Previous Glycemic Control Research Articles

Treatment‐induced neuropathy of diabetes: an update

Abstract Background and aims: Treatment‐induced neuropathy of diabetes is an acute small‐fibre neuropathy associated with rapid glycaemia improvement.Methods: This study is a narrative review carried out based on a bibliographic review, using articles indexed in PubMed/Medline and Scielo.Results: This entity is more frequent in adult patients with poor previous glycaemic control. Its precise pathophysiology is unknown, but it is likely related to unrestored microcirculation changes that occurred during the hyperglycaemic period. It presents with intense, sudden neuropathic pain and autonomic dysfunction after a rapid glycaemic correction and a poorer analgesic response than in diabetic neuropathy.Conclusions: Since rapid glycaemia correction is the cause of this problem, clinical practice guidelines that can help physicians to prevent, diagnose and manage this entity should be developed. Copyright © 2023 John Wiley & Sons.

Clinical outcome of patients with diabetes mellitus infected by SARS-COV-2

Introduction: Diabetes, a chronic metabolic disease with high prevalence in Brazil, is a risk factor for severe SARS COV-2 infection. The relationship between previous glycemic control and the prognosis of patients hospitalized with COVID-19 is not fully understood. Objective: analyze the clinical outcome of patients with diabetes mellitus infected by SARS-COV-2. Outlining: A retrospective analysis of medical records was carried out using the Trakcare electronic system of all diabetic patients hospitalized with a confirmatory diagnosis of pneumonia due to COVID-19 in the medical clinic ward of HRAN, from June to August 2021, who, upon admission, performed the glycated hemoglobin test and analyzed it using the SPSS software (20.0). Results: A sample of 52 patients was obtained during the study period. Most patients are female, with a mean age of approximately 58 years. The comorbidity most associated with the participants was systemic arterial hypertension, with most diabetics presenting good prior glycemic control, represented by HbA1c ≤ 7%. The lethality found was 7.7%. Implications: The study shows a high lethality of diabetic patients infected by COVID 19, but no statistical significance was found for HbA1c levels with the increase in length of stay, use of non-rebreathing mask, need for invasive mechanical ventilation or lethality

The importance of glycemic control in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) covers a range of liver lesions of various severity, from isolated steatosis to non-alcoholic steatohepatitis (NASH) with or without fibrosis, liver cirrhosis and hepatocellular carcinoma (HCC). NAFLD has reached the scale of a pandemic that affects approximately 25 % of the world’s population and approximately 60 % of patients with type 2 diabetes mellitus (DM2) worldwide. Diabetes mellitus is also considered a risk factor for the development of NAFLD/NASH and is a strong predictor of the development and progression of fibrosis, HCC and associated mortality. Despite a clear link between NAFLD and DM2, it is still unclear how glycemic control affects the severity and associated risk of progression of NAFLD and NASH.
 The aim of the study. To investigate the relationship between glycemic control (using the mean hemoglobin A1c [HbA1c] levels) and development and severity of NAFLD and hepatic fibrosis.
 Materials and methods. Investigations involved 113 patients who met the following criteria: age ≥ 18 years, diagnosis of NAFLD/NASH, confirmed by multimodal ultrasound and/or sustained increase in transaminases, and at least one documented value of HbA1c within 90 days before the clinical diagnosis of NAFLD/NASH. All patients underwent clinical and anamnestic, general clinical, biochemical studies to determine liver functional tests and lipid spectrum, HbA1c and fasting glucose, multimodal ultrasound to determine steatosis (steatometry) and liver fibrosis (elastography). Depending on the average level of HbA1c before the diagnosis of NAFLD/NASH, 3 subgroups of patients were identified — with good, moderate and poor glycemic control (average HbA1c values were 6.5 %, 7.6 % and 10.0 %, respectively).
 Results. In the majority of patients (76.9 %) with established NASH, the previous glycemic control determined by the level of HbA1c was moderate (57.7 %) or poor (19.2 %). In contrast, in most patients (62.3 %) with good glycemic control, simple steatosis was detected, and NASH was not confirmed by clinical and biochemical criteria. Relevant data were obtained for elevated levels of ALA and alkaline phosphatase, as well as triglycerides, which in patients with good glycemic control did not exceed normal values. Liver fibrosis (F1—F4) was detected in only 20 % with good glycemic control, while in moderate and poor glycemic control it was detected in most patients (80 %; p < 0.001). In addition, advanced liver fibrosis (F3—F4) was diagnosed only in patients with moderate and poor glycemic control.
 Conclusions. Poor glycemic control as determined by HbA1c can be considered as a potential modifier of the risk of progression of NAFLD/NASH.

Association between glycemic control and the outcome in hospitalized patients with COVID-19.

PurposeCoronavirus disease 2019 (COVID-19) clinical outcome and disease severity affected by several factors; deterioration of glycemic control is one of them. Therefore, achieving optimum blood glucose parameters is hypothesized for better consequences of COVID-19. However, varying data supporting this hypothesis is available in literature. The intention of this study was to investigate the role of glycemic management on the prognosis of hospitalized COVID-19 patients with varying degrees of severity.MethodsFrom April 2020 to January 2021, we carried this retrospective cohort in a clinical care facility in Pakistan.ResultsMortality was lowest in patients with HbA1c of less than 7% (53 mmol/mol) (p < 0.001). Similarly, mortality was found lowest in patients with fasting blood glucose less than 126 mg/dl and random blood glucose less than 160 mg/dl (p < 0.001 in each). In contrast, need for admission in critical care was found highest in patients with HbA1c between 7 and 10% (53–86 mmol/mol) (p 0.002). However, participants with blood glucose levels during fasting greater than 200 mg/dl and random blood glucose levels greater than 250 mg/dl were found to have a greater need for invasive mechanical ventilation. Cox regression hazard showed no difference in risk of death and invasive mechanical ventilation based on previous glycemic control.ConclusionEffective diabetic management is correlated with a considerably lower risk of mortality and invasive mechanical ventilation in COVID-19 cases.

Association of Stress Hyperglycemia and Adverse Cardiac Events in Acute Myocardial Infarction - A Cohort Study.

Stress hyperglycemia is a common phenomenon in patients presenting with acute myocardial infarction (MI). We aim to evaluate the association of stress hyperglycemia at the time of hospital presentation and adverse cardiac events in myocardial infarction during the course of hospital stay. Subjects with age ≥18 years with acute MI were recruited on hospital admission and categorized based on admission blood glucose (<180 and ≥180 mg/dl, 50 patients in each group). Both groups were compared for clinical outcomes, adverse cardiac events and mortality. We also compared the adverse cardiac outcomes based on HbA1c levels (<6% and ≥6%). Patients with high blood glucose on admission (stress hyperglycemia) had significant increased incidences of severe heart failure (Killip class 3 and 4), arrythmias, cardiogenic shock and mortality (p value = 0.001, 0.004, 0.044, and 0.008 respectively). There was no significant association between adverse cardiac events and HbA1c levels (heart failure 18.8% vs. 25%, p value = 0.609 and mortality 16.7% vs. 17.3%, p value = 0.856). Stress hyperglycemia is significantly associated with adverse clinical outcomes in patients with MI irrespective of previous diabetic history or glycemic control. Clinicians should be vigilant for admission blood glucose while treating MI patients.

Flash glucose monitoring system: impact on glycemic control and body mass index in type 1 diabetes mellitus.

Flash glucose monitoring (FGM) is increasingly used in type 1 diabetes mellitus (T1D) management. This study aimed to assess glycated hemoglobin (HbA1c) and body mass index (BMI) in the first year of FGM use in patients with T1D and to identify predictive factors of benefit associated with its use. Retrospective study of T1D patients, using FGM for ≥ 6 months and under intensive insulin therapy with multiple daily injections. In 179 patients with a median (Md) age of 43.0 years (P25 31.0; P75 52.0) and disease duration of 18.0 years (P25 10.0; P75 28.0), initial HbA1c was 7.9% (P25 7.2; P75 8.8) and initial BMI was 24.0 kg/m2 (P25 21.9; P75 26.2). With FGM, HbA1c improved significantly to 7.6% (P25 7.0; P75 8.3) at 6 months and 7.7% (P25 6.95; P75 8.5) at 12 months (p < 0.05), with more patients with HbA1c < 7% (16.1% vs 22.5%) and fewer patients with HbA1c ≥ 8% (49.1% vs 35.8%) (p < 0.05). Initial HbA1c 8.0-8.9% (HR 1.886; 95% CI 1.321-2.450) and ≥ 9.0% (HR 3.108, 95% CI 2.454-3.761) predicted greater HbA1c reduction. BMI increased significantly, especially between 6 and 12 months (BMI Md 23.8 [P25 21.9; P75 26.2] kg/m2 and 24.0 [P25 22.0; P75 26.2] kg/m2, respectively) (p < 0.05). Overweight (HR 4.319, 95% CI 3.185-5.453) and obesity (HR 8.112, 95% CI 3.919-12.306) predicted greater weight gain. FGM use was associated with significant improvement in HbA1c, mainly in patients with worse previous glycemic control. It was also associated with increased BMI, especially if baseline BMI ≥ 25 kg/m2, so weight control strategies should be emphasized.

The association of diabetes and the prognosis of COVID-19 patients: A retrospective study

AimsThis study evaluated the impact of previous glycemic control and in-hospital use of antidiabetic/antihypertensive drugs on the prognosis of COVID-19 patients with diabetes. MethodsIn this retrospective cohort study, consecutive inpatients with laboratory confirmed COVID-19 were enrolled from Tongji Hospital (Wuhan, China). Patients without diabetes were matched to those with diabetes based on age, sex, and comorbidities. All patients were followed up to a clinical endpoint (discharge, worsening including transferring to ICU or immediate death). Data and outcomes were extracted from medical records and analyzed. Results64 patients with pre-existing diabetes were included in this study, with 128 matched patients without diabetes included as a control group. Patients with diabetes had a higher rate of worsening (18.8% versus 7.8%, p = 0.025). Multivariable regression showed increased odds of worsening associated with previous glycemic control reflected by HbA1c (odds ratio 3.29, 95% CI 1.19–9.13, p = 0.022) and receiver-operating characteristics (ROC) curve identified HbA1c of 8.6% (70 mmol/mol) as the optimal cut-off value. Univariate analysis demonstrated the in-hospital use of antidiabetic/antihypertensive drugs were not associated with a higher risk of worsening. ConclusionsCOVID-19 patients with diabetes had a higher risk of worsening, especially those with poorly-controlled HbA1c, with an optimal cut-off value of 8.6%. The in-hospital use of antidiabetic/antihypertensive drugs were not associated with increased odds of worsening in patients with diabetes.

Glycated hemoglobin A1c level on the day of emergency surgery is a marker of premorbid glycemic control: a retrospective observational study

BackgroundCurrent international guideline recommends to maintain blood glucose level ≤ 180 mg/dL in acute ill patients, irrespective of presence of premorbid diabetes. However, there are studies suggested that optimal acute glycemic control should be adjusted according to premorbid glycemic control in patients with chronic hyperglycemia. Accordingly, to obtain the information of premorbid glycemic control would be relevant. However, the HbA1c level on the day of the emergency operation (HbA1c-ope) might not be useful as a surrogate of premorbid chronic glycemic control, since glucose metabolism can be affected by inflammation, severity of illness and surgical invasion.MethodsWe hypothesized that HbA1c-ope reflects pre-morbid glycemic control. To assess this hypothesis, we conducted a single-center retrospective observational study to assess the association between HbA1c-ope and HbA1c level measured within 30 days before the operation (HbA1c-pre). We screened patients who had been admitted to the ICU of our hospital after emergency surgery during the period from January 2008 to December 2016. Patients in whom both of HbA1c-ope and HbA1c-pre were measured were included in this study. We compared HbA1c-ope and HbA1c-pre using the paired t-test. The correlation between the two HbA1c measurements was assessed using Pearson’s correlation coefficient. Its agreement was assessed using the Bland-Altman approach with 95% confidence intervals.ResultsWe included 48 patients in this study. The mean value of HbA1c-pre was 6.3%, which was not significantly different from the mean value of 6.2% for HbA1c-ope (p = 0.12). There was a significant correlation between HbA1c-pre and HbA1c-ope (r2 = 0.70, p < 0.001). The mean difference between two HbA1c measurements was 0.12% (95% CI: -0.03% to 0.27%). The limit of agreement ranged from − 0.9% to +1.1%.ConclusionsWe found that there was a significant correlation between HbA1c-ope and HbA1c-pre. Our findings suggest that HbA1c-ope can be used to estimate previous glycemic control with an acceptable degree of accuracy, enabling personalized glycemic control in the perioperative period.

Self-monitoring blood glucose improves glycemic control in type 2 diabetes without intensive treatment: A systematic review and meta-analysis

AimsSystematic review and meta-analysis to evaluate the effect of Self-Monitoring of Blood Glucose (SMBG) on glycemic control in patients with type 2 Diabetes (T2D). MethodsWe searched the Medline, Embase, Cochrane Central, and ClinicalTrials.gov databases up to 20 July 2017. We also performed a manual search of abstracts from recent meetings of the American Diabetes Association and the European Association for the Study of Diabetes. Study selection: randomized controlled trials (RCTs) conducted in patients with T2D comparing any kind of SMBG to a control group. Two independent reviewers assessed the eligibility of references. Influence of SMBG in glycated hemoglobin (HbA1c) was aggregated as weighted mean difference accessed by direct random effect meta-analyses at 12, 24 weeks and 1 year. Sub-analyses were made to assess the effects of previous glycemic control and number of tests performed. ResultsSMBG was associated with a reduction of HbA1c at 12 weeks (−0.31%; 95% CI: −0.57 to −0.05) and 24 weeks (−0.34%; 95%CI: −0.52 to −0.17), but no difference was found for 1 year. Subgroup analysis including studies with baseline HbA1c greater than 8% showed a higher reduction of HbA1c: −0.83% (95% CI: −1.55 to −0.11) at 12 weeks, and −0.48% (95% CI: −0.77 to −0.19) at 24 weeks, with no difference for 1 year nor for the stratification for number the tests. ConclusionSMBG seems to lead to a slightly better glycemic control in the short term in patients with T2D. Patients decompensated at baseline appear to have the greatest benefit. PROSPERO register: CRD42016033558.

Intensity of dapagliflozin induced glycosuria correlates with previous glycemic control but not with body weight or duration of type 2 diabetes

Intensity of dapagliflozin induced glycosuria correlates with previous glycemic control but not with body weight or duration of type 2 diabetes

Glycemic Control and Diabetic Complications—Is the Predominant Current Rationale Rational?

Although the level of glycated hemoglobin (HbA1C) reflects chronic glycemic control, treatment-induced decreases in HbA1Cin patients who have established diabetes do not always predict beneficial clinical outcomes. Clinical outcomes are dramatically influenced by the history of previous glycemic control, the extent of current clinical complications, and the side effects of therapeutic agents. Rational approaches to the intensity of glycemic control in individual patients should take these factors into consideration, as well as in setting an appropriate goal for the HbA1Ctarget.

Evaluation of the understanding the degree of diabetes decompensation in elderly patients without satisfactory glycemic control

Objectives Assess the degree of understanding of diabetes without appropriate control in elderly patients. Materials and methods: We performed a Cross study of diabetic patients in the Endocrinology Department of a Brazilian tertiary hospital who were treated between June and December 2014. We include patients over 60 yrs. of age, of both sexes, with HbA1c ≥ 8.5% using oral hypoglycemic agents and insulin. All patients underwent five questions related to satisfaction with the diet and treatment for diabetes. We reviewed the records of patients to assess the previous glycemic control.

Contrasting effects of preexisting hyperglycemia and higher body size on hospital mortality in critically ill patients: a prospective cohort study.

BackgroundObesity and diabetes mellitus are well-defined risk factors for cardiovascular mortality. The impact of antecedent hyperglycemia and body size on mortality in critical ill patients in intensive care units (ICUs) may vary across their range of values. Therefore, we prospectively analyzed the relationship between in-hospital mortality and preexisting hyperglycemia and body size in critically ill ICU patients to understand how mortality varied among normal, overweight, and obese patients and those with low, intermediate, and high glycated hemoglobin (HbA1c) levels.MethodsMedical history, weight, height, physiologic variables, and HbA1c were obtained during the first 24 h for patients who were consecutively admitted to the high complexity ICU of Hospital de Clínicas de Porto Alegre, Brazil, from April to August 2011. The relationships between mortality and obesity and antecedent hyperglycemia were prospectively analyzed by cubic spline analysis and a Cox proportional hazards model.ResultsThe study comprised 199 patients. The overall hospital mortality rate was 43.2% during a median 16 (8–28) days of follow-up. There was a progressive risk of in-hospital mortality with higher HbA1c levels, with the relationship becoming significant at HbA1c >9.3% compared with lower levels (hazard ratio 1.74; 95% confidence interval with Bonferroni correction 1.49–2.80). In contrast, mean body mass index (BMI) was higher in survivors than in nonsurvivors (27.2 kg/m2 ± 7.3 vs. 24.7 kg/m2 ± 5.0 P = 0.031, respectively). Cubic spline analysis showed that these relationships differed nonlinearly through the spectrum of BMI values. In a Cox proportional hazards model adjusted for Acute Physiology and Chronic Health Evaluation II score and HbA1c, the risk of in-hospital mortality progressively decreased with increasing BMI (BMI <20 vs. 20–23.9 kg/m2, P = 0.032; BMI <20 vs. 24–34.9 kg/m2, P = 0.010; BMI <20 vs. ≥35 kg/m2, P = 0.032).ConclusionsOur findings suggest that significant hyperglycemia prior to ICU admission is a risk factor for in-hospital mortality. Conversely, increasing BMI may confer an advantageous effect against mortality in critical illness independently of previous glycemic control.

Association of Autoimmunity to Autonomic Nervous Structures With Nerve Function in Patients With Type 1 Diabetes: A 16-Year Prospective Study

OBJECTIVE We prospectively evaluated the association between autoimmunity to autonomic nervous structures and autonomic neuropathy in type 1 diabetes in relation to clinical variables. RESEARCH DESIGN AND METHODS A cohort of 112 patients with type 1 diabetes was prospectively followed from adolescence (T0) to approximately 4 (T4) and 16 (T16) years later. Standard cardiovascular (CV) tests and neurological examination were performed and related to the presence of circulating antibodies (Ab) to autonomic nervous structures detected at T0 and T4. Quality of life was assessed by a diabetes-specific questionnaire. RESULTS Sixty-six patients (59% of the cohort) were reexamined at T16 (age 31.4 ± 2 years; disease duration 23.4 ± 3.7 years). Nineteen had circulating Ab to autonomic structures. Prevalence of abnormal tests and autonomic symptoms were higher in Ab-positive (68 and 26%, respectively) than Ab-negative (32 and 4%) patients (P < 0.05). Among Ab-positive patients, the relative risk (RR) of having at least one altered CV test was 5.77 (95% CI 1.56-21.33), and an altered deep breathing (DB) test (<15 bpm) was 14.65 (2.48-86.46). Previous glycemic control was the only other predictor (RR 1.06 [1.002-1.13]/mmol/mol HbA1c increase). Presence of Ab carried over a 68% probability of developing an altered CV test; absence of Ab carried a 91% probability of not having an altered DB test and an 89% probability of not having an altered Valsalva ratio. Autonomic neuropathy was independently associated with worse quality of life. CONCLUSIONS Circulating Ab to autonomic structures are associated with the development of autonomic dysfunction in young diabetic patients independent of glycemic control.

Recurrent insulin injection abscesses: Atypical etiology

Sir, A 63-year-old man with type 2 diabetes presented with a 2-month history of swellings and discharge over his thighs and abdomen at the injection sites of insulin. He was using glargine insulin for the past one year, once daily at night time, with vial and syringe. He used to change the syringe once in 3 days and follow the storage guidelines for the insulin.. His previous glycemic control was poor with evidence of microvascular and macrovascular complications and HbA1c of 10.2%. Clinical examination revealed normotensive individual with multiple subcutaneous abscesses over anterior abdominal wall and thighs [Figure ​[Figure1a1a and ​andb].b]. Pus drained from the abscesses did not stain any organism on Gram's stain and no organism was grown after 7 days culture in agar medium. The patient was treated initially with beta lactam antibiotics and cephalosporins without any improvement. Figure 1 Insulin site abscesses over anterior abdominal wall (a) and thighs (b) Repeat staining with Ziehl–Neelsen stain showed the presence of alcohol fast bacilli (AFB) and prolonged culture led to the isolation of the pathogen. Recurrent abscesses coupled with negative cultures led to the possibility of atypical organism. Positive AFB staining and culture characteristics of the bacteria confirmed the diagnosis of Mycobacterium chelonae as the underlying etiology of injection abscesses. Cultures from the tip of insulin syringe needles and insulin from the bottle did not reveal presence of this organism. He was treated with clarithromycin (500 mg thrice daily) and lineozolid (600 mg twice daily) for 8 weeks. The abscesses healed completely without any recurrence. M. chelonae is an atypical mycobacterium and is classified under rapid growers (Group IV of Runyon's classification).[1] The organism is present ubiquitously in the environment and is difficult to culture. Cutaneous infections are seen in immunocompetent individuals and disseminated disease in immunocompromised patients. The portal of entry commonly is skin, leading to cellulitis, granulomas, nodules, ulcers, and abscesses.[2] Disseminated infections lead to deep-seated infections like osteomyelitis, endocarditis, meningitis, and keratitis. M. chelonae is not amenable to antitubercular therapy and is sensitive to clarithromycin, linezolid, and ciprofloxacin.[3] Deep-seated infections require parenteral mode of therapy in addition to use of imipenem in resistant cases. To conclude, our case highlights the need to look for atypical organisms in cases of recurrent insulin injection site abscesses.

Detection of autoantibodies against glycosylated-DNA in diabetic subjects: Its possible correlation with HbA(1C).

Aims: The vascular tissues have a long memory of their previous glycemic control and intervention studies have demonstrated that microvascular complications are highly correlated with mean glycemic control as measured by glycolated hemoglobin A1C (HbA1c). The present study was carried out to evaluate the autoantibodies against glycosylated DNA (DNAAGEs) in diabetic sera to see if the level of HbA1c has correlation with the activity of DNA-AGEs, another marker of chronic glycemia. Methods: Glucose-6-phosphate induced glycosylation of native DNA was studied in 150 diabetic sera (T1DM = 9, T2DM = 141) by spectroscopic techniques (UV and fluorescence) and agarose gel electrophoresis. Direct binding and inhibition enzyme immunoassays were carried out to evaluate binding and specificity of anti-glycated-DNA autoantibodies (anti-DNA-AGE autoantibodies) in sera of diabetes patients. A quantitative estimation of HbA1c was carried out in normal and diabetes sera.Results: Anti-DNA-AGEs autoantibodies in 55% of diabetic sera (85/150) showed more binding with glycated-DNA compared to native DNA which was subjected to inhibition ELISA indicating true interaction of these autoantibodies in diabetes with glycated DNA. Higher binding with glycosylated-DNA against native-DNA was observed in subjects with HbA1c of 9.8 ± 3.3% compared to those with HbA1c of 7.7 ± 1.7% (p < 0.001). Linear correlation analysis showed that mean absorbance difference was significantly related to HbA1c (r = 0.486, p < 0.001), nephropathy (r = 0.239, p < 0.003), retinopathy (r = 0.165, p < 0.05). Conclusions: Autoantibodies against glycosylated DNA were correlated with HbA1c and microvascular complications and may be useful as another biomarker for assessment of chronic glycemia.

Detection of Autoantibodies Against Glycosylated-DNA in Diabetic Subjects: Its Possible Correlation with HbA1C

Aims: The vascular tissues have a long memory of their previous glycemic control and intervention studies have demonstrated that microvascular complications are highly correlated with mean glycemic control as measured by glycolated hemoglobin A1C (HbA1c). The present study was carried out to evaluate the autoantibodies against glycosylated DNA (DNAAGEs) in diabetic sera to see if the level of HbA1c has correlation with the activity of DNA-AGEs, another marker of chronic glycemia.Methods: Glucose-6-phosphate induced glycosylation of native DNA was studied in 150 diabetic sera (T1DM = 9, T2DM = 141) by spectroscopic techniques (UV and fluorescence) and agarose gel electrophoresis. Direct binding and inhibition enzyme immunoassays were carried out to evaluate binding and specificity of anti-glycated-DNA autoantibodies (anti-DNA-AGE autoantibodies) in sera of diabetes patients. A quantitative estimation of HbA1cwas carried out in normal and diabetes sera.Results: Anti-DNA-AGEs autoantibodies in 55% of diabetic sera (85/150) showed more binding with glycated-DNA compared to native DNA which was subjected to inhibition ELISA indicating true interaction of these autoantibodies in diabetes with glycated DNA. Higher binding with glycosylated-DNA against native-DNA was observed in subjects with HbA1c of 9.8 ± 3.3% compared to those with HbA1c of 7.7 ± 1.7% (p &lt; 0.001). Linear correlation analysis showed that mean absorbance difference was significantly related to HbA1c (r= 0.486, p &lt; 0.001), nephropathy (r= 0.239, p &lt; 0.003), retinopathy (r= 0.165, p &lt; 0.05).Conclusions: Autoantibodies against glycosylated DNA were correlated with HbA1cand microvascular complications and may be useful as another biomarker for assessment of chronic glycemia.

Glycaemic control and cardiovascular morbi-mortality: The contribution of the 2008 studies

The year 2008 was rich in teachings and suspense in diabetology. Past studies, i.e. United Kingdom Prospective Diabetes Study (UKPDS) in type 2 diabetic patients and Diabetes Control and Complications Trial (DCCT) in type 1 diabetic patients, have shown that in the short term, intensive treatment reduces the incidence of microvascular complications linked to diabetes and in the long term that of both microvascular and macrovascular ones. The in-the-raw conclusions of the recent Action to Control Cardiovascular risk in Diabetes (ACCORD) study note an increase in mortality in type 2 diabetic patients treated intensively, while the Action in Diabetes and Vascular disease, Perindopril and Indapamide Controlled Evaluation (ADVANCE) study evidences a reduction in microvascular complications and the Veterans Affairs Diabetes Trial (VADT) study shows that intensive treatment has no significant effect. A well thought-out analysis of the studies published in 2008 (ACCORD, STENO 2 post-trial, ADVANCE, VADT, UKPDS post-trial, Epidemiology of Diabetes Interventions and Complications [EDIC]) is particularly instructive and highlights the existence of glycaemic memory, the non-existence of blood pressure memory, the need to control all cardiovascular risk factors and to treat diabetes early while avoiding hypoglycaemic incidents. The glycaemic target based on HbA1c must take into account the patient's age and the duration of his diabetes, as well as his cardiovascular risk factors and previous glycaemic control. All in all, the intensive treatment of type 2 diabetes must begin early; it must not be too rapid and must avoid hypoglycaemic incidents and be combined with a strict control of other cardiovascular risk factors.

Transient improvement in glycemic control. The impact of pregnancy in women with IDDM.

Good glycemic control throughout pregnancy in patients with diabetes is of paramount importance but often appears to deteriorate in the postpartum period. The aim of this study was to ascertain the timing of the improvement in glycemic control associated with pregnancy in women with IDDM and to examine changes in glycemic control after delivery. Peripartum glycemic control was assessed in a retrospective study of 30 women with IDDM whose age was 28 +/- 6 years (means +/- SD) and whose diabetes duration was 14 +/- 6 years. Mean total HbA1 fell incrementally from a peak at 2-3 years preconception to a nadir between 24 weeks and term, only to return to preconception levels within a year after delivery. Of the 30 women, 15 (50%) attained an HbA1 in the nondiabetic range for pregnancy at some point during their pregnancy, and 7 (23%) women achieved this by 24 weeks gestation. Women with an HbA1 > 9% at booking had a significantly higher HbA1 at 0-6 and 6-12 months preconception, and throughout pregnancy their HbA1 was significantly higher. After delivery, attendance rates at routine diabetes review clinics were low, with 11% of women not attending for longer than 24 months. Nearly all women with IDDM can achieve near normoglycemia during pregnancy, irrespective of previous glycemic control, although those with high HbA1 levels at booking are less likely to achieve this. After delivery, glycemic control deteriorates. Efforts to improve glycemic control should be intensified in the preconception period and maintained after delivery. The poor postpartum attendance at diabetes clinics requires specific action.

Factors influencing preference of insulin regimen in people with type 1 (insulin–dependent) diabetes

The two commonest insulin regimens in current use in the UK are twice daily administration of short- and intermediate-acting insulins in combination, and soluble insulin before meals with intermediate-acting insulin at bed-time (basal-bolus regimen). A cross-sectional sample of patients with type 1 diabetes was studied using either a twice daily insulin regimen ( n=30) or a basal-bolus regimen ( n=30), to assess their satisfaction with choice of insulin regimen and to examine the relationships between type of insulin regimen, personality, demographic variables and glycaemic control. Patients treated with a basal-bolus insulin regimen tended to be younger ( P=0.07), had an earlier onset of type 1 diabetes ( P=0.04), adjusted their dose of insulin more frequently ( P=0.01), had received more secondary and further education ( P=0.03), belonged to a higher socio-economic class, tended to be unmarried ( P=0.07) and were less likely to be smokers ( P=0.03), than the group treated with twice daily administration of insulin. Current and previous glycaemic control assessed by glycated haemoglobin concentration, showed no correlation with type of insulin regimen, demographic data or personality variables.