Significant Predictors Of HbA1c Research Articles

Assessing the readiness to transition to adult care, perceived medication barriers, and glycemic control among teens with type 1 diabetes

AimThis study assessed the readiness to transition (RT) from pediatric to adult care, perceived medication barriers (PMB), and glycemic control in teens with type one diabetes (T1D). BackgroundDuring the transition from pediatric to adult care, teens with T1D are at risk of long-term complications related to impaired adherence. With the increasing prevalence of T1D in Saudi Arabia, research is required to identify the challenges facing teens with T1D during their transition. MethodsThis was a cross-sectional study with a convenient sample of 83 adolescents (12–17 years old) diagnosed with T1D for ≥6 months, their parents, and their pediatric endocrinologists from the pediatric endocrinology clinic in a tertiary hospital in Riyadh. The RT Questionnaire was used to measure RT, and the Medication Barriers Scale was used to measure PMB. Glycemic control was measured using hemoglobin A1c (HbA1c). ResultsAbout 96 % of teens had HbA1c > 7 %. Male teens had higher HbA1c than female teens. Teens and their parents reported high PMB and low RT. PMB (teens), disease duration, family history of diabetes mellitus, and comorbidity were significant predictors of RT (parents). PMB (teens), teens' age, and having a family history of diabetes mellitus were significant predictors of RT (providers). RT (parents) and RT (providers) were the only significant predictors of HbA1c, with RT (providers) being the strongest predictors of HbA1c. ConclusionsHealth policy reform is required to develop national RT programs to prepare teens with T1D to take full responsibility for managing their medical conditions while ensuring adherence.

Effectiveness of Telemedicine in Diabetes Management: A Retrospective Study in an Urban Medically Underserved Population Area (UMUPA)

This paper examines the efficacy of telemedicine (TM) technology compared to traditional face-to-face (F2F) visits as an alternative healthcare delivery service for managing diabetes in populations residing in urban medically underserved areas (UMUPAs). Retrospective electronic patient health records (ePHR) with type 2 diabetes mellitus (T2DM) were examined from 1 January 2019 to 30 June 2021. Multiple linear regression models indicated that T2DM patients with uncontrolled diabetes utilizing TM were similar to traditional visits in lowering hemoglobin (HbA1c) levels. The healthcare service type significantly predicted HbA1c % values, as the regression coefficient for TM (vs. F2F) showed a significant negative association (B = −0.339, p < 0.001), suggesting that patients using TM were likely to have 0.34 lower HbA1c % values on average when compared with F2F visits. The regression coefficient for female (vs. male) gender showed a positive association (B = 0.190, p < 0.034), with HbA1c % levels showing that female patients had 0.19 higher HbA1c levels than males. Age (B = −0.026, p < 0.001) was a significant predictor of HbA1c % levels, with 0.026 lower HbA1c % levels for each year’s increase in age. Black adults (B = 0.888, p < 0.001), on average, were more likely to have 0.888 higher HbA1c % levels when compared with White adults.

The Geriatric Depression Scale Predicts Glycemic Control in Older Adult with Type 2 Diabetes Mellitus: A Longitudinal Study.

The presence of comorbid depression and diabetes is associated with worse glycemic control, higher complication and greater mortality risk than expected by each condition alone. The association between various levels of severity of depressive symptoms and glycemic control over time among type 2 diabetic older patients was unclear. This study aimed to investigate a longitudinal association between depression and HbA1c among type 2 diabetic older patients. Type 2 diabetes patients aged 60 years and above with normal cognition were recruited from the outpatient department from 1 June 2020 to 1 July 2021. The Thai Geriatric Depression Scale (TGDS) and HbA1c were assessed at five time points (baseline and every 12 weeks) for 1 year. A linear mixed effect model was used. Of the 161 enrolled participants, 146 completed the study. At baseline, 14% were susceptible to depression or having depression (TGDS score 6 and above), and there was a significant correlation between HbA1c and depression (r = 0.26, p ≤ 0.01). The longitudinal analysis indicated that TGDS was a significant predictor of HbA1c in the next visit, and the relationship was J-shaped. A TGDS below 5 was associated with decreasing HbA1c in the next visit, but the association became positive at a TGDS score at 5 or higher. The presence of significant symptoms of depression was associated with glycemic control in the next 3-month interval OPD visit event, although major depressive disorder has not yet been established.

Longitudinal Associations Between Illness Perceptions and Glycemic Control in Type 2 Diabetes.

BackgroundCross-sectional research demonstrates associations between illness perceptions and glycemic control in people with type 2 diabetes (T2D). Prospective studies are limited and show mixed findings. This study aimed to investigate (1) whether baseline illness perceptions predicted glycemic control (HbA1c levels) at 6–12-month follow-up and (2) possible differences in baseline illness perceptions between individuals who completed at least one HbA1c blood test during the 12-month follow-up and those who did not.MethodsA total of 115 individuals with T2D were recruited from an outpatient clinic. Demographic and clinical information and illness perceptions were assessed at baseline. HbA1c was assessed at baseline and 12 months later from clinical records. Hierarchical multiple linear regression examined associations between baseline illness perceptions and HbA1c levels at 6–12-month follow-up, controlling for age, sex, education, types of diabetes medication, and baseline HbA1c.ResultsUnivariate analysis showed perceived weight management effectiveness at baseline was associated with lower HbA1c at follow-up (rho = −.25, p = .04, n = 67). Adjusted multiple regression showed that HbA1c at baseline was the only significant predictor of HbA1c at 6–12-month follow-up (β = 0.51, p < .001). There were no significant differences in baseline illness perceptions between individuals who completed HbA1c blood tests during follow-up (n = 78) and those who did not (n = 34), p > .05.ConclusionIllness perceptions at baseline did not predict longitudinal HbA1c in adjusted analyses, nor completion of HbA1c tests. Results may be due to temporal variability in HbA1c and barriers to accessing blood tests.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12529-021-10024-y.

VitaminD affects the neutrophil-to-lymphocyte ratio in patients with type2 diabetes mellitus.

Aims/IntroductionChronic inflammation is an underlying feature of type 2 diabetes mellitus. Hypovitaminosis D is associated with type 2 diabetes mellitus, but whether it contributes to chronic inflammation is unclear. We examined the effects of vitamin D on various immune markers to evaluate its contribution to systemic inflammation in type 2 diabetes mellitus.Materials and MethodsWe retrospectively analyzed data from type 2 diabetes mellitus patients, people with prediabetes and control patients without diabetes (n = 9,746). Demographic and clinical variables were evaluated using descriptive statistics and generalized linear regression. A stratified analysis based on total serum vitamin D was also carried out.ResultsNeutrophil count was a significant predictor of 1,5‐anhydroglucitol and glycated hemoglobin (HbA1c) in patients with prediabetes (1,5‐anhydroglucitol: β = −0.719, P < 0.001 and HbA1c: β = −0.006, P = 0.002) and patients with diabetes (1,5‐anhydroglucitol: β = 0.207, P = 0.004 and HbA1c: β = −0.067, P = 0.010). Lymphocyte count was a significant predictor of HbA1c in patients without diabetes (β = 0.056, P < 0.001) and patients with prediabetes (β = 0.038, P < 0.001). The neutrophil‐to‐lymphocyte ratio (NLR) was a significant predictor of HbA1c in patients without diabetes (β = −0.001, P = 0.032). No immune markers differed significantly based on vitamin D level among patients without diabetes (P> 0.05 for all). Among patients with prediabetes, those who were vitamin D‐deficient had the highest NLR (P = 0.040). Among patients with diabetes, those who were vitamin D‐deficient had the highest neutrophil count (P = 0.001), lowest lymphocyte count (P = 0.016) and highest NLR (P < 0.001).ConclusionsThe NLR is strongly influenced by serum vitamin D level. Given the high prevalence of hypovitaminosis D and elevated NLR among chronic disease patients and the elderly, our results suggest that clinical interpretation of NLR as a predictive marker of type 2 diabetes mellitus‐related inflammation should consider vitamin D level, age and pre‐existing morbidity.

Effect of Total Hemoglobin level on HbA1c value in Type 2 Diabetes Mellitus patients

Background &amp; objectives: Glycated hemoglobin level (HbA1c) is widely used for the diagnosis, prognosis and monitoring of therapy in diabetes mellitus patients. The hemoglobin molecule is a part of the non- enzymatic glycation reaction, so it is assumed that the total hemoglobin concentration may have an effect on the HbA1c value along with blood glucose concentrations. Hence this study was done to evaluate the effect of total hemoglobin level on HbA1c value in type 2 diabetes mellitus patients and to find out whether reduced total hemoglobin level is reflected on the HbA1c level giving an erroneous impression on the glycaemic status of the patient.&#x0D; Methods: 100 diagnosed Type 2 Diabetes Mellitus patients were evaluated for their Fasting Blood Sugar (FBS), Total Hemoglobin level and HbA1c level and assessed for any effect of reduced total hemoglobin level on the HbA1c value.&#x0D; Results: It was observed that HbA1c value correlated significantly only with FBS level and total Hemoglobin level was not found to have any effect on the HbA1c value in Type 2 Diabetes Mellitus patients.&#x0D; Interpretation : The factor significantly affecting the HbA1c value is Fasting Blood Sugar level. Hemoglobin level doesn’t seem to be affecting the HbA1c indicating that Hemoglobin is not a significant predictor of HbA1c.&#x0D; Conclusions: This study documented a significant positive relationship between FBS and HbA1c level only. No correlation was found between total Hemoglobin level and HbA1c.Patients with mild to moderate anemia still revealed a high HbA1c value correlating only with the blood sugar status.&#x0D; Bangladesh Journal of Medical Science Vol.19(1) 2020 p.110-113

204-OR: Advancing Our Understanding of the Relationships between Diabetes Distress and Depressive Symptoms with Biobehavioral Variables in Adolescents with Diabetes

In adolescents with diabetes, associations of depressive symptoms and diabetes distress (DD) with self-care behaviors and glycemic control vary considerably across studies, yet in adults, DD is a stronger predictor than depressive symptoms. This secondary data analysis compared the strength of the association of DD and depressive symptoms on bio-behavioral (HbA1c and average daily blood glucose monitoring checks [BGM]) and perceived global health among adolescents with diabetes. Results: Data from 119 adolescents (75% T1D; diabetes duration of 4.8±4.5 years; HbA1c 8.7 ±2.3%; 62% female; mean age of 15.8±2.1 years; 36% Hispanic, 31% white) screened in clinic were analyzed. Teens completed the 2-item DD Scale (DDS2), the PHQ-9, and PROMIS Pediatric Global Health (PGH). Demographics, HbA1c, and BGM were obtained from medical chart review. Of the 119, 6% had severe depression (PHQ &amp;gt;10) and 22% had moderate to severe DD. DD was significantly correlated with HbA1c and BGM (r=.27, -.32;p=.004, .002; respectively); and both DD and PHQ were significantly correlated with the PGH (r=.43, -.57;ps&amp;lt;.001; respectively). In the regression models that included both DD and PHQ along with demographic and clinical covariates, DD was a significant predictor of HbA1c (ß= .31, partial r=.27, p=.004) and BGM (ß= -.24, partial r=-.23, p=.03). PHQ was not a significant predictor of either, but was a significant predictor of PGH (ß=-.6, partial r=-.47, p&amp;lt;.001). Type of diabetes was not a significant covariate. Conclusion: DD had stronger associations with diabetes biobehavioral variables than depressive symptoms. Considering the outcomes are diabetes-specific, this is not surprising. However, it shows that simply screening for depression may miss an important aspect of the psychosocial health of adolescents with diabetes. Appropriate intervention should follow positive screens of DD to improve adolescents’ diabetes-related variables. Disclosure H. Abujaradeh: None. J.J. Wong: None. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson &amp; Johnson Diabetes Institute.

Effect of heterozygous beta thalassemia on HbA1c levels in individuals without diabetes mellitus: A cross sectional study

AimsTo investigate the effect of heterozygous β-thalassemia on HbA1c levels in a population without diabetes mellitus (DM). MethodsUsing a cross-sectional design, HbA1c levels were compared between two groups of 100 consecutive carriers of β-thalassemia and 100 healthy controls matched for age, gender and BMI, taking into account fasting serum glucose and fructosamine levels. The effect of hemoglobin concentration on HbA1c was also examined. ResultsThe mean HbA1c level was almost identical in the two groups (33.6 mmol/mol [5.23%] vs. 33.6 mmol/mol [5.22%], p = 0.857). Within the group of β-thalassemia, there was a positive correlation between HbA1c and hemoglobin concentration (r = 0.455, p < 0.001), which was not observed in controls. β-thalassemia carriers without anemia had slightly higher HbA1c levels compared to those with anemia (34.9 mmol/mol [5.35%] vs. 32.5 mmol/mol [5.12%] p < 0.001, absolute difference (2.4 mmol/mol [0.23%]). In multivariable analysis, hemoglobin concentration, BMI and 1st degree family history of T2DM were significant predictors of HbA1c, while β-thalassemia carrier state was non-significant (p = 0.07). ConclusionsIn individuals without DM, heterozygous β-thalassemia has a borderline effect on HbA1c levels, while the impact of β-thalassemia trait-associated anemia on HbA1c is of negligible clinical significance. These findings advocate for the clinical use of HbA1c as a diagnostic criterion for diabetes mellitus in this population.

The relationship between the quality of life and depression levels of young people with type I diabetes.

The aim of this study is to examine the relationship between the quality of life and depression levels of the youth with type I diabetes. DESIGNANDMETHODS: The study was a cross-sectional descriptive study. It was found that there is a negative correlation between participants' HbA1c levels and quality of life, and a positive correlation between HbA1c levels and depression. It was determined that quality of life and depression are significant predictors of HbA1c (R 2 = 0.72, P < 0.01). The depression levels of the young people with increased and their metabolic control was affected negatively as the quality of life levels decreased. Depression measurements should be made during the routine control of youth with diabetes who have difficulty in maintaining metabolic control.

Association between cognitive vulnerability to depression - dysfunctional attitudes and glycaemic control among in-patients with type 2 diabetes in a hospital in Beijing: a multivariate regression analysis

This cross-sectional study aimed to investigate the relationship between glycosylated haemoglobin (HbA1c) and cognitive vulnerability to depression (dysfunctional attitudes) in patients with type 2 diabetes mellitus. A total of 245 valid records from June 2016 to December 2016 were collected from a hospital in Beijing. Participants were asked to complete four questionnaires (Dysfunctional Attitudes Scale, Automatic Thoughts Questionnaire, Zung Self-rating Depression Scale, and World Health Organization Quality of Life Instrument-Short Form) to assess mental health and quality of life. Multivariate regression analysis was conducted to determine the correlations between HbA1c, mental health, quality of life and other clinical variables. The results showed that dysfunctional attitudes were associated with HbA1c, with a standardized regression coefficient (β) of .13 (p = .01), although 1 h C-peptide (β = −.75, p < .0001) was the most significant predictor of HbA1c in the regression model. The results indicated that dysfunctional attitudes, as a cognitive vulnerability to depression, were a relevant factor in HbA1c, although further studies are needed to establish the nature of the connection between dysfunctional attitudes and glycaemic control in diabetes patients.

Impact of neighbourhood-level inequity on paediatric diabetes care.

To evaluate the association between neighbourhood-level inequity and glycaemic control in paediatric participants with Type 1 diabetes using the Neighbourhood Equity Index (NEI). The NEI was linked to the clinical data of 519 children with diabetes followed at the Hospital for Sick Children (Toronto, Canada). The NEI is a composite measure of inequity developed using the World Health Organization's Urban Health Equity Assessment and Response Tool (HEART), which encompasses 15 weighted indicators evaluating economic, social, environmental and lifestyle factors. The geographic distribution of participants was determined using postal codes, and the relationship between HbA1c and NEI was evaluated using regression and spatial analysis techniques. Participants' mean HbA1c was significantly correlated with NEI (R = -0.24, P < 0.0001). Regression analysis demonstrated that NEI was a strong predictor of mean HbA1c (P < 0.0001), accounting for differences in HbA1c as large as 1.0% (11 mmol/mol) when controlled for age, sex, diabetes duration, insulin pump therapy and number of annual clinic visits. Geo-mapping using spatial scan testing revealed the presence of two clusters of low-equity neighbourhoods containing 3.22 (P = 0.001) and 2.83 (P = 0.02) times more participants with HbA1c ≥ 9.5% (80 mmol/mol) than expected. Our findings demonstrated that NEI was a significant predictor of HbA1c in our clinic population and a useful tool for investigating spatial trends related to inequities in health, providing evidence that a composite, area-based measure of overall inequity is well suited to the study of glycaemic control in urban paediatric Type 1 diabetes populations.

A multivariate model exploring the predictive value of demographic, adolescent, and family factors on glycemic control in adolescents with type 1 diabetes.

The current study examined how a comprehensive set of variables from multiple domains, including at the adolescent and family level, were predictive of glycemic control in adolescents with type 1 diabetes (T1D). Participants included 100 adolescents with T1D ages 10-16 yrs and their parents. Participants were enrolled in a longitudinal study about youth decision-making involvement in chronic illness management of which the baseline data were available for analysis. Bivariate associations with glycemic control (HbA1C) were tested. Hierarchical linear regression was implemented to inform the predictive model. In bivariate analyses, race, family structure, household income, insulin regimen, adolescent-reported adherence to diabetes self-management, cognitive development, adolescent responsibility for T1D management, and parent behavior during the illness management discussion were associated with HbA1c. In the multivariate model, the only significant predictors of HbA1c were race and insulin regimen, accounting for 17% of the variance. Caucasians had better glycemic control than other racial groups. Participants using pre-mixed insulin therapy and basal-bolus insulin had worse glycemic control than those on insulin pumps. This study shows that despite associations of adolescent and family-level variables with glycemic control at the bivariate level, only race and insulin regimen are predictive of glycemic control in hierarchical multivariate analyses. This model offers an alternative way to examine the relationship of demographic and psychosocial factors on glycemic control in adolescents with T1D.

High cardiorespiratory fitness can reduce glycated hemoglobin levels regardless of polygenic risk for Type 2 diabetes mellitus in nondiabetic Japanese men.

High cardiorespiratory fitness (CRF) is associated with a reduced risk of Type 2 diabetes mellitus (T2DM) and improved β-cell function; genetic factors also determine these risks. This cross-sectional study investigated whether CRF modifies the association of polygenic risk of T2DM with glucose metabolism in nondiabetic Japanese men. Fasting plasma glucose, insulin, and glycated hemoglobin (HbA1c) levels were measured in 174 Japanese men (age: 20-79 yr). β-Cell function and insulin resistance were evaluated by calculating HOMA-β and HOMA-IR, respectively. CRF was assessed by measuring maximal oxygen uptake (V̇o2max). Subjects were divided into the low and high CRF groups within each age group according to the median V̇o2max. Eleven single nucleotide polymorphisms (SNPs) associated with T2DM were analyzed and used to calculate genetic risk score (GRS); subjects were divided into the low, middle, and high GRS groups. The high GRS group had higher HbA1c levels than the low GRS group in both the low and high CRF groups (P < 0.05). Furthermore, the individuals with a high GRS had a lower HOMA-β than those with a low GRS regardless of CRF (P < 0.05). In multiple linear regression analysis, although GRS was a significant predictor of HbA1c (β = 0.153, P = 0.025), V̇o2max was also associated with HbA1c (β = -0.240, P = 0.041) independent of GRS. These results suggest that CRF is associated with HbA1c levels independent of GRS derived from T2DM-related SNPs; however, it does not modify the association of GRS with increased HbA1c or impaired β-cell function.

Glycemic control in young children with diabetes: The role of parental health literacy

ObjectiveThis cross sectional study examined the relationship between parental health literacy (HL), diabetes related numeracy, and parental perceived diabetes self-efficacy on glycemic control in a sample of young children with Type 1 DM. MethodsSeventy primary caregivers of children (age 3–9 years) with Type 1 DM were recruited and surveyed at diabetes outpatient clinic visits. Patients’ medical histories were obtained by medical chart review. ResultsParental diabetes related numeracy (r=−.52, p<01), but not reading skills (r=−.25, p=NS) were inversely correlated with the child's glycemic control (HbA1c). Parental perceived diabetes self-efficacy was also negatively correlated to their child's HbA1c (r=−.47, p<01). When numeracy and parental perceived diabetes self-efficacy were included as predictors of HbA1c, the model was significant (F=12.93, p<.01) with both numeracy (β=−.46, p<.01) and parental perceived diabetes self-efficacy (β=−.36, p=.01) as significant predictors of HbA1c. ConclusionsData from this study highlight the importance of considering the role of parental numeracy, in health outcomes for children with Type 1 DM. Practice implicationsPractitioners should assess parental health literacy and consider intervention when needed.

Predictor variables and an equation for estimating HbA1c attainable by initiation of basal supported oral therapy.

Aims/Introduction: A method of estimating HbA1c attained after initiation of basal supported oral therapy (BOT) has not been reported previously. The aim of the present study was to determine which characteristics of patients could influence the effectiveness of BOT introduction, and to obtain an equation to estimate HbA1c after BOT initiation. Sixty consecutive insulin-naive type 2 diabetic patients with poor glycemic control (HbA1c ≥7.5%) started once-daily injections of insulin glargine. Simple correlations were calculated between parameters such as HbA1c at baseline, HbA1c at week 24, reduction rate of HbA1c over 24 weeks (calculated as: [HbA1c level at baseline - HbA1c level at week 24]/HbA1c level at baseline), duration of diabetes, and the number of classes of coadministered oral antidiabetic drugs. Using multiple linear regression models, the independent effects of these parameters on HbA1c at week 24 were evaluated separately. Multiple linear regression analysis revealed that duration of diabetes (β = 0.561; P < 0.001) and HbA1c at baseline (β = 0.284; P = 0.006) were significant predictors of HbA1c at week 24. The best fitting multiple regression equation was: HbA1c at week 24 = 0.078 × duration of diabetes + 0.218 × HbA1c at baseline + 4.628 (r (2) = 0.437). The equation based on the multiple linear regression models indicates necessary conditions for type 2 diabetic patients to achieve target HbA1c. The present findings emphasize the principle that early initiation of BOT in type 2 diabetes effectively achieves good glycemic control. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00164.x, 2011).

Comparison of Glycated Albumin and Hemoglobin A1c Concentrations in Diabetic Subjects on Peritoneal and Hemodialysis

Relative to hemoglobin A(1c) (HbA(1c)), percentage of glycated albumin (GA%) more accurately reflects recent glycemic control in diabetic hemodialysis (HD) patients. To determine the accuracy of glycemic assays in a larger sample including patients on peritoneal dialysis (PD), HbA(1c) and GA% were measured in 519 diabetic subjects: 55 on PD, 415 on HD, and 49 non-nephropathy controls. Mean +/- SD serum glucose levels were higher in HD and PD patients relative to non-nephropathy controls (HD 169.7 +/- 62 mg/dL, PD 168.6 +/- 66 mg/dL, controls 146.1 +/- 66 mg/dL; p = 0.03 HD vs controls, p = 0.13 PD vs controls). GA% was also higher in HD and PD patients (HD 20.6% +/- 8.0%, PD 19.0% +/- 5.7%, controls 15.7% +/- 7.7%; p < 0.02 HD vs controls and PD vs controls). HbA(1c) was paradoxically lower in dialysis patients (HD 6.78% +/- 1.6%, PD 6.87% +/- 1.4%, controls 7.3% +/- 1.4%; p = 0.03 HD vs controls, p = 0.12 PD vs controls). The serum glucose/HbA(1c) ratio differed significantly between dialysis patients and controls (p < 0.0001 HD vs controls, p = 0.002 PD vs controls), while serum glucose/GA% ratio was similar across groups (p = 0.96 HD vs controls, p = 0.64 PD vs controls). In best-fit multivariate models with HbA(1c) or GA% as outcome variable, dialysis status was a significant predictor of HbA(1c) but not GA%. The relationship between HbA(1c) and GA% differs in diabetic patients with end-stage renal disease who perform either PD or HD compared to those without nephropathy. HbA(1c) significantly underestimates glycemic control in peritoneal and hemodialysis patients relative to GA%.

Diabetes Self‐Management Cuban Americans

ObjectivesWe investigated the relationship among factors predicting inadequate glucose control among 182 Cuban‐Americans (Females=110, Males=72) (CA) with type 2 diabetes mellitus (T2DM).MethodsCross‐sectional study CA adults self‐reported with type 2 diabetes (T2D) from a randomized mailing list in three counties of South Florida. Participants were screened by trained interviewers for heritage and diabetes status and participants signed informed consent form. Statistical analyses used SPSS and included descriptive statistic, multiple logistic and ordinal logistic regression models.ResultsOnly 54% reported having a diet prescribed/told to schedule meals. Those told to schedule meals were 3.62 more likely to schedule (CI 1.81, 7.26) p&lt;0.001. Age, WC, BMI and gender were not significant predictors of HbA1c. We found, by ordinal logistic regression of 5‐scale Likert, that participants with inadequate glucose control (HbA1c&gt; 8.5) were more than four‐fold likely to never follow a meal plan , OR 5.39 (1.40, 20.7).ConclusionsNearly half CA are not given dietary guidance, yet our results indicate CA may improve glycemic control by receiving dietary instructions.Grant Funding SourceAmerican Diabetes Association

The impact of modifiable family factors on glycemic control among youth with type 1 diabetes

To identify modifiable family factors impacting glycemic control in youth with type 1 diabetes (T1DM) beyond the anticipated physical, developmental, and behavioral issues associated with adolescence. In 153 youth (aged 8-16 yr) with T1DM duration of 6.3 +/- 3.5 yr and average hemoglobin A1c (HbA1c) of 8.4 +/- 1.4%, we examined modifiable family factors that might impact adherence to diabetes management and, in turn, influence glycemic control. Youth and parents completed surveys that assessed diabetes-specific knowledge, negative affect related to blood glucose monitoring (BGM), and parental-perceived burden of diabetes care. Clinician report and chart review provided data on growth, pubertal development, and diabetes management tasks. Glycemic control was measured as HbA1c. In bivariate analyses, higher parental diabetes-specific knowledge (p < 0.0001), less youth negative affect related to BGM (p = 0.0005), and less parental-perceived burden (p = 0.0008) were associated with lower HbA1c. In a multivariate model controlling for demographic and diabetes-specific variables, these three factors remained independent and significant predictors of HbA1c (R(2) = 0.31 and p < 0.0001). Higher parental knowledge, less youth negative affect, and less parental burden predicted lower HbA1c, while youth knowledge and parental negative affect did not. To attain optimal glycemic control, treatment programs for youth with T1DM should include ongoing efforts to reinforce parental knowledge of diabetes tasks, promote positive youth affect related to diabetes management, and acknowledge and reduce parental-perceived burden of diabetes management.

Comparison of glycated albumin and hemoglobin A1c levels in diabetic subjects on hemodialysis

Glycated albumin is thought to more accurately reflect glycemic control in diabetic hemodialysis patients than hemoglobin A(1c) because of shortened red cell survival. To test this, glycated hemoglobin and albumin levels were measured in blood samples collected from 307 diabetic subjects of whom 258 were on hemodialysis and 49 were without overt renal disease. In diabetic subjects with renal disease, relative to those without, the mean serum glucose and glycated albumin concentrations were significantly higher while hemoglobin A(1c) tended to be lower. The glycated albumin to hemoglobin A(1c) ratio was significantly increased in dialysis patients compared with the controls. Hemoglobin A(1c) was positively associated with hemoglobin and negatively associated with the erythropoietin dose in hemodialysis patients, whereas these factors and serum albumin did not significantly impact glycated albumin levels. Using best-fit multivariate models, dialysis status significantly impacted hemoglobin A(1c) levels without a significant effect on glycated albumin. Our results show that in diabetic hemodialysis patients, hemoglobin A(1c) levels significantly underestimate glycemic control while those of glycated albumin more accurately reflect this control.

Diabetes Management and Metabolic Control in School-Age Children With Type 1 Diabetes

This study investigated the effect of mother's coping resources, cognitive resources, family stress, and demographic variables on diabetes management and the mediating role of diabetes management on metabolic control among children with diabetes. Mothers (N = 59) completed self-report measures. HbA1c was obtained from the medical records. Although cognitive resources, coping resources, and family stress accounted for 30% of the variance in diabetes management, the hypothesis of mediation was not supported. The only significant predictor of HbA1c was African American race/ethnicity. The findings identify modifiable targets for practice and highlight the increased risk for poor metabolic control for minority children.