Predictors Of Glycemic Control Research Articles

Influence of socioeconomic and psychological factors in glycemic control in young children with type 1 diabetes mellitus

ObjectiveTo evaluate the influence of socioeconomic and psychological factors on glycemic control in young children with type 1 diabetes mellitus. MethodsThis was a cross-sectional study assessing prepubertal children with type 1 diabetes mellitus. The authors analyzed the socioeconomic status using the Brazil Economic Classification Criterion (Critério de Classificação Econômica Brasil [CCEB]) and psychological conditions through the Brazilian version of the Problem Areas in Diabetes, associated with glycemic control, measured by glycated hemoglobin (HbA1c). Descriptive analysis was used. The variables were assessed by bivariate and multivariate robust Poisson regression model, as well as Fisher's exact and Pearson's chi-squared tests to obtain the ratios of gross and adjusted prevalence ratio, with confidence interval being estimated at 95%. ResultsA total of 68 children with type 1 diabetes mellitus were included in the study. A negative association between glycemic control (glycated hemoglobin levels), socioeconomic status (Brazil Economic Classification Criterion), and psychological condition (Brazilian version of the Problem Areas in Diabetes) was observed. Among the study participants, 73.5% (n=50) of the children had an unfavorable socioeconomic status; these participants were 1.4 times more likely to present altered glycated hemoglobin values. In relation to individuals with compromised psychological status, 26 (38.2%) had a score above 70, thus being classified with psychological stress; these children were 1.68 times more likely (95% confidence interval: 1.101, 1.301) to have higher glycated hemoglobin levels. ConclusionsThe socioeconomic conditions and psychological characteristics of the study participants were negatively associated with glycated hemoglobin results. These data reinforce the importance of the studied variables as predictors of glycemic control.

Maternal glycoregulation in pregnancies complicated by diabetes mellitus in the prediction of fetal echography findings and perinatal outcomes.

We aimed to determine maternal hemoglobin A1c (HbA1c) levels and pregestational body mass index (BMI) as the predictors of glycemic control and its importance for fetal echography findings and perinatal outcomes in pregnancies complicated by diabetes mellitus (DM). Our intention was to evaluate how BMI and HbA1c levels might be used to predict fetal interventricular septum (IVS) thickness, atrioventricular inflow early diastole (E)/ atrial systole (A) velocity ratio, and perinatal outcomes. Patients in the 38th gestational week were divided into three groups according to their insulin therapy: (i) patients with gestational diabetes mellitus (GDM) treated only with dietary changes (GDM group, n = 32); (ii) patients with GDM treated with insulin therapy (DM2 group, n = 27); and (iii) patients with type 1 DM (DM1 group, n = 22). In the DM1 group, we found statistically significant correlations between BMI and IVS thickness (P = 0.036), HbA1c and IVS thickness, as well as the mitral E/A velocity ratio (P = 0.013 vs P = 0.007). In this group, HbA1c showed a statistically significant correlation to neonatal birth weight (P = 0.037) and BMI influenced on appearance respiratory distress syndrome in neonates in DM1 group (P = 0.027). The values of HbA1c predict neonatal respiratory distress syndrome in DM2 and GDM groups (P = 0.036). As good predictors of maternal glycoregulation, BMI and HbA1c levels determine fetal echography findings as well as neonatal outcomes in pregnancies complicated by DM.

Predictors of glycemic control in the first year of diagnosis of childhood onset type 1 diabetes: A systematic review of quantitative evidence.

Early glycemic control is associated with reduced future vascular complications risk in type 1 diabetes (T1D). The aim of this study was to systematically review evidence on the predictors of glycemic control within 12 months of diagnosis of childhood onset T1D. Inclusion criteria for the electronic search were: interventional and observational studies that assessed and quantified an association between the predictor and glycemic control within 12 months of diagnosis of childhood onset T1D. A total of 17 915 articles were identified from 6 databases and 20 studies were finally included in the analysis. Harvest plots and narrative synthesis were used to summarize data from intervention (n = 0), prospective/retrospective cohort (n = 15), and cross-sectional (n = 5) studies. Significant predictors of poorer glycemic control 0 to 3 months after diagnosis were older age and female gender. Non-white ethnicity, diabetes autoantibody positivity, measures of deprivation, and non-private health insurance were potential predictors. Predictors of poorer glycemic control 4 to 12 months after diagnosis were: older age, non-white ethnicity, a single parent family, high hemoglobin A1c (HbA1c) levels at diagnosis, longer T1D duration, and non-intensive insulin therapy. Potential predictors included: family with health issues, clinical factors, and comorbidities at diagnosis. Most significant predictors of poor glycemic control within 12 months of diagnosis of childhood onset T1D are non-modifiable. These factors need to be recognized and addressed through individualized and multidisciplinary diabetes care. Further research is required to confirm the association of potential predictors with early glycemic control.

The Impact of Frequency and Tone of Parent–Youth Communication on Type 1 Diabetes Management

BackgroundThe purpose of this study is to assess the impact of frequency and tone of parent–youth communication on glycemic control as measured by the Family Communication Inventory (FCI). Adolescence provides a unique set of diabetes management challenges, including suboptimal glycemic control. Continued parental involvement in diabetes management is associated with improved HbA1c outcomes; however, diabetes-related conflict within the family can have adverse effects. Although it is clear that communication plays an important role in diabetes outcomes, the specific impact of frequency and tone of such communication is largely understudied.MethodsA total of 110 youths with type 1 diabetes and their parents completed questionnaires assessing diabetes-related adherence, family conflict, and family communication (i.e., frequency and tone) during a routine clinic visit. Routine testing of HbA1c was performed.ResultsYouth- and parent-reported frequency of communication were unrelated to HbA1c. Instead, greater discrepancies between parents and children on reported frequency of communication (most commonly parents reporting frequent and youth reporting less frequent communication) corresponded with poorer glycemic control and increased family conflict. More positive tone of communication as rated by youth was associated with lower HbA1c.ConclusionsDiabetes-related communication is more complex than conveyed simply by how often children and their parents communicate. Tone of communication and discrepancies in a family’s perception of the frequency of communication were better than frequency as predictors of glycemic control. The FCI appears to capture the frequency and tone of diabetes-related communication, though larger-scale studies are warranted to inform future use of this scale.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0259-2) contains supplementary material, which is available to authorized users.

Pattern and Predictors of Glycemic Control among Type 2 Diabetics in Armed Forces Hospital of Jizan, southwestern Saudi Arabia

Pattern and Predictors of Glycemic Control among Type 2 Diabetics in Armed Forces Hospital of Jizan, southwestern Saudi Arabia

Are general practice characteristics predictors of good glycaemic control in patients with diabetes? A cross-sectional study.

Objectives: To determine whether certain characteristics of general practices are associated with good glycaemic control in patients with diabetes and with completing an annual cycle of care (ACC). Research design and methods: Our cross-sectional analysis used baseline data from the Australian Diabetes Care Project conducted between 2011 and 2014. Practice characteristics were self-reported. Characteristics of the patients that were assessed included glycaemic control (HbA₁(c) level ≤ 53 mmol/mol), age, sex, duration of diabetes, socio-economic disadvantage (SEIFA) score, the complexity of the patient's condition, and whether the patient had completed an ACC for diabetes in the past 18 months. Clustered logistic regression was used to establish predictors of glycaemic control and a completed ACC. Results: Data were available from 147 general practices and 5455 patients with established type 1 or type 2 diabetes in three Australian states. After adjustment for other patient characteristics, only the patient completing an ACC was statistically significant as a predictor of glycaemic control (P = 0.011). In a multivariate model, the practice having a chronic disease-focused practice nurse (P = 0.036) and running educational events for patients with diabetes (P = 0.004) were statistically significant predictors of the patient having complete an ACC. Conclusions: Patient characteristics are moderately good predictors of whether the patient is in glycaemic control, whereas practice characteristics appear to predict only the likelihood of patients completing an ACC. The ACC is an established indicator of good diabetes management. This is the first study to report a positive association between having completed an ACC and the patient being in glycaemic control.

Treatment beliefs, health behaviors and their association with treatment outcome in type 2 diabetes

ObjectiveWhile the prevalence of type 2 diabetes is growing, it is increasingly well recognized that treatment outcomes in primary care practice are often suboptimal. The aim of this study is...

Correlation of fasting and postprandial plasma glucose with HbA1c in assessing glycemic control; systematic review and meta-analysis.

BackgroundGlycemic control in diabetes mellitus is a cornerstone in reducing morbidity and mortality of the disease. Achieving glycemic control or reducing hyperglycemia significantly decreases the microvascular and macrovascular complications of diabetes. Even though measurement of glycated hemoglobin (HbA1c) remains the gold standard for assessment of glycemic control, there is no consensus whether fasting or postprandial plasma glucose (PPG) is a better predictor of glycemic control in resource-poor settings when HbA1c is not available. The aim of this systematic review and meta-analysis was to summarize evidences on the significance of fasting and postprandial plasma glucose, and their correlation with HbA1c.MethodsRelevant studies were identified through systematic search of online databases (e.g. EMBASE, MEDLINE/PubMed and Cochrane library) and manual search of bibliographies of the included studies. Original research papers describing the correlations or associations of fasting and postprandial plasma glucose with HbA1c were included. The MedCalc software was used for data entry and analysis. We used the random effect model to estimate the pooled correlations of fasting and postprandial plasma glucose with HbA1c. Heterogeneity assessment and robustness analysis was also performed.ResultFrom total 126 articles identified, 14 articles were eligible for systemic review. Eleven of these eligible studies evaluated the correlations of fasting and postprandial plasma glucose to the standard HbA1c values and used in meta-analysis. Seven of these studies (63.5 %) found better or stronger correlations between PPG and HbA1c than fasting plasma glucose (FPG). In all the studies that estimated the relative contribution FPG and PPG to the overall hyperglycemia, decreases in PPG was accounted for greater decrease in HbA1c compared with decreases in FPG value. PPG also showed a better sensitivity, specificity and positive predictive value than FPG. The pooled correlation coefficient (r) between PPG and HbA1c was 0.68 (P < 0.001, 95 % CI; 0.56–0.75) slightly higher than pooled correlation coefficient of FPG (r = 0.61(P < 0.001, 95 % CI; 0.48–0.72)).ConclusionPPG has a closer association with HbA1c than FPG. Hence, PPG is better in predicting overall glycemic control in the absence of HbA1c.Electronic supplementary materialThe online version of this article (doi:10.1186/s13690-015-0088-6) contains supplementary material, which is available to authorized users.

PDB9 - Predictors of Glycemic Control and diabetes-related costs among adult type 2 Diabetes Patients Initiating Therapy with Liraglutide

PDB9 - Predictors of Glycemic Control and diabetes-related costs among adult type 2 Diabetes Patients Initiating Therapy with Liraglutide

G556(P) Is mean blood sugar monitoring with smart metre a better indicator of control than hba1c in paediatric diabetes?

Context Kettering General Hospital, Distric Hospital, United Kingdom. Number of paediatric patients with type 1 diabetes - 140. Multidisciplinary Team: Paediatric Diabetes Specialist Consultant, paediatric registrars, diabetic nurses, dietician. Problem For paediatric diabetes patients, effective glucose control with less variability is always challenging. Inadequate control can lead to recurrent hospital admissions affecting patient’s quality of life. Assessment of problem and analysis of its causes MDT identified following potential causes for inadequate control. Clinic HbA1C is performed 4 times a year to monitor glycaemic control but it may not truly reflect day to day control of patient’s blood sugar levels at home which can be significantly up and down. Maintaining a hand written sugar diary can be difficult for patients with compliance issues. Interpretation of an inadequately filled paper diary can be challenging for doctors as well as patients as it does not give an idea of trends of sugar levels and therefore does not reflect glycaemic control and variability. Patients can also experience difficulties in calculating right dose of insulin at home. Intervention Patients were provided SMART metres after an education about their use. They were taken through a process of on-going learning to review and analyse the SMART metre downloads and make appropriate changes to their insulin needs to prevent high and low sugars. The MDT had an oversight of the process to actively facilitate the learning to decrease admissions aiming for diabetes home care. In 3 monthly clinics near patient HbA1c testing as well as SMART metre downloads were used to analyse patient compliance and treatment results Study design Prospective data collection during clinics from January to June 2014. A retrospective analysis of prospectively collected database of blood sugar downloads from SMART metres and near patient A1C tests. Strategy for change Change was implemented through education with MDT approach. Families were supported through the process of changing metres and offered open access to MDT. Measurement of improvement The effect of the planned changes were measured by patient confidence in self-management, glycaemic control, Variability of blood sugars versus A1C levels and need for hospital admissions. Better understanding amongst the patients of their own control led to the patient empowerment in a friendlier home environment. Mean A1C for 100 downloads was 61.67 mmol/mol (9.8 mmol/L) that was comparable to a mean blood sugar of 9.6 mmol/L with a mean standard deviation of 4.7. However this correlation changed when the data was stratified based on Standard deviation (SD). SD SD 2–4: co-related to mean A1C 53.9 mmol/mol (8.7 mmol/L) to average mean blood sugar 7.9 mmol/L. SD >4: mean A1C 63.4 mmol/mol (10 mmol/L) and average mean blood sugars-9.97 mmol/L were exactly same. SD >6: mean A1C of 73.89 mmol/mol (11.6 mmol/L) compared to average mean blood sugar of 12.4 mmol/L. Admissions due to DKA and hypoglycaemia decreased by half. Effects of changes Better control closer to home improving patient experience and quality of life at reduced heath care cost. There was initial hesitation around new metre and tight targets which was overcome by education, close supervision and reflection. Lessons learnt SMART metre download review is a good way of analysing blood sugars targets, variability and control over a period of time. They are better predictors of glycaemic control It has its advantages in empowering patients at the comfort of their own homes. Message for others SMART metres have taken paediatric diabetes management closer to home. Mean blood sugars are a better indicator of glycaemic control and variability when the standard deviation is between 0–4.

Predictors of glycaemic control among HIV-positive veterans with diabetes

Antiretroviral therapy has decreased HIV-related mortality. However, the incidence of diabetes as a co-morbidity is increasing as HIV-positive patients age. The purpose of this study was to assess the correlation between markers of HIV-infection and diabetes and to determine the proportion of patients achieving an haemoglobin A1c (HbA1c) goal <7% according to specific antiretroviral therapy regimens and adherence. In this retrospective study, HIV-positive veterans with diabetes from 2007 to 2012 were identified. Patients were required to be on the same antiretroviral therapy and diabetes regimen for ≥3 months. In 56 patients, it was identified that for each unit increase in log10 viral load, HbA1c increased 0.67 units (p = 0.0085). Only 38% of patients prescribed a protease inhibitor-based regimen vs. 56% of patients not on a protease inhibitor-based regimen achieved an HbA1c goal (p = 0.1864). Additionally, patients on an insulin-based regimen and patients that were less adherent were less likely to be at HbA1c goal (p = 0.018 and p = 0.0378, respectively). Patients with higher viral loads and patients that were less adherent to antiretroviral therapy were more likely to have a higher HbA1c demonstrating that poor adherence to antiretroviral therapy leads to poor control of both disease states.

Predictors of Glycemic Control among Patients with Type 2 Diabetes in Najran Armed Forces Hospital: A Pilot Study

Background: Diabetes mellitus is a serious condition with potentially devastating complications that affects all age groups worldwide. The purposes of this study are to describe the glycemic control levels and to determine the associated factors of poor glycemiccontrol among type 2 diabetes patients followed in Najran Armed Forces Hospital. Methods:We conducted a retrospective analysis of administrative data from adult patients with diabetes type 2 followed in NAFH clinics. To be included in the pilot study, patients needed to meet the following criteria: 1) Be identified as having diabetes type 2 using algorithms employed by disease management oasis program; 2) Be at least aged 18; 3) Be male or female; 4) Have Fasting Plasma Glucose (FPG) and HbA1c measured at least twice during the last year. Both univariate and multivariate approaches of logistic regression were applied to determine factors associated with poor glycemic control. Results: Data from a total of 100 patients were analyzed. There were 22% of patients that achieved glycemic control. The risk factors associated with poor glycemic control were being female, age

Gender difference in response predictors after 1-year exenatide therapy twice daily in type 2 diabetic patients: a real world experience

PurposeTo investigate whether gender affects therapeutic response by exenatide twice a day (BID) in type 2 diabetes by using a database concerning patients monitored by five outpatient clinics in Tuscany, Italy.Patients and methodsWe considered a cohort of 315 (154 male/161 female) patients experiencing therapeutic failure while on oral therapy (metformin, or combination therapy metformin + sulphonylureas), who were given exenatide (10 μg/BID) and who fully completed 4 months, 8 months, and 12 months of follow-ups.ResultsAmong patients stratified by gender and well matched for age, body mass index, and hemoglobin A1c (HbA1c), it was found that the length of disease was longer in females than in males (12 ± 8 years versus 10 ± 7 years; P = 0.037), and the ratio of patients on metformin to those on combination therapy was higher in men (P = 0.018). Target glycemic response (1-year HbA1c ≤ 7%) was achieved in a significantly higher proportion of males than females (38% versus 27%; χ2 = 4.66; P = 0.03). Target weight loss expressed as 1-year weight percent fall from baseline ≥ 75th percentile (8.5%) was significantly higher in females at 8 and 12 months (P < 0.05; for both). One-year glycemic target response was inversely related to baseline HbA1c levels and diabetes duration among males, while metformin therapy (compared to oral combination therapy) was a significant predictor of better glycemic targets among females. Homeostasis model assessment-B, measured in 117 patients, predicted hypoglycemic response only in women (P = 0.009). Target 1-year weight loss was predicted by longer diabetes duration among males and by lower baseline HbA1c among females. Finally, no significant difference between genders was noted as to gastrointestinal side effects after exenatide therapy.ConclusionAccording to this “real world” experience, predictors of glycemic control and body weight loss after 12 months of exenatide BID therapy are different between genders in type 2 diabetes.

Determinants of Glycosylated Haemaglobin among Adults with Type 2 Diabetes Mellitus

Purpose: The purpose of this study is to assess the determinants of demographic and clinical factors associated with HbA1C levels among adults with type 2 diabetes mellitus (T2DM) in Muscat. Glycosylated Hemoglobin (HbA1C) is used as marker for long term blood glucose control in adults with type 2 diabetes mellitus. Methods: A cross-sectional design was used. Simple random sampling was used to select 300 adults with T2DM in Oman in 2011. Ethical approval and hospital permission was completed from the Institutional Research and Ethics Committee. Informed consent was obtained from the participants. Chi-square and multiple logistic regression models with demographic and clinical characteristics as predictors of glycemic control (HbA1C) were used to analyze the results. Results: Nearly half percentage of the adults with T2DM had better or controlled HbA1C ( 7%). Younger ages, females, higher education, non-tobacco users, short duration of diabetes, compliance with OHA and high waist-hip ratio predicted better control of HbA1C. Conclusions: Socio-demographic and clinical factors were consistently associated with glycemic control. Gender, education, perception of prevention of ADL, doctor-patient relationship, compliance with medications, and non-tobacco users were significant predictors of better glycemic controls among adults with T2DM. Relevance to clinical practice. Assessment of determinants of HbA1C may assist in determining individualized goals and strategies, subsequently improve glycemic control and enhance self-care management.

Predictors of Glycemic Control in Children and Adolescents with Type 1 Diabetes in Southwestern Ontario

s / Can J Diabetes 37 (2013) S13eS84 S77 15.0%), indicating that approximately 40% of diabetes cases are undiagnosed. Conclusions: A substantial proportion of diabetes cases are missed by surveillance methods that use health administrative databases. This finding is concerning because individuals with undiagnosed diabetes are likely to have a delay in treatment and, thus, a higher risk for diabetes-related complications.

Exploratory analysis of the relationships among different methods of assessing adherence and glycemic control in youth with type 1 diabetes mellitus.

The present study examined four methods of assessing diabetes adherence (self-report, diary measure, electronic monitoring, and provider rating) within a population of youth with Type I Diabetes Mellitus (T1DM). Comparisons were conducted among the four methods of assessing diabetes adherence. Associations among the seven different measures of blood glucose monitoring (BGM) and HbA1c were examined. An exploratory stepwise regression analysis was conducted to determine the best predictors of glycemic control (i.e., Hemoglobin A1c; HbA1c) while controlling for relevant demographic variables. The adherence measures appeared to be interrelated. The relationships between many of the BGM measures and HbA1c demonstrated a medium effect size. The Self Care Inventory (SCI) adjusted global score was the strongest predictor of HbA1c, even after taking the demographic variables into account. The SCI is a robust, easy-to-use, and cost-efficient measure of adherence that has a strong relationship to HbA1c. Demographic variables are important to examine within the context of different methods of assessing adherence. The research methodology utilized to assess both general diabetes adherence and more specific behavioral measurements of BGM should be clearly documented in future studies to ensure accurate interpretation of results.

Predictors of glycaemic control in patients with Type 1 diabetes commencing continuous subcutaneous insulin infusion therapy

To identify variables that predict glycaemic control in Type 1 diabetic patients switched to a continuous subcutaneous insulin infusion (CSII) regimen, in order to improve patient selection for this treatment. The notes of 421 Type 1 diabetic patients aged 2.6-39.8 years (median 19.4) who initiated CSII treatment in 1998-2007 and used it for > or = 1 year were reviewed. Details about their background and disease-related and treatment-related variables were recorded. At pump initiation, the mean age was 15.9 +/- 7.2 years, mean diabetes duration 6.4 +/- 5.8 years. Mean time of CSII use was 4.1 +/- 2.1 years. Good glycaemic control was defined by glycated haemoglobin (HbA(1c)) stratified by age (American Diabetes Association target levels). Improvement in glycaemic control was defined as a reduction of > or = 0.5% in HbA(1c) from baseline. The change in the rate of severe hypoglycaemic or diabetic ketoacidosis events was also determined. There was a significant sustained decrease in HbA(1c) with CSII for an average of 6 years, without increased rates of hypoglycaemia. Achievement of target HbA(1c) was significantly associated with the following parameters at pump initiation: lower HbA(1c) (P < 0.001), younger age (< 12 years), shorter diabetes duration (P < 0.001) and more frequent daily self blood glucose monitoring (SBGM) (P < 0.01). Improved glycaemic control was associated with longer CSII use (P = 0.032) and higher HbA(1c) at CSII initiation (P < 0.001). Switching patients to CSII resulted in sustained decrease in HbA(1c) and improved glycaemic control in patients with high HbA(1c). Young age, frequent SBGM and lower HbA(1c) at pump initiation were identified as predictors of achieving glycaemic targets with CSII.

Impact of health literacy and patient trust on glycemic control in an urban USA population

Diabetes, with its consequences of premature death, complications, and economic costs, is a precursor to a public health crisis that is expected to worsen over the next several decades. The improvement of diabetes outcomes, specifically glycemic control as measured by glycosylated hemoglobin concentration (HbA1c), can impact this critical situation. A quantitative study was conducted that examined health literacy and patient trust as predictors of glycemic control. The related factors of demographics, socioeconomic status, diabetes knowledge, self-care activities, and depression were also considered. Implementing a cross-sectional, predictive design, a convenience sample of 102 patients with diabetes was recruited from two urban primary care clinics in the USA. A simultaneous multiple regression was conducted. The regression analysis was significant, with patient trust and depression accounting for 28.5% of the variance in HbA1c. There was a significant positive relationship between socioeconomic status and health literacy and between diabetes knowledge and health literacy. The results support promotion of the patient-provider relationship, depression screening among individuals with diabetes, and exploration of new strategies for diabetes education. Future research is needed to advance the framework, ascertain which factors engender patient trust, and determine the role of health literacy in glycemic control.

Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes.

Obstructive sleep apnea (OSA), a treatable sleep disorder that is associated with alterations in glucose metabolism in individuals without diabetes, is a highly prevalent comorbidity of type 2 diabetes. However, it is not known whether the severity of OSA is a predictor of glycemic control in patients with diabetes. To determine the impact of OSA on hemoglobin A1c (HbA1c), the major clinical indicator of glycemic control, in patients with type 2 diabetes. We performed polysomnography studies and measured HbA1c in 60 consecutive patients with diabetes recruited from outpatient clinics between February 2007 and August 2009. A total of 77% of patients with diabetes had OSA (apnea-hypopnea index [AHI] > or =5). Increasing OSA severity was associated with poorer glucose control, after controlling for age, sex, race, body mass index, number of diabetes medications, level of exercise, years of diabetes and total sleep time. Compared with patients without OSA, the adjusted mean HbA1c was increased by 1.49% (P = 0.0028) in patients with mild OSA, 1.93% (P = 0.0033) in patients with moderate OSA, and 3.69% (P < 0.0001) in patients with severe OSA (P < 0.0001 for linear trend). Measures of OSA severity, including total AHI (P = 0.004), rapid eye movement AHI (P = 0.005), and the oxygen desaturation index during total and rapid eye movement sleep (P = 0.005 and P = 0.008, respectively) were positively correlated with increasing HbA1c levels. In patients with type 2 diabetes, increasing severity of OSA is associated with poorer glucose control, independent of adiposity and other confounders, with effect sizes comparable to those of widely used hypoglycemic drugs.

Predictors of glycemic control in Japanese subjects with type 2 diabetes mellitus

The purpose of this study was to investigate which pathophysiological and demographic characteristics of Japanese subjects with type 2 diabetes mellitus were associated with poor glycemic control and to propose a statistical model for predicting their glycemic control. A total of 220 subjects with type 2 diabetes mellitus were enrolled in this study. Frequently sampled intravenous glucose tolerance test was performed to determine the first-phase C-peptide secretion rate (CS1) and insulin sensitivity index. Multiple regression analysis in a stepwise manner was carried out to identify independent regulators of glycemic control. Upon stepwise linear regression analysis with hemoglobin A 1c as a dependent parameter, fasting plasma glucose concentration (FPG), CS1, and onset age remained as predictors, explaining 41.0% of glycemic control. The young-onset group (onset age ≤48 years) had significantly higher hemoglobin A 1c than the old-onset group (onset age >48 years) ( P = .0148), although the present age was significantly older in the old-onset group; and there were no significant differences in duration of diabetes, treatment, body mass index, FPG, fasting insulin level, homeostasis model assessment of insulin resistance, CS1, and log(insulin sensitivity index) between them. Worsening factors of glycemic control in Japanese subjects with type 2 diabetes mellitus were elevated FPG, impaired first-phase insulin secretion, and young age of onset of the disease. Because glycemic control in the subjects with young-onset diabetes tends to be worse, early and aggressive intervention should be required for those with young-onset diabetes to prevent long-term complications.