infection were observed in 26 patients with elevated HbA1c and 2 patients in the normal HbA1c group respectively (15. 3% vs 3.6%, p = 0.002), Pneumonia, were observed in 11 in the elevated and 3 in the normal HbA1c respectively (6.5% vs 5.5%), Furthermore, Septicemia was observed in 3 patients (1.8%) with elevated HbA1c. The 30 days mortality was Zero in both groups. Conclusion Our cohorts of patients have a high incidence of diabetes, and 66.3% of the patients have elevated HbA1c at the time of surgery. Patients with elevated HbA1c, undergoing isolated coronary artery bypass surgery have a significantly higher risk of surgical site infection and may have a higher risk of other infectious complications, but have no impact on early mortality.

1374 EFFECTS OF DM ON TREATMENT PROGNOSIS IN ACUTE PYELONEPHRITIS

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 20111374 EFFECTS OF DM ON TREATMENT PROGNOSIS IN ACUTE PYELONEPHRITIS Sung Jin Yim, Young Sam Cho, Kwangchon Ko, Kwan Joong Joo, Heung Jae Park, and Chil Hun Kwon Sung Jin YimSung Jin Yim Seoul, Korea, Republic of More articles by this author , Young Sam ChoYoung Sam Cho Seoul, Korea, Republic of More articles by this author , Kwangchon KoKwangchon Ko Seoul, Korea, Republic of More articles by this author , Kwan Joong JooKwan Joong Joo Seoul, Korea, Republic of More articles by this author , Heung Jae ParkHeung Jae Park Seoul, Korea, Republic of More articles by this author , and Chil Hun KwonChil Hun Kwon Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1198AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Diabetes mellitus (DM) is a major risk factor for the urogenital tract infections and is known to arouse serious complications such as emphysematous pyelonephritis. The authors have set to find out the influences of DM and the controlling degrees on the treatment prognosis for females with actue pyelonephritis (APN), using the HbA1c (hemoglobin A1c) test. METHODS Among the female patients who have received inpatient care due to APN from January 2007 to December 2009, we selected a total of 225 patients and analyzed medical records. We excluded those patients with urinary tract stones or anatomical abnormalities of urinary tract. We compared the age, duration of fever and hospital stay, positive rates in kidney ultrasonography (US) and most common organism in urine culture in patients with and without DM. Further analysis performed in DM patients according to normal or abnormal HbA1c test. RESULTS The mean age of patients with and without DM were 58.6±14.2 and 38.4±13.3 years, respectively. There were no significant differences in the positive rates of APN in kidney US, the mean duration of fever and hospital stay between the two groups (Table). However, the mean duration of fever in patients with normal HbA1c (2.4±1.2 days) was significantly shorter than that in patients with abnormal HbA1c (3.3±1.6 days) (p=0.045, chi-square test). The duration of hospital stay was also significantly shorter in the normal HbA1c group (6.6±1.5 days) than that in the abnormal HbA1c group (9.7±3.4 days, p=0.03). The positive rates of APN in kidney US was not statistically significant according to normal and abnormal HbA1c (53.6% vs 62.5%, p=0.565). Escherichia coli was the most common microorganism found in both groups (51.4% in no DM group, 63.6% in DM group). CONCLUSIONS In the APN patients with DM, abnormal HbA1c group showed longer duration of fever and hospital stay when compared to normal HbA1c group. This suggests that the HbA1c could be a prognostic factor of APN in DM patients. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e548 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sung Jin Yim Seoul, Korea, Republic of More articles by this author Young Sam Cho Seoul, Korea, Republic of More articles by this author Kwangchon Ko Seoul, Korea, Republic of More articles by this author Kwan Joong Joo Seoul, Korea, Republic of More articles by this author Heung Jae Park Seoul, Korea, Republic of More articles by this author Chil Hun Kwon Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bio-impedance gastric motility in patients with type 2 diabetes mellitus

Objective To detect the gastric motility in patients with type 2 diabetes mellitus, and to explore the relationship between disorder of gastric motility in diabetes and the influential factors. Methods Sixty-five patients with type 2 diabetes mellitus and 30 health control subjects were collected. The gastric motility was tested with the signal processing device designed by Chongqing University of Posts and Telecommunications. The impedance and electrical signals were collected at the same time. Fasting blood glucose (FBG) was detected by oxidation enzyme method, while microcolumn method was adopted to test HbA1c. Results In the 65 patients with type 2 diabetes mellitus,the occurrence of abnormal gastric motility was 53.85% , they had several symptoms, such as abdominal distension, early satiety, and belching. The percentage of dominant frequency of impedance gastrogram in diabetes group was lower than that in the normal controls (P<0. 05 ). The percentage of dominant frequency of EGG in the abnormal HbA1c group( ≥6. 5% ) was significantly lower than that in the normal HbA1c group ( P<0. 01). The percentage of bradygastria in the elderly was higher than that in young and middle-aged subjects (P<0. 05), respectively. Disorder of gastric motility was not correlated with FBG and course of disease. Conclusions The incidence of disordered gastric motility is very high in patients with type 2 diabetes mellitus. Elderly patients and those with higher HbA1c are prone to suffer from disordered gastric motility. However, disorder in gastric motility is not correlated with FBG and duration of the illness. Key words: Diabetes mellitus,type 2; Diabetic gastroparesis; Bio-impedance

Abnormal glycosylated hemoglobin as a predictive factor for glucose metabolism disorders in antipsychotic treatment

The aim of this study was to observe the changes in glucose metabolism after antipsychotic (APS) therapy, to note the influencing factors, as well as to discuss the relationship between the occurrence of glucose metabolism disorders of APS origin and abnormal glycosylated hemoglobin (HbA1c) levels. One hundred and fifty-two patients with schizophrenia, whose fasting plasma glucose (FPG) and 2-h plasma glucose (2hPG) in the oral glucose tolerance test (2HPG) were normal, were grouped according to the HbA1c levels, one normal and the other abnormal, and were randomly enrolled into risperidone, clozapine and chlorpromazine treatment for six weeks. The FPG and 2hPG were measured at the baseline and at the end of the study. In the group with abnormal HbA1c and clozapine therapy, 2HPG was higher after the study [(9.5 ± 1.8) mmol/L] than that before the study [(7.2 ± 1.4) mmol/L] and the difference was statistically significant (P < 0.01). FPG had no statistically significant difference before and after the study in any group (P > 0.05). HbA1c levels and drugs contributing to 2HPG at the end of study had statistical cross-action (P < 0.01). In the abnormal HbA1c group, 2HPG after the study was higher in the clozapine treatment group [(9.5 ± 1.8) mmol/L] than in the risperidone treatment group [(7.4 ± 1.7) mmol/L] and the chlorpromazine treatment group [(7.3 ± 1.6) mmol/L]. The differences were statistically significant (P < 0.01). In the normal HbA1c group there was no statistically significant difference before and after the study in any group (P > 0.05). 2HPG before [(7.1 ± 1.6) mmol/L] and after the study [(8.1 ± 1.9) mmol/L] was higher in the abnormal HbA1c group than in the normal HbA1c group [(6.2 ± 1.4) mmol/L vs (6.5 ± 1.4) mmol/L] with the difference being statistically significant (P < 0.01 vs P < 0.001). As compared with normal HbA1c group, the relative risk (RR) of glucose metabolism disease occurrence was 4.7 in the abnormal HbA1c group with the difference being statistically significant (P < 0.001). Patients with abnormal HbA1c are more likely to have a higher risk of having glucose metabolism disorders after APS treatment.

Relationship between HbA1c and mortality in a Japanese population

HbA(1)c concentrations are known to be associated with all-cause excess mortality risk in Caucasians. However, the relationship has not been clarified well in the Japanese. In addition, studies of the relationship between HbA(1)c and mortality from malignant neoplasms are scarce. HbA(1)c was measured for 3,710 people of a cohort composed of A-bomb survivors and controls. At baseline they were divided into five groups: a normal HbA(1)c group of 1,143 individuals with HbA(1)c of <5.5%, a slightly high but normal HbA(1)c group of 1,341 individuals with HbA(1)c > or =5.5% to <6.0%, a slightly high HbA(1)c group of 589 individuals with HbA(1)c > or =6.0% to <6.5%, a high HbA(1)c group of 259 individuals with HbA(1)c > or =6.5%, and a group of 378 individuals known to have type 2 diabetes. Using a Cox proportional hazards model, hazard ratios based on comparisons with the normal HbA(1)c group were obtained. During the observation period there were 754 deaths. For all-cause and cardiovascular disease mortality, a significant increase of the hazard ratio was observed for the slightly high HbA(1)c group. A similar increase in malignant neoplasm-related mortality was observed for both the high HbA(1)c group and the diabetes group. Our results suggest that individuals in the Japanese population with HbA(1)c levels of 6% or more might have increased mortality risk. The results indicate that HbA(1)c measurements should be sought even for people who have not been diagnosed with diabetes.

Endothelial Function Evaluated by Flow-Mediated Dilatation in Pediatric Vascular Disease

The endothelial function of children with and without vascular disease, consisting of 41 controls, 24 with Kawasaki disease (KD), and 46 with diabetes mellitus (DM), was examined. Age at examination ranged from 3 to 23 years (mean, 12.0 +/- 4.7). The flow-mediated dilatation (FMD) and intima-media complex in the common carotid artery were measured. In controls age at examination was not associated with FMD or intima-media complex. FMD significantly decreased in children with KD and DM compared with the control group (control vs KD or DM: 11.7 +/- 14.7 vs 3.0 +/- 11.0 or 6.4 +/- 8.5%, respectively; p < 0.05). However, there was no significant difference for intima-media complex among the groups. Furthermore, FMD in KD patients with coronary arterial aneurysm was lower than that in KD patients without aneurysm (-0.5 +/- 9.2 vs 8.3 +/- 9.1%, p < 0.05). In DM patients, FMD in the high HbA1c group (HbA1c = 7%) was lower than that in the normal HbA1c group (HbA1c < 7%) (4.8 +/- 8.1 vs 11.4 +/- 7.8%, p < 0.05). In conclusion, FMD detected endothelial impairment in children with KD or type 1 DM regardless of overt vascular complications, and FMD impairment occurs prior to intima-media complex thickening. By measuring both FMD and intima-media complex, useful information for predicting vascular complications may be obtained.

Glycosylated hemoglobin as a predictor of fetal pulmonic maturity in insulin-dependent diabetes at term.

In insulin dependent diabetic (IDDM) gestations, fetal pulmonary maturity is delayed in the presence of suboptimal glycemic control. Serum glycosylated hemoglobin (HbA1c) provides a means of assessing glycemic control. We evaluated maternal HbA1c in IDDM pregnancies at term undergoing amniocentesis for lung maturity to establish if euglycemia is associated with improved fetal lung maturity. Between July 1995 and June 1996, IDDM patients undergoing amniocentesis at term for lung maturity studies had a maternal serum sample analyzed for HbA1c. Fetal lung maturity was established by the presence of phosphatidylglycerol (PG) in amniotic fluid. HbA1c was considered elevated if >6.2%. Mean HbA1c level was 6.8% (range 4.4 to 9.9%). PG was present in 54% of patients with elevated HbA1c (7/13) versus 80% of those with normal HbA1c (8/10) (p = 0.4). Although birth weight was higher in the elevated than in the normal HbA1c group (3770 +/- 514 vs. 3215 +/- 610 g), no association was present between birth weight and HbA1c level (r = 0.22, p = 0.4). The rate of a mature pulmonic profile at term is not significantly different between IDDM women with good or poor glycemic control. HbA1c values should not be used to predict the presence or absence of amniotic fluid PG.