Normal HbA1c Research Articles

Early pregnancy high normal HbA1c: a high risk group?

To determine if high normal early pregnancy HbA1c (35-40mmol/mol), in the absence of diabetes, was associated with increased risk of adverse perinatal outcomes compared to normal HbA1c (<35mmol/mol). A retrospective chart review was carried out on all singleton births in the Wellington region from 1 July 2019 to 31 December 2019. Exclusion criteria were participants domiciled outside the Wellington region, HbA1c ≥50mmol/mol, pre-existing diabetes, gestational diabetes in current pregnancy, no HbA1c performed <20 weeks or the first HbA1c was taken at ≥20 weeks. Baseline characteristics, HbA1c and pregnancy outcomes were obtained. The primary outcome was birth weight and was analysed using multiple linear regression. There were 1,067 participants in the normal HbA1c (nHbA1c) group and 186 in the high normal HbA1c (hnHbA1c) group. There was no difference in birth weight between hnHbA1c and nHbA1c. hnHbA1c had significantly lower odds of post-partum haemorrhage and composite maternal adverse outcomes compared to nHbA1c (OR 0.52, 95% CI 0.35-0.76) and (OR 0.64, 95% CI 0.46-0.89). High normal HbA1c was not associated with increased risk of adverse perinatal outcomes in pregnant people who did not develop gestational diabetes.

Maternal periconception hyperglycemia, preconception diabetes, and risk of major congenital malformations in offspring.

What are the roles of maternal preconception diabetes and related periconceptional hyperglycemia on the risk of major congenital malformations (MCMs) in offspring? Maternal periconceptional glycated hemoglobin (HbA1c) levels over 5.6% were associated with an increased risk of congenital heart defects (CHD) in the offspring, and maternal preconception diabetes was associated with an increased risk of CHD, including when HbA1c levels were within euglycemic ranges. Maternal preconception diabetes has been linked with MCMs in the offspring. However, evidence concerning associations with specific periconception serum measures of hyperglycemia, and susceptibility of different organ systems, is inconsistent. Moreover, limited evidence exists concerning the effectiveness of antidiabetic medications in mitigating diabetes-related teratogenic risks. A large Israeli birth cohort of 46534 children born in 2001-2020. Maternal HbA1c test results were obtained from 90 days before conception to mid-pregnancy. Maternal diabetes, other cardiometabolic conditions, and MCMs in newborns were ascertained based on clinical diagnoses, medication dispensing records, and laboratory test results using previously validated algorithms. Associations were modeled using generalized additive logistic regression models with thin plate penalized splines. Maternal periconceptional HbA1c value was associated with CHD in newborns, with the risk starting to increase at HbA1c values exceeding 5.6%. The association between HbA1c and CHD was stronger among mothers with type 2 diabetes mellitus (T2DM) compared to the other diabetes groups. Maternal pre-existing T2DM was associated with CHD even after accounting for HbA1C levels and other cardiometabolic comorbidities (odds ratio (OR)=1.89, 95% CI 1.18, 3.03); and the OR was materially unchanged when only mothers with pre-existing T2DM who had high adherence to antidiabetic medications and normal HbA1c levels were considered. The rarity of some specific malformation groups limited the ability to conduct more granular analyses. The use of HbA1c as a time-aggregated measure of glycemic control may miss transient glycemic dysregulation that could be clinically meaningful for teratogenic risks. The observed association between pre-existing diabetes and the risk of malformations within HbA1c levels suggests underlying causal pathways that are partly independent of maternal glucose control. Therefore, treatments for hyperglycemia might not completely mitigate the teratogenic risk associated with maternal preconception diabetes. The work was supported by NIH grants K99ES035433, R01HD097778, and P30ES000002. None of the authors reports competing interests. N/A.

Characteristics and risk factors associated with developing prediabetes in Saudi Arabia

Objective Prediabetes is prevalent in Saudi Arabia and globally. It is associated with adverse health outcomes and complications. Consequently, this study aimed to determine the risk factors associated with developing prediabetes in Saudi Arabia. Methods This is a case-control study conducted at the Family and Community Medicine Department at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. The cases included individuals with prediabetes (prediabetes group), and the control group included individuals with normal HbA1c levels who were not diagnosed with prediabetes or diabetes. The data collected included sociodemographic data, clinical parameters, laboratory tests, and medical conditions. Results The study included 46,201 patients (16,029 patients with prediabetes and 30,173 in the control group). The age of the patients (mean ± SD) with prediabetes was significantly higher than that of the control group (47.22 ± 14.04 versus 36.12 ± 11.83, p < 0.0001). A higher proportion of men was noted in the prediabetes group compared to the control group (36.32% versus 26.54%, p < 0.0001). The body mass index (mean ± SD) was higher in the prediabetes group compared to the control group (33.76 ± 6.75 versus 30.16 ± 7.26, p < 0.0001). The multiple logistic regression analysis showed six independent risk factors associated with prediabetes. These included age (aOR [95% CI] = 1.067 [1.065–1.069]) and gender, with women at a lower risk compared to men (aOR [95% CI] = 0.695 [0.664–0.728]). Other independent risk factors included polycystic ovarian syndrome (aOR [95% CI] = 58.102 (35.731–94.479]), obesity (aOR [95% CI] = 1.265 [1.075–1.487]), cardiac conditions (aOR [95% CI] = 4.870 [1.024–23.154]), and hypertension (aOR [95% CI] = 1.133 [1.031–1.245]). Conclusions The study showed that several risk factors are associated with the development of prediabetes in the Saudi population. Addressing these factors can help prevent prediabetes, and consequently, its burden and further progression to diabetes.

12450 Beyond the Surface: A Deep Dive into Pancreatic Insulinoma

Abstract Disclosure: S. Bhandari: None. R. Elhag: None. J. Singh: None. N. Rastogi: None. Background: Pancreatic neuroendocrine tumors (NET) are rare lesions that are typically sporadic, solitary and usually &amp;lt;2cm in diameter, with reported incidence of 4 cases per 1 million patients per year[1]. The most common hormone secreting NET are insulinomas. The hallmark of insulinomas is hypersecretion of insulin, leading to neuroglycopenic symptoms and uncontrolled sympathoadrenal activity. Clinical case: 51 years old female with no significant past medical history was referred to endocrine clinic by her primary care physician for hypoglycemia with a blood glucose level of 48 mg/dl. She reported an increased frequency of headaches and dizziness which began with intermittent fasting (10-12 hours) for past 6 months. These symptoms improved upon increasing meal frequency. Initial laboratory investigations revealed glucose of 54 mg/dl, normal HbA1c, and negative sulfonylurea panel. The patient had normal liver and kidney function with no malnutrition or malabsorption issues. Further work up showed C-peptide level 1.56 ng/ml (n 0.80-3.85ng/ml), insulin level 7.9 uIU/mL (n &amp;lt;18.4 uIU/mL), pro-insulin level significantly elevated at 77.6 pmol/L (n &amp;lt;/= 18.8pmol/L) and beta hydroxybutyrate of 0.12 mmol/l (n 0.02-0.27mmol/l). Insulin like growth factor was normal. Insulin antibodies were negative, and pituitary hormones were within normal limits. Pancreatic ultrasound was normal. CT abdomen/pelvis showed a 0.8x1.1 cm homogenously hypervascular anterior pancreatic body soft tissue lesion consistent with NET. Patient was started on diazoxide and continuous glucose monitoring (CGM). She was referred to general surgery and underwent successful tumor resection. Insulinoma is suggested by Whipple's triad, which is presence of hypoglycemic symptoms, documented hypoglycemia and resolution of hypoglycemic symptoms after glucose administration. As clinical manifestations are non-specific, diagnosing an insulinoma is challenging and depends on collateral history and a high index of suspicion. The gold standard of diagnosis is supervised 72-hour fasting test with plasma glucose, insulin, C-peptide, and proinsulin level measurements. Medical management of insulinoma includes the use of diazoxide, calcium channel blockers, propranolol, and glucocorticoids. Surgery is definitive treatment for insulinomas, with cure rates ranging from 77 to 100%. Conclusion: Insulinomas are benign and curable in most cases but can be fatal if misdiagnosed. Incidental findings of hypoglycemia should warrant thorough diagnostic workup to facilitate timely diagnosis and management.

12395 Continuous Glucose Monitoring In Pseudohypoparathyroidism Type 1a

Abstract Disclosure: J. Tamaroff: None. A.E. Lee: None. A.H. Shoemaker: None. Background: Pseudohypoparathyroidism type 1A (PHP1A), due to heterozygous mutations in GNAS, is a rare disorder that leads to multi-hormone resistance, cognitive impairment, and early-onset obesity. Individuals with PHP1A have dysglycemia on oral glucose tolerance tests and increased rates of type 2 diabetes (T2DM). Individuals with rare diseases, like PHP1A, may travel significant distances for specialized clinical or research care. Wearable technology may alleviate barriers and provide useful information for clinical care or for use as potential biomarkers. The objective of this study is to evaluate glycemia in individuals with PHP1A and feasibility of utilizing continuous glucose monitors (CGMs) in this population. Methods: Observational study of individuals with PHP1A (3R01DK118407-03S1). CGMs (Dexcom Pro, Dexcom Inc, San Diego, CA) were placed on participants’ abdomens, typically by a family member, over secure-video call with study staff. CGMs collected data every 5 minutes for up to 10 days. Results: Seven participants (all female) with PHP1A without a diagnosis of diabetes had available data. Median age was 17 years (IQR: 14, 19; range: 8-23). Body mass index (BMI) categories (by percent of the 95th percentile for those under 18 years and BMI for adults) spanned from overweight to class 3 obesity. In terms of feasibility, 1 individual had to replace a CGM sensor due to an upcoming MRI and 1 individual had a “sensor failure” of unclear etiology. Both were able to place new CGMs. Individuals participated across 5 states in the United States. Median length of wear was 9.8 days (IQR 8.6, 9.9). Participants had a median average glucose of 104mg/dL (IQR 102, 111) and COV of 16% (15, 21). Percent of glucose &amp;gt; 140mg/dL was 5.0% (IQR: 1.8, 10.9; range:1.2-19.4%). One individual had 3.2% of glucose values ≥ 200mg/dL despite a normal hemoglobin A1c (HbA1c) level (5.5%). This level of hyperglycemia is qualitatively higher than published CGM data in healthy individuals. One study found individuals (6-24 years of age) had median percent of glucose values over 140mg/dL ranging from 1.2 to 2.4% with IQR values ranging from 0.3 to 4.4%, based on age categories.1Conclusions: In females with PHP1A, with overweight or obesity, CGM placement at home is a feasible way to collect real-world data. Participants with rare diseases often must travel for clinical and research care and CGMs may provide insight into glycemia without requiring an in-person visit. This “real-world” data mirrors research data reporting glycemia with normal HbA1c levels. The rate of hyperglycemia is higher than expected in some individuals with PHP1A though more data is needed. Ongoing studies will evaluate matched control participants and assess drivers of glycemia including inactivity and decreased sleep duration, as measured by actigraphy.

A-051 Validation and Implementation of the Stanbio Beta-Hydroxybutyrate Assay on Roche c502 Analyzer

Abstract Background β-hydroxybutyrate (βOHB) serves as a crucial biomarker in assessing, managing, and monitoring ketosis in various clinical scenarios, such as diabetic ketoacidosis and instances of alcohol abuse combined with starvation. This study aimed to validate a βOHB assay (Stanbio Laboratory) conducted on a Roche Cobas c502 analyzer and establish performance specifications. Additionally, we conducted a method comparison for three assays: Randox D-3-Hydroxybutyrate (Ranbut) assay on Roche c501 analyzer, Abbott Freestyle Precision B-Ketone strip point-of-care test, and the Stanbio Laboratory β-Hydroxybutyrate LiquiColor assay on Roche c502 analyzer. Methods Precision, linearity, limit of quantification (LOQ), method comparison, and sample stability were determined according to Clinical and Laboratory Standards Institute (CLSI) guidelines, using commercial quality control materials (Randox Multisera) and residual patient samples (Lithium heparin anti-coagulated plasma). The reference interval was verified by residual samples from 20 healthy individuals (normal blood glucose, HbA1c, liver enzymes, and lipid panel results). Statistical analysis was performed by EP-Evaluator (v12). Results Intra-assay and total coefficient of variation (CV) were determined as 0% and 2.4% at 0.3 and 1.21 mmol/L, respectively. The linearity range of the assay was verified from 0.0 to 9.0 mmol/L. Using CV &amp;lt; 20% as criteria, the functional sensitivity (LOQ) was 0.10 mmol/L at least. Lithium heparin anti-coagulated plasma specimens were stable for 24 hours at room temperature or seven days at 4 - 8 ̊C. The manufacturer’s reference interval was verified as 0.00 - 0.40 mmol/L. The Stanbio βOHB assay on the Roche c502 analyzer demonstrated a strong agreement with the Randox D-3-Hydroxybutyrate assay on the Roche c501 analyzer with a slope of 1.053 (95% CI: 1.037, 1.070) and intercept of -0.005 (95% CI: -0.068, 0.059) (coefficient correlation R = 0.9992). A positive bias was observed compared to the Abbott Freestyle Precision B-Ketone strip POC test (mean bias = + 0.50 mmol/L; slope = 1.630, 95% CI: 1.404, 1.857; R = 0.9184), and this discrepancy occurred particularly at βOHB &amp;gt; 5.5 mmol/L measured by Abbott method. Conclusions The Standbio βOHB assay exhibited excellent precision and linearity across a brand range of concentrations. This assay strongly agrees with the Randox assay run on a similar instrument but discordance with Abbott’s POCT method at high βOHB concentration. Overall, the validated method provides a reliable and efficient means for measuring βOHB levels on a Roche chemistry analyzer, facilitating accurate diagnosis and monitoring of ketosis-related conditions in clinical settings.

Small Donors, Big Impact: Optimizing Organ Utilization in Simultaneous Pancreas and Kidney Transplantation From Extra Small Pediatric Donors.

Simultaneous pancreas-kidney transplantation (SPK) is the preferred treatment for individuals with type-1 diabetes and end-stage renal disease. However, a limited supply of "Ideal Pancreas Donors" contributed to a growing disparity between available organs and recipients. Even though SPK outcomes from pediatric donors match those from adult donors, unclear guidelines on minimum age and weight criteria for extra small pediatric pancreas donors lead to hesitancy among several transplant centers to utilize these grafts due to concerns about inadequate islet mass, technical challenges, and increased risk of allograft thrombosis. This report details the successful outcomes of SPK transplantations performed at the study center between December 2021 and January 2024, using four extra small pediatric brain-dead donors (ESPDs). Each donor was aged ≤5 years and weighed <20kg. All SPK recipients achieved immediate posttransplant euglycemia without requiring insulin. None of the recipients experienced graft pancreatitis, graft thrombosis, allograft rejection, or required re-exploration. During a 5-27-month follow-up period, all ESPD recipients maintained optimal graft function, as evidenced by normal glucose tolerance tests and HbA1c (4.9%-5.2%), with 100% graft and patient survival. This report examines the usage of ESPDs in SPK transplantation, highlighting their potential to expand the donor pool and reduce wait times in areas with scarce deceased organ donations, thereby increasing the number of available organs for transplantation with acceptable outcomes. Revising donor selection guidelines to reflect the diverse risk-benefit profiles of waitlisted individuals is crucial to addressing geographical disparities and reducing organ discard rates.

Pre-Prediabetes: Insulin Resistance is Associated with Cardiometabolic Risk in Non-obese Patients (STOP DIABETES).

To examine if insulin resistance is associated with markers of glycemic, cardiometabolic and atherosclerotic risk in non-obese, non-prediabetic individuals compared to insulin sensitive subjects matched for BMI, gender, and age. Of 1860 patients from STOP DIABETES study, 624 had normal fasting plasma glucose, body mass index < 30, and HbA1c < 5.7%. All received oral glucose tolerance test (OGTT). Insulin sensitivity was quantitated using Matsuda index: <25th percentile = Insulin Resistant (IR) (n=151) and ≥ 25th percentile = Insulin Sensitive (IS) (n=473). Measures of dysglycemia and cardiometabolic risk were compared between insulin resistant subjects (n=151) and subset of insulin sensitive individuals who were matched for BMI, gender, age (n=151). Carotid intima media thickness (CIMT) and carotid plaque were measured in 65 IR and 76 IS individuals. Compared to matched insulin sensitive patients, insulin resistant non-obese subjects demonstrated increased indicators of glycemic and cardiometabolic risk including: increased 60-minute plasma glucose and percentage of patients with 60-minute plasma glucose > 155mg/dL; increased 120-minute plasma glucose; unrecognized impaired glucose tolerance (IGT) and type 2 diabetes (T2D), decreased disposition index; increased systolic and diastolic blood pressure; elevated plasma triglycerides; reduced HDL cholesterol; increased triglyceride/HDL ratio and hs-CRP. The presence, size, and number of carotid plaques was greater in the insulin resistant group. Approximately 1 in 4 non-obese patients in this population with normal fasting glucose and HbA1c were insulin resistant. In these non-obese subjects, insulin resistance was associated with multiple indicators of dysglycemia and cardiometabolic risk.

Associations of glycemic measures in the normal range with all-cause mortality in the absence of traditional risk factors.

The investigation of the association between blood glucose within normal range and all-cause mortality among individuals without traditional risk factors is limited. To determine the associations of 3 glycemic measures (fasting plasma glucose [FPG], hemoglobin A1c [HbA1c], and 2-h glucose) in the normal range with all-cause mortality among individuals without traditional risk factors. Retrospective cohort study. US National Health and Nutrition Examination Survey in 1988-1994 and 1999-2018. Non-pregnant adults who had a measurement of 2-h glucose, FPG, and HbA1c, and absence of traditional risk factors were included. Cox proportional hazard models were performed to examine the associations of normal FPG (n=5793), normal HbA1c (n=8179), and normal 2-h glucose (n=3404) with all-cause mortality. The significant association was found between 2-h glucose within the normal range and all-cause mortality among those without traditional risk factors. Compared to participants with 2-h glucose <80 mg/dL, participants with a higher normal 2-h glucose level had a higher risk of all-cause mortality (110-139 mg/dL: HR, 1.80 [95% CI, 1.03-3.15]). In the subgroup analysis, significant associations were also found among people aged ≥60 years and men. No significant associations were found between normal FPG and HbA1c levels and all-cause mortality. Among US adults without traditional risk factors, high normal 2-h glucose level was positively associated with all-cause mortality. This result highlights the potential importance of maintaining a lower normal level of 2-h glucose for preventing mortality in individuals who are conventionally considered to be cardiovascular healthy.

Hubungan Kadar HbA1c Dengan Kadar Serum Kreatinin Pada Penderita Diabetes Melitus Tipe 2 Di RSU Sinar Kasih Purwokerto

Diabetes Mellitus is a metabolic disorder caused by a decrease in insulin products in the body. The World Health Organization estimates an increase in the number of diabetes mellitus sufferers from 8.4 million in 2000 to around 21.3 million in 2030. Chronic diabetes mellitus sufferers can cause complications, one of which is kidney complications. Kidney damage can occur due to uncontrolled blood sugar levels. Complications of diabetes mellitus can be detected by examining HbA1c. HbA1c is a non-enzymatic binding of glucose molecules to hemoglobin through a post-translational glycation process. Uncontrolled HbA1c levels can cause various complications in the body.The samples used for this research were 106 samples with normal HbA1C examination results, namely 59 patients and high results, namely 47 patients. Creatinine examination with normal results was 81 patients and high results were 25 patients. The P-value from the calculation results is 0.066 higher than 0.005. Based on the results of the chi square calculation, it can be concluded that there is not a relationship between HbA1C examination and creatinine examination in type 2 diabetes mellitus patients at Sinar Kasih Hospital.

Description of HbA1c Levels in Fatty Liver Disease Patients in a West Jakarta Private Hospital in 2018-2019

Fatty liver disease is a chronic disease that is very often found in the community and is often called "silent" liver disease because there are no specific symptoms in patients. The incidence of fatty liver disease in Indonesia is quite high by 30 percent and this disease can develop into liver cirrhosis. The high incidence of fatty liver disease can be caused by various factors such as obesity, dyslipidemia, hypertension, unhealthy lifestyles and insulin resistance. Insulin resistance can be characterized by an increase in HbA1c levels in the blood. This study aims to determine the description of HbA1c levels in patients with fatty liver disease. This research is an observational descriptive study using a cross-sectional approach by using medical record data of fatty liver disease patients who have been on radiologic examination and doing HbA1c examination. Fatty liver disease affects more male sex groups by 55.4 percent, with the most age range at 51-60 years by 34.9 percent. Diabetes HbA1c levels (59%) are more than prediabetes (25.3%) and normal HbA1c levels (15.7%). Abnormal HbA1c levels (prediabetes and diabetes) were found to be higher in men (47 % vs 47,3%). The most accompanying diseases in patients with fatty liver disease are diabetes mellitus (51.8%), hypertension (33.7%), dyslipidemia (26.5%), dyspepsia (28.9%), and hyperuricemia (15.7%). Fatty liver disease patients were also found to have metabolic syndrome by 54.2% which was dominated by female sex by 53.3% with 91.1% having 3 components of metabolic syndrome and 8.9% having 4 components of metabolic syndrome

Association between glycemic control and autonomic dysfunction: A cross-sectional study in type 2 diabetes mellitus patients

Background. Orthostatic hypotension (OH) stands as one of the initial indications of cardiac autonomic dysfunction in diabetic individuals. Our objective is to assess the prevalence of OH across different degrees of diabetes. Materials and methods. This study is a cross-sectional investigation conducted at a tertiary care center. After obtaining ethical committee clearance and informed consent, 150 individuals aged above 50 years were recruited for this study. 50 of them had normal HbA1c levels, 50 with HbA1c levels between 7-8 and another 50 individuals with more than 8 HbA1c values. Results. The duration of diabetes exhibited a strong correlation with HbA1c levels, which was statistically significant (p=0.000). The systolic BP difference in normal, HbA1c 7-8 and HbA1c levels more than 8 were 6.34±1.95, 15.70±8.37 and 17.04±7.74 respectively. The diastolic BP difference in normal, HbA1c 7-8 and HbA1c levels more than 8 were 4.00±1.42, 7.72±5.26 and 12.22±7.77. These results were found to be statistically significant (p=0.000). Conclusion. OH serves as an ominous sign in diabetic patients, indicating a poor prognosis. Individuals with OH are at a heightened risk of falls, which in turn, is associated with increased morbidity and mortality. Therefore, it is crucial to prioritize the early detection of autonomic neuropathy, particularly in diabetic patients.

Low preoperative hemoglobin A1c level is a predictor of perioperative infectious complications after esophagectomy: A retrospective, single-center study.

This retrospective, single-center study aimed to evaluate the impact of blood glucose (BG) markers on perioperative complications after esophagectomy in a cohort of 176 patients. Study analyses included the correlation of daily maximum BG level and hemoglobin A1c (HbA1c) with clinicopathological factors. Maximum BG levels were significantly higher on postoperative day (POD) 0 than on PODs 2, 3, 5, and 7 (p < 0.05). Additionally, maximum BG levels on PODs 1, 2, and 7 were significantly higher in patients with preoperative HbA1c levels of ≥ 5.6% than in those with preoperative HbA1c levels of < 5.6% (p < 0.05 for all). The rates of any complications and infectious complications were higher in patients with preoperative HbA1c levels of < 5.6% than in those with preoperative HbA1c levels of ≥ 5.6% (p < 0.05 for both). A preoperative HbA1c level of < 5.6% was a significant predictor of infectious complications after esophagectomy by logistic regression analysis (p < 0.05). Maximum BG level after esophagectomy remained high in patients with high preoperative HbA1c levels, whereas a normal HbA1c level was an independent risk factor for infectious complications.

The Effect of Glycemic Status on P Wave Dispersion.

Background and aim The growing number of people with diabetes mellitus (DM) across the world is a public health concern. The diabetes epidemic involves enormous health costs to the patients, their careers, and society at large. Cardiovascular diseases such as atrial fibrillation (AF) often develop in the diabetic population. An increase in the P wave dispersion (PWD) has been established as an independent risk factor for the occurrence of AF, hence the present study was conducted to establish a possible relationship between PWD and the glycemic status of the individualto predict the occurrence of AF ahead of clinical symptomology. Methodology A comparative cross-sectional study was conducted at a tertiary care hospital after obtaining approval from the institutional ethics committee and written consent of each study subject. The main steps included the selection and categorization of the study population based on their glycemic status, collection of demographic data, performing ECGs calculating PWD using digital calipers, and recording the data systematically for evaluation. Results In this study, 234 patients with a mean age of 53.3 ± 13.1 years were studied, of which 121 (51.7%) were maleand 113 (48.29%) were female. The 234 patients were divided into four groups based on their glycemic status - 74 uncontrolled DM patients (31.62%), 51 type 2 DM (T2DM) patients (21.78%), 56 prediabetespatients (23.93%), and 53 patients in thecontrol group (22.64%; not a known case of diabetes with normal HbA1c and fasting blood sugar (FBS) levels).Minimal correlation was observed between FBS with PWD (r value0.175)and age with PWD (r value0.161), butstatisticalsignificance was observed only between age and PWD (p-value 0.014).The difference in means between the four different study groupswas found to be not statistically significant (p-value- 0.104); hence, no intergroup variation was noted. Conclusion Advancing age and higher fasting blood sugars have shown minimal correlation with widening P-wave dispersion. With further studies involving larger populations, this can be a promising aid in identifying PWD as a probable early predictor of atrial arrhythmias among diabetic patients.

Relation of Raised HbA1C Level with Congenital Deformity of Fetus Detected by Anomaly Scan in 2nd Trimester of Pregnancy in Diabetic Mother

Background: Pregnant women with pre-existing diabetes face an elevated risk of congenital anomalies in their offspring. However, research on the pattern of congenital anomalies and its correlation with blood sugar control in pre-gestational diabetic mothers is limited, especially in our country's context. This study investigated the association between elevated HbA1c levels and congenital anomalies in diabetes-related pregnancies. Objective: To assess whether raised HbA1c levels were linked to an increased incidence of congenitally deformed fetal outcomes in pregnancies affected by diabetes. Method: This cross-sectional study was conducted from August 2018 to September 2019 at the Department of Obstetrics and Gynaecology, DMCH. Women with pre-gestational diabetes were sequentially enrolled if they provided informed consent. Data, including HbA1c levels and anomaly scans, were collected at 18-24 weeks of gestation. Participants were divided into two groups based on HbA1c levels: Group-1 (elevated HbA1c) and Group-2 (normal HbA1c). Statistical analysis was performed using SPSS 22, with significance at p&lt;0.05. Result: The mean ages of Group 1 and Group 2 were 31.60±2.89 &amp; 30.51±2.99 (SD) years. Both groups were similar concerning age, residence, education, occupation, economic status, and BMI (p&gt;0.05 in all factors). Mean HbA1C (%) of Group-1 and Group-2 were 8.57±2.22 &amp; 6.18±0.20 (p&lt;0.001), respectively. Congenital anomalies were more frequent in Group 1 (15.6 vs 2.2; p&lt;0.05), and it is associated with high blood sugar levels (p&lt;0.001) and with a previous history of anomalous babies in preceding pregnancies. Conclusion: Elevated HbA1c levels are associated with an increased incidence of congenital anomalies in pregnancies complicated by diabetes. This underscores the importance of strict glycemic control in pregnant women with pre-gestational diabetes to mitigate the risk of adverse fetal outcomes. Further, population-based studies are desired to validate these findings and inform clinical management strategies.

Diabetes mellitus geïnduceerd door immuuntherapie: een casus

Immunotherapy-induced diabetes mellitus: a case-report A 73-year-old man presented with diabetic ketoacidosis (DKA) after the recent initiation of immunochemotherapy to treat a lung adenocarcinoma. Pembrolizumab is an IgG4 monoclonal antibody targeting an immune checkpoint protein called ‘programmed cell death protein 1’ (PD-1), which results in antitumoral immunity. Immune checkpoint inhibitors (ICI), such as pembrolizumab, are known for their ability to cause immune-related adverse events (irAEs). Immunotherapy-induced diabetes mellitus (DM) occurs predominantly with the inhibition of PD-1 or its ligand (‘programmed cell death protein 1 ligand’ (PD-L1)). The onset is typically acute with a rapidly progressive deficiency of the endogenous insulin production, resulting in hyperglycaemia and a low or absent serum level of C-peptide with a relatively low to normal HbA1c in the acute phase. The significant loss of endogenous insulin production makes DKA a frequent first presentation. This rapid pathophysiological evolution was present in the discussed patient, who developed DM in less than 6 weeks and needed insulin therapy to establish an adequate glycaemic control. Given the increasingly widespread use of ICI in the treatment of various tumours, caution has to be taken to identify these potentially life-threatening irAEs. Awareness and alertness to glycemia on blood sampling, as well as patient education regarding red flags are fundamental, in addition to adequate recognition and treatment of (potential) ketoacidosis.

Associations Between Risk Factors of Cardiovascular Disease in Young Adults

Introduction Cardiovascular disease (CVD) impacts 50% of U.S. adults although few studies evaluate young adults’ cardiovascular disease risk. Early identification of cardiovascular disease risk may mitigate increased adulthood incidence. We analyzed (CVD) risk factors and their association with cardiovascular fitness ([Formula: see text] o2max) to devise effective strategies to improve cardiovascular health across the lifespan. Methods A cross-sectional study evaluated the effect of a single bout of aerobic exercise on cardiovascular disease risk factors in adults aged 18 to 36 years. Glycemic control (HbA1C), cardiovascular fitness ([Formula: see text]o2max), percent body fat, lean body mass, waist circumference, and body mass index (BMI) were analyzed using correlation analysis and multiple linear regression. Results Statistically significant relationships were observed between percent body fat (r = .83, P &lt; .001) and BMI, and waist circumference (r = .83, P &lt; .001) and BMI. Percent body fat ( P &lt; .001) and race ( P = .018) predicted exercise time, with Asians exercising the longest. Percent fat ( P &lt; .001) and HbA1C ( P = .039) were identified as predictors of cardiovascular fitness which was low in spite of primarily normal average HbA1C levels. Conclusions HbA1C and body fat negatively influence cardiovascular fitness ([Formula: see text] o2max) in young adults increasing adulthood cardiovascular disease risk. Research investigating the effect of HbA1C on cardiovascular health especially in youth is warranted.

Hemoglobin A1c levels and 1-year mortality in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention.

Background: In this study, we investigated whether different levels of hemoglobin A1c (HbA1c) are associated with different short-term and 1-year mortality rates among diabetic patients undergoing percutaneous coronary intervention. Patients & methods: Clinical events including in-hospital, 1-month and 1-year mortality were compared between three groups based on HbA1c levels of patients (I: ≤5.6%, II: 5.7-6.4%, III: ≥6.5%). Results: Among 165 diabetic individuals, patients with abnormal HbA1c levels (≥6.5%) experienced significantly higher hospitalization days (7.65±1.64days) compared with those with normal HbA1c (4.94±0.97days) (p <0.0001). In-hospital mortality was significantly higher in group III (14.5%) and II (5.5%) compared with group I (0%) (p =0.008). Conclusion: HbA1c levels may be a reliable predictor of short-term clinical events in diabetic patients.

Effect of nutrition education on serological variables of type 2 diabetes mellitus patients attending Nigerian National Petroleum Company Limited Clinic Warri, Delta State Nigeria

Background: The increasing prevalence of diabetes mellitus around the world appears as dramatic as to have been characterized as an epidemic. Diabetes mellitus causes prolonged ill-health, imposes morbidity and mortality risks, and necessitates a change in lifestyle, with a meticulous daily routine and long-term self-care. Objective: The objective of the study was to assess the effect of nutrition education on serological variables of the type 2 diabetes mellitus patients. Methodology: Two Hundred and Thirty (230) out of 258 subjects who participated in the longitudinal study were confirmed Type 2 diabetics. One hundred and Fifty (150) subjects were grouped into education group and Eighty (80) subjects into control group. Information on socio-demographic, life-style characteristics, and management regimens of the diabetes were collected using structured, validated and pretested questionnaire. Subject’s serological variables such as glycated hemoglobin (HbA1c), Fasting Blood Glucose (FBG), 2-hours post prandial and fasting lipid profile were collected. Nutrition education was instituted and was performed in a group of 15 patients per session in 2 hours. Results: Most of the subjects (70.0%) in the education group at baseline had elevated HbA1c with a mean baseline HbA1c level of 8.08+1.88%. While most of the subjects (65.00%) in the control group at baseline had normal HbA1c with a mean baseline glycated hemoglobin level of 7.01+1.86%. However, there was a significant difference (P&lt;0.05) in the mean and percentage number of HbA1c of the subjects in education and control group. Only 6.7% of the subjects had low Fasting Blood Glucose (&lt;4.2mmol/l), 58.0% had high Fasting Blood Glucose (&gt;7.0mmol/l) and 35.3% had normal Fasting Blood Glucose (4.2-5.9mmol/l). After three months follow up, the number of subjects who had normal FBG increased from 35.3% to 54.7%, the low FBG levels increased from 6.5% to 10.0% but high Fasting Blood Glucose levels reduced from 58.0% to 35.3%. Conclusion: There was significant reduction in the glycated hemoglobin (HbA1c) and Fasting Blood Glucose (FBG) of the subjects after nutrition education and follow up, indicating that nutrition education and follow up has positive impact the serological variables of the subjects who are diabetics.

The Practices and Glycated Hemoglobin Levels of Adults with Diabetic Neuropathy in Nakuru County, Kenya

Diabetic neuropathy is a common complication of diabetes that can significantly impact patients’ quality of life. Practices play a crucial role in managing the condition and preventing further complications. This cross-sectional study examined the practices and glycated hemoglobin levels among adult patients with diabetic neuropathy. The study employed a cross-sectional design. A sample of adult patients diagnosed with diabetic neuropathy at Nakuru referral and teaching hospital was recruited. Data on dietary practices, including food choices, meal patterns, and dietary restrictions, were collected through structured interviews. Nutrient intake was assessed using dietary recall methods and analyzed using descriptive statistics. The chi-square test was used across the glycated hemoglobin (HbA1c) levels to compare categorical variables. Adherence to dietary recommendations was evaluated based on established guidelines for diabetic neuropathy management. Preliminary findings reveal sub-optimal practices in adults with diabetic neuropathy. Those with one or two daily meals reported significantly elevated HbA1c levels [χ2=11.808, p=0.008]. Skipping meals, especially breakfast and lunch, correlated with elevated HbA1c [χ2=17.622, p=0.001]. Smokers and alcohol consumers had a higher proportion of elevated HbA1c [χ2=7.269, p=0.007] and [χ2=15.610, p&lt;0.001], respectively. Regular exercise, particularly daily or 1-3 times a week, is associated with lower HbA1c [χ2=37.329, p&lt;0.001]. Elevated HbA1c correlated significantly with daily intake of animal products [χ2=18.931, p&lt;0.001], fats and oils [χ2=12.211, p =0.00], fruits [χ2= 22.106, p&lt;0.001], and cereals [χ2=21.728, p&lt;0.001]. Conversely, daily consumption of vegetables [χ2=8.255, p=0.016], pulses, and legumes [χ2 =53.757, p&lt;0.001] were associated with normal HbA1c. However, occasional sugar and honey intake did not significantly impact HbA1c [χ2=1.082, p=0.582]. In conclusion, our study highlights sub-optimal practices in adult diabetic neuropathy patients, particularly in those consuming one or two meals daily, skipping breakfast and lunch, and engaging in smoking or alcohol. Regular exercise correlates with lower HbA1c, while certain dietary habits influence glycemic control. These insights inform targeted interventions for improved patient care.