HbA1c Test Research Articles

Latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes-related deaths and healthcare costs

BackgroundThe prevalence of diabetes is escalating globally, underscoring the need for comprehensive evidence to inform health systems in effectively addressing this epidemic. The purpose of this study was to examine the patterns of countries’ capacity to manage diabetes using latent class analysis (LCA) and to determine whether the patterns are associated with diabetes-related deaths and healthcare costs.MethodsEight indicators of country-level capacity were drawn from the World Health Organization Global Health Observatory dataset: the widespread availability of hemoglobin A1C (HbA1c) testing, existence of diabetes registry, national diabetes management guidelines, national strategy for diabetes care, blood glucose testing, diabetic retinopathy screening, sulfonylureas, and metformin in the public health sector. We performed LCA of these indicators, testing 1–5 class solutions, and selecting the best model based on Bayesian Information Criteria (BIC), entropy, corrected Akaike Information Criteria (cAIC), as well as theoretical interpretability. Multivariable linear regression was used to assess the association between capacity to manage diabetes (based on the latent class a country belongs) and diabetes-related deaths and healthcare costs.ResultsWe included 194 countries in this secondary analysis. Countries were classified into “high capacity” (88.7%) and “limited capacity” (11.3%) countries based on the two-class solution of the LCA (entropy = 0.91, cAIC = 1895.93, BIC = 1862.93). Limited capacity countries were mostly in Africa. Limited capacity countries had significantly higher percentage of their deaths attributable to diabetes (adjusted beta = 1.34; 95% CI: 0.15, 2.53; p = 0.027) compared to high capacity countries even after adjusting for income status and diabetes prevalence.ConclusionsOur findings support the report by the Lancet commission on diabetes, which suggests that differences in diabetes outcomes among countries may be explained by variations in the capacity of and investments made in their health systems. Future studies should evaluate initiatives such as the WHO Global Diabetes Compact that are currently underway to improve the capacity of resource-limited countries.

Analysis of glycemic control in diabetic patients by monitoring HbA1c levels before, during and after Covid-19 confinement in Auvergne, France.

To describe glycemic control in diabetic patients monitored by glycated hemoglobin (HbA1c) before, during and after COVID-19 confinement. To identify factors, measured before confinement, associated with HbA1c testing during confinement and those associated with a 1 % increase in HbA1c after confinement. Retrospective, descriptive study of diabetic patients over 18 years old who underwent at least one HbA1c test before and after confinement. The data were collected from medical analysis laboratories in the Auvergne region (France) and included HbA1c measurements between March 17, 2019, and May 11, 2021, age, sex, residential area, and medical specialty of the prescribing physician. 70,286 patients were included (54.1 % men, mean age 71.7 ± 13.1 years). The average preconfinement HbA1c level (6.80 % ± 1.16) was similar to the average post-confinement HbA1c level (6.80 % ± 1.14). A larger median reduction of 0.90 % points in HbA1c level in the year following confinement was observed in patients whose preconfinement HbA1c level was ≥ 9 %. Only 24.5 % of the patients had an HbA1c test performed during confinement, the majority of whom were over 80 years of age and had an average HbA1c level between 7 and 9 % before confinement. For 5.1 % of the patients, the average HbA1c level increased by one percentage point or more after confinement. Patients ≤ 64, those with an insufficient number of blood tests before confinement and those with an imbalance in HbA1c before confinement were at risk of glycemic imbalance after confinement. Confinement had no impact on HbA1c levels in diabetic patients.

Impact of Order Restrictions on Hemoglobin A1c Requests at Primary Health Care Centers in Riyadh, Saudi Arabia.

The aim of the study was to assess the effect of policy intervention on the physician ordering of HbA1c for the patients seen at the primary health care center in Riyadh, Saudi Arabia. The study included patients over the age of 18 for whom HbA1c tests were ordered before and after the policy restrictions were implemented at the three main Primary Health Care Centers under the Ministry of National Guard Health Affairs (MNGHA) in Riyadh, between October 2020 and August 2023. Several data management steps and restrictions were carried out to identify the patients seen before and after the intervention and controlled for the confounders. The outcome variable was inappropriate testing, and early testing was defined based on standard cutoffs of HbA1c, diabetic control, and patient history. The logistic regression analysis was used to identify predictors for early testing. Among 16,290 participants, the mean age was 50 ± 16 years, with a predominance of females (66.5%). Approximately 22.3% of participants were diabetic, and the mean HbA1c level was 6.2 ± 1.55%. About 89.6% of tests were deemed inappropriate based on criteria for glycemic control, diabetic status, and duration of testing. Policy restrictions led to a 70.3% reduction in the odds of early testing (OR = 0.297, 95% CI: 0.246-0.358, p < 0.001). Each unit increase in HbA1c decreased the odds of early testing by 1.517 (OR = 0.219, 95% CI: 0.193-0.249, p < 0.001). Additionally, younger participants were more likely to undergo early testing, with odds decreasing by 3% for each additional year of age (OR = 0.970, 95% CI: 0.966-0.974, p < 0.001). We conclude that policy restriction alone might not be effective in reducing the burden of early testing. The early testing tendency was less in the post-intervention period. However, early testing was a common practice in both pre- and post-intervention phases. As physicians are the ones ordering the tests, deeper insight is needed from the physician's perspective.

The Impact of Age and Sex on Fasting Plasma Glucose and Glycated Haemoglobin (HbA1c) in the Non-diabetes Population.

We previously reported sex differences in the distribution of glycated haemoglobin (HbA1c) for men/women aged < 50years vs older individuals, with implications for delayed diabetes diagnosis. Here, we explored whether this pattern was also seen in matched fasting plasma glucose (FPG) levels. We extracted data on same-day, paired HbA1c and FPG levels from clinical biochemistry laboratory databases from Mersey and West Lancashire Teaching Hospitals NHS Trust (n = 10,153) and Cambridge University Hospitals NHS Foundation Trust (n = 10,022) between Jan 2019 and Dec 2023. Only cases with a single, general-practice HbA1c test were utilised to minimise the risk of including non-diagnostic tests and tests from specialist care (e.g. endocrinology, antenatal services; final dataset: n = 17,271). We examined the links of HbA1c and FPG levels to age and sex. Median HbA1c levels were 1mmol/mol lower in women aged < 45years compared to men aged < 45years but not in those aged ≥ 45years. This pattern was not seen with FPG, where median levels in women were 0.1-0.2mmol/L lower across all ages. The HbA1c:FPG ratio was significantly higher in women than men in the 45-54 and ≥ 55years age groups (p = 0.004, Z-score = 2.9 and p = < 0.001, Z-score = 8.9, respectively) but not in the < 45 years age group (p = 0.649, Z-score = 0.5). We confirmed our previous finding that median HbA1c levels in women aged ≥ 55 years and 45-55years were the same as those in men (39 and 37mmol/mol, respectively) and that for women aged < 45years, the median HbA1c (34mmol/mol) was 1mol/mol lower than for men (35mmol/mol). This is reflected in the Z-scores, which showed the largest deviation from zero in the < 45years age group (- 9.1) and the smallest in the older age group (- 2.9). We showed differences in HbA1c and FPG patterns with age between men and women, with implications for the diabetes diagnostic threshold for HbA1c in pre-menopausal women, the underdiagnosis of type 2 diabetes in younger women, and missed opportunities for intervention. We propose that a suggested change to HbA1c reference ranges in this group warrants serious consideration and detailed evaluation.

Body Mass Index and Waist Circumference as Parameters of Diabetes Mellitus in Nursing Homes with HBA1C Indicators: Contributing to Ensure Healthy Lives and Promote Well-Being for All at All Age

Objectives: The purpose of this study was to determine the value of BMI and waist circumference with HbA1c levels as indicators for determining the diagnosis of type 2 DM in the elderly. Framework: The health of the elderly requires special attention due to the decline of various organ functions like chronic diseases. Among all chronic diseases, Diabetes mellitus is one of the diseases that are frequently observed and found especially in nursing homes. Methods: A cross-sectional study was conducted involving 55 older people who live in nursing home. Waist circumference and BMI was measured directly. HbA1c testing was performed in the laboratory. Results: It can be concluded that the average age of the elderly in nursing homes is 56 years old with an average waist circumference of 91.76 cm, an average BMI of 24.74, an average HbA1c level of 7.77%, and most of them are female (96.4%). Gender did not correlate with HbA1c level (pv = 0.17). While age had poor correlation (r = 0.32) and waist circumference and BMI had strong correlation with HbA1c ( r = 0.60; 0.76). Conclusions: Waist circumference and BMI can be used as a predictive factors for diabetes mellitus in elderly at nursing home.

Changes in diabetes care and management practices during the COVID-19 pandemic.

We examined changes in diabetes care and management practices before and during the COVID-19 pandemic. Population-based data regarding four diabetes-related healthcare engagement and four self-management indicators were obtained from adults with diabetes surveyed in 19 US States and Washington DC through the Behavioral Risk Factor Surveillance System. Using logistic regression, we estimated changes in the prevalence of each indicator, overall and by sociodemographic subgroups in 2019 (before the pandemic) and 2021 (during the pandemic). Between 2019 and 2021, the prevalence of biannual HbA1c tests reduced by 2.6 percentage points (pp; 95% confidence interval: -4.8, -0.4), from 75.4% to 73.1%, and prevalence of annual eye exams fell by 4.0pp (-6.2, -2.8), from 72.2% to 68.7%. The composite indicator of engagement with healthcare for diabetes control fell by 3.5pp (-5.9, -1.1), from 44.9% to 41.9%. Of self-management behaviors, avoidance of smoking increased by 2.0pp (0.4, 3.6) from 84.7% to 87.1%. The findings suggest a deterioration of the uptake of evidence-based, preventive health services requiring laboratory services and clinical examination for diabetes control during the pandemic. On the other hand, smoking rates decreased, suggesting potential positive impacts of the pandemic on health behaviors in people with diabetes.

A sequential explanatory mixed method study of maternal and fetal outcome in gestational diabetes mellitus using Diabetes in Pregnancy Study Group India (DIPSI) test in Puducherry.

Gestational diabetes mellitus in pregnancy is associated with polyhydramnios, macrosomia, and shoulder dystocia, and it also increases maternal and perinatal mortality. This sequential explanatory mixed-method study was conducted for six months. All the pregnant women attending the outpatient department of the Obstetrics and Gynaecology Department at 24-28 weeks of gestation were subjected to universal screening with 75 gms of glucose and 2 hours of plasma glucose >140 mgs% is taken for diagnosis (according to DIPSI guidelines). After diagnosis, they were subjected to an HbA1c test. Women with HbA1c is >6.5% were excluded from the study. If pregnant women are screened negative by the DIPSI test, the test was repeated in the third trimester (32-34 weeks of gestation). Chi-square tests were used to find out the test of association for quantitative data and manual content analysis was performed for qualitative data. DIPSI test was found to decrease the adverse maternal and neonatal outcome by early screening and management. The stakeholders' perspectives identified by key informant interview were improper knowledge and awareness about the testing and others were anxiety and fear associated with the testing procedure. As DIPSI test is an effective single step in screening and diagnostic test, hence all pregnant mothers should undergo this glucose challenge test in their antenatal visits.

Visit-to-visit HbA1c variability and risk of potentially avoidable hospitalisations in adults with type 2 diabetes receiving outpatient care at a tertiary hospital.

This study aims to investigate the relationship between long-term visit-to-visit within-person HbA1c variability and hospitalisation outcomes in adults with type 2 diabetes (T2D). We conducted a cohort study at a tertiary hospital in Singapore involving people aged 21 to 101 years with T2D who had ≥3 HbA1c tests over 2 years. HbA1c variability was assessed using coefficient of variation (CV), variability independent of the mean (VIM) and HbA1c variability score (HVS). A 1-year follow-up was performed after the last HbA1c measurement to identify all-cause and potentially avoidable hospitalisations (PAH), categorised as overall, acute, chronic and diabetes composites. The study included 14 923 patients (mean age: 62.9 ± 12.9 years; 55% male). The median HbA1c variability was 8.6% CV (IQR: 5.1-14.3). Higher quartiles of HbA1c variability were associated with greater risks of PAH and all-cause hospitalisations, independent of glycaemic control. Compared to Q1, for example, the risk ratios and 95% confidence intervals for diabetes-related PAH based on HbA1c CV were as follows: Q2, 1.32 (0.93-1.88); Q3, 1.65 (1.18-2.31) and Q4, 2.16 (1.54-3.03). For all-cause hospitalisations, they were as follows: Q2, 0.97 (0.90-1.05); Q3, 1.08 (1.00-1.17) and Q4, 1.16 (1.07-1.26). When stratified by glycaemic control, elevated risk of PAH persisted even in those with optimal glycaemic control. Consistent findings were observed using HbA1c VIM and HVS measures. In individuals receiving care at specialist outpatient clinics of a tertiary hospital, HbA1c variability is associated with a higher risk of PAH. Comprehensive diabetes management strategies addressing both glycaemic control and variability may offer benefits.

Hb Tacoma by seven HbA1c methods – one with significant interference

Hemoglobin Tacoma is known to potentially interfere HbA1c assays. The variant is common in Finland with prevalence of up to 2% regionally and cases are also reported in areas that have attracted Finnish immigrants, especially in Sweden and North America. Here, we investigated the effect of Hb Tacoma on seven HbA1c methods. 20 non-variant and 20 Hb Tacoma samples were measured with Tina-quant Gen. 3 (immunoassay, considered as reference) and the following point of care instruments: Afinion 2, HbA1c 501 (both utilizing boronate affinity), QuikRead go, cobas b 101, DCA Atellica, and Standard F (all immunoassays). Repeatability was also assessed by measuring both non-variant and Hb Tacoma samples five times each at two different levels. For non-variant samples, the mean relative bias with all methods was < ±4%, whereas for Hb Tacoma samples Standard F had 38% mean relative bias. In absolute bias, the difference was 17 mmol/mol on average and constant through the measured range. For other methods the mean relative bias for Hb Tacoma samples was < ±6%. The repeatability with all methods was similar for non-variant and Hb Tacoma samples and at highest 4.1% (mean CV% of two levels). The observed interference by Standard F is likely due to two-antibody assay design as Hb Tacoma has been shown to result in conformational change. This interference is clinically significant and highlight the need for better controlling and better understanding hemoglobin variants in HbA1c testing.

Demographic, Clinical, Psychosocial, and Behavioral Predictors of Continuous Glucose Monitor Use in Adults with Type 2 Diabetes.

Continuous glucose monitor (CGM) use is increasing rapidly among people with type 2 diabetes, although little is known about predictors of CGM use beyond clinical and demographic information available in electronic medical records. Behavioral and psychosocial characteristics may also predict CGM use. We examined clinical, psychosocial, and behavioral characteristics that may predict CGM use in adults with type 2 diabetes. This longitudinal observational study comprised a secondary analysis of data collected in a larger trial. Enrollment included HbA1c tests and surveys assessing demographic, clinical, psychosocial, and behavioral characteristics. We queried participants regarding their CGM use during the study on their final self-report surveys, 15months post-enrollment. Participants were 245 community-dwelling adults with type 2 diabetes recruited from primary care. We used logistic regression to predict CGM use during the 15-month trial period from baseline characteristics. Around one-third of participants (37.1%; 91/245) started CGM. Predictors of starting CGM in bivariate models included younger age, higher socioeconomic status, insulin use, higher HbA1c, and more diabetes distress. When including all potential predictors in a single multivariable model, only younger age (aOR = 0.95, p = 0.001), insulin use (aOR = 2.33, p = 0.006), and higher socioeconomic status (aOR = 0.44, p = 0.037) were significant predictors. Despite the association between higher HbA1c and CGM use, neither diabetes self-care behaviors nor diabetes self-efficacy significantly predicted CGM use. Of participants who tried a CGM, 14.3% (13/91) had stopped, with cost being the most-cited reason. Even when including behavioral and psychological characteristics, younger age, using insulin, and higher socioeconomic status remain key predictors of CGM use. These findings emphasize the importance of access and affordability for people who may benefit from CGM. Providers should not bias their introduction of CGM towards those with (perceived or actual) optimal or sub-optimal self-care behaviors.

Neighborhood Environment and Longitudinal Follow-Up of Glycosylated Hemoglobin for Youth with Overweight or Obesity.

Background: Neighborhood environment, which includes multiple social drivers of health, has been associated with a higher incidence of chronic conditions in adult cohorts. We examine if neighborhood environment is associated with glycosylated hemoglobin (HbA1c) and body mass index (BMI) as a percentage of the 95th percentile (BMIp95) for youth with overweight and obesity. Methods: Cohort study using electronic health record data from a large Midwestern Children's Hospital. Youth aged 8-16 years qualified for the study with a documented BMI ≥ 85th percentile and two HbA1c test results between January 1, 2017, and December 31, 2019. Neighborhood environment was measured using area deprivation index (ADI). Results: Of the 1,309 youth that met eligibility, mean age was 14.0 ± 3.2 years, 58% female, 48% Black, and 39% White. At baseline, the average (SD) of BMIp95 was 126.1 (26.14) and HbA1c5.4 (0.46). 670 (51%) lived in a more deprived (MD) area. The median time to follow-up was 15-months. Youth that lived in a MD area had a significantly higher follow-up HbA1c (β = 0.034, p = 0.03, 95% confidence interval [CI]: [0.00, 0.06]) and BMIp95 (β = 1.283, p = 0.03, 95% CI: [0.13, 2.44]). An increase in BMIp95 was associated with worse HbA1c for most youth that lived in a MD area. Conclusions: Youth that lived in an MD area had a small but statistically significant higher level of HbA1c and BMIp95 at follow-up. Public health surveillance systems should include ADI as a risk factor for longitudinal progression of cardiometabolic diseases.

The Relation of Diabetes Complications to a New Interpretation of Glycaemic Variability from Continuous Glucose Monitoring in People with Type 1 Diabetes.

Microvascular and macrovascular complications in type 1 diabetes (T1D) may be linked to endothelial stress due to glycaemic variability. Continuous glucose monitoring systems (CGMs) provide new opportunities to quantify this variability, utilising the amplitude of glucose change summated over time. The aim of this study was to examine whether this determination of glucose variability (GV) is associated with microvascular clinical sequelae. Continuous glucose monitoring values were downloaded for 89 type 1 diabetes mellitus (T1D) individuals for up to 18 months from 2021 to 2023. Data for patient demographics was also taken from the patient record which included Sex, Date of Birth, and Date of Diagnosis. The recorded laboratory glycated haemoglobin (HbA1c) test results were also recorded. The glucose management index (GMI) was calculated from average glucose readings for 18 months using the formula GMI (%) = (0.82-(Average glucose/100)). This was then adjusted to give GMI (mmol/mol) = 10.929 * (GMI (%) - 2.15). Average Glucose Fluctuation (AGF) was calculated by adding up the total absolute change value between all recorded results over 18 months and dividing by the number of results minus one. The % Above Critical Threshold (ACT) was calculated by summing the total number of occurrences for each result value. A cumulative 95% limit was then applied to identify the glucose value that only 5% of results exceeded in the overall population. Using this value, we estimated the percentage of total tests that were above the Critical Threshold (ACT). Results for the 89 individuals (44 men and 45 women) were analysed over 18months. The mean age of participants was 43 years and the mean duration of diabetes was 18years. A total of 3.22 million readings were analysed, giving an average of 10.3mmol/L blood glucose. Those with the largest change in glucose from reading to reading, summated over time, showed the greatest change in eGFR of 3.12ml/min/1.73 m2 (p = 0.007). People with a higher proportion of glucose readings > 18mmol/L showed a fall in eGFR of 2.8ml/min/1.73 m2 (p = 0.009) and experienced higher rates of sight-threatening retinopathy (44% of these individuals) (p = 0.01) as did 39% of individuals in the highest tertile of glucose levels (p = 0.008). Those individuals with T1D in the highest tertile of reading-to-reading glucose change showed the greatest change in eGFR. Those with a higher proportion of glucose readings > 18mmol/L also showed a fall in eGFR and experienced higher rates of sight-threatening retinopathy, as did people with higher mean glucose. Discussions with T1D individuals could reflect on how the percentage recorded glucose above a critical level and degree of change in glucose are important in avoiding future tissue complications.

Unveiling the Spectrum of Glucose Variability: A Novel Perspective on FreeStyle Libre Monitoring Data.

Since the introduction of insulin therapy, it has become apparent that type 1 diabetes (T1D) is accompanied by long-term microvascular and macrovascular complications. In the context of the many benefits of continuous glucose monitoring (CGM), there remain opportunities to study the large amount of data now available in order to maximise its potential in the endeavour to reduce the occurrence of diabetes tissue complications in the longer term. Continuous glucose monitoring values were downloaded for 89 type 1 diabetes mellitus (T1D) individuals for up to 18 months from 2021 to 2023. Data for patient demographics was also taken from the patient record which included Sex, Date of Birth, and Date of Diagnosis. The recorded laboratory glycated haemoglobin (HbA1c) test results were also recorded. The glucose management index (GMI) was calculated from average glucose readings for 18 months using the formula GMI (%) = (0.82-(Average glucose/100)). This was then adjusted to give GMI (mmol/mol) = 10.929 * (GMI (%) - 2.15). Average Glucose Fluctuation (AGF) was calculated by adding up the total absolute change value between all recorded results over 18 months and dividing by the number of results minus one. The % Above Critical Threshold (ACT) was calculated by summing the total number of occurrences for each result value. A cumulative 95% limit was then applied to identify the glucose value that only 5% of results exceeded in the overall population. Using this value, we estimated the percentage of total tests that were above the Critical Threshold (ACT). The mean age of the participants was 42.6years, and the mean duration of T1D was 18.4years. A total of 3.22 million readings were analysed, yielding an average blood glucose level of 10.3mmol/l and a GMI of 57.2mmol/mol. There was a strong correlation between GMI and measured HbA1c (r2 = 0.82). However, there were patients who had an above-critical threshold (ACT) of 4-10% at a GMI of 60mmol/mol or less. The percentage average value at the time of day (%AVTD) was applied to all blood glucose readings at each 15-min interval throughout the day, averaged over 18months. The %AVTD of GMI (overall average 57.2mmol/mol) increased after midday, dipped at 18:00, and peaked at 22:00. The %AVTD of AGF (overall average 0.60mmol/l) showed higher change rates after 09:00 declining at the end of the day. The %AVTD of ACT peaked at 22:00, with those having the highest %ACT showing an additional peak at 15:00. We have shown here that the percentage glucose results above 18mmol/l (top 5% of distribution) increased exponentially above 54mmol/mol HbA1c. The %AVTD is introduced as a useful measure. Our data indicate that over the 24-h period, improvement in metabolic control could be focussed on the afternoon and evening, when there are higher-than-average levels of GMI, a higher-than-average degree of glucose change, and higher-than-average risks of being above the critical threshold. In conclusion, a measure of glycaemic variation based on the amplitude of glucose change to a population mean could be used to provide valuable clinical insights into glucose change over a 24-h period.

The Association Between Type 2 Diabetes Mellitus and Levels of Total Cholesterol, Low-Density Lipoprotein (LDL) Cholesterol, Very Low-Density Lipoprotein (VLDL) and the Role of Dehydrated Vegetables in Glycemic Control

Objective: This study aimed to assess Total Cholesterol, Low-Density Lipoprotein (LDL) and Very Low-Density Lipoprotein (VLDL) Levels, identify specific lipid markers altered in individuals with type 2 diabetes mellitus (T2DM), and evaluate the correlation between HbA1C and total cholesterol, LDL cholesterol, and VLDL levels. Materials and Methods: Ninety-six volunteers aged 35-72 with confirmed T2DM underwent total cholesterol, LDL, VLDL and HbA1c testing using the COBAS INTEGRA 400 PLUS device. Data on age, gender, diabetes status, and lipid profiles were collected in November 2023 to April 2024 from Layla Qasim Health Center located in Erbil, Iraq and then analyzed. Results: Result: In our study, the prevalence of dyslipidemia among type 2 diabetes mellitus (T2DM) patients was 50.88%. This varied regionally, from 59.3% in China to 83.9% in Saudi Arabia. Dyslipidemia was more common in patients with poor blood glucose control. Weight and waist circumference were positively correlated with HbA1c levels, while age showed no significant effect on glycemic control. Women showed higher LDL and HbA1c levels than men. Although weak correlations were observed between HbA1c and LDL cholesterol, LDL was strongly correlated with total cholesterol and moderately with VLDL. Early detection and management of dyslipidemia is important to reduce the risk of cardiovascular disease in patients with T2DM. Conclusion: Our study highlights the significant prevalence of dyslipidemia among patients with type 2 diabetes mellitus (T2DM), emphasizing the importance of lipid profile management to reduce the risk of cardiovascular disease. We found associations between weight, waist circumference and HbA1c levels, with gender differences in lipid profiles. While the association between HbA1c and LDL cholesterol was weak, early diagnosis and management of dyslipidemia could significantly reduce CVD risk, advocating a comprehensive strategy targeting both glycemic control and lipid management in T2DM patients.

Effects of collaborative learning-based food literacy program on healthy eating behavior and hemoglobin A1c among older adults with uncontrolled type 2 diabetes: A randomized controlled trial study in Thailand.

Uncontrolled type 2 diabetes mellitus (T2DM) is a prevalent issue among older adults. Healthy eating behavior (HEB) is a significant factor contributing to blood sugar control. It is a complex behavior that requires knowledge, attitudes, and skills in food literacy, which can be achieved through collaborative learning by nurses. Although collaborative learning has successfully improved food literacy and HEB among adults and older adults in general, its effectiveness has not been investigated among older adults with uncontrolled T2DM. This randomized controlled trial aimed to examine the effects of the Collaborative Learning-Based Food Literacy Enhancement Program (CLFLEP) on HEB and hemoglobin A1c (HbA1c) levels among older adults with uncontrolled T2DM. Participants were 80 older adults with uncontrolled T2DM attending primary care units (PCUs) or sub-district health promotion hospitals in northern Thailand. They were randomly assigned to either the experimental group (n = 40) or the control group (n = 40). The experimental group received the CLFLEP to enhance four domains of food literacy through five major elements of collaborative learning, while the control group received standard care. Data were collected between January and June 2023 using the Demographic Data Form, the Eating Behavior Questionnaire, the HbA1c test, and the Short Food Literacy Questionnaire. Data analysis involved descriptive statistics for demographic characteristics and independent t-test and paired sample t-test for HEB and HbA1c based on intention-to-treat (ITT) and per-protocol (PP) analyses. The experimental group had a higher HEB score than the control group (p <0.001 for ITT and PP) and higher than their scores before program participation (p <0.001 for ITT and PP). The effect size (Cohen's d) was 1.46. The experimental group also had a lower HbA1c level than the control group (p = 0.002 for ITT and PP) and lower than their levels before program participation (p = 0.005 for ITT and 0.001 for PP). The effect size (Cohen's d) was 0.70. The CLFLEP was effective in promoting food literacy, HEB, and blood sugar control. Nurses can be trained to use this program to provide collaborative health education for older adults with uncontrolled T2DM. Nursing administrators can use these findings to develop organizational policies that enhance nurses' competencies as educators skilled in collaborative learning. TCTR20221222005 [Thai Clinical Trials Registry].

Establishment and application of autoverification system for HbA1c testing.

This study aimed to determine autoverification rules for routine glycated hemoglobin (HbA1c) analysis based on high-performance liquid chromatography (HPLC) principle. Laboratory information system (LIS) and Bio-Rad D-100 Advisor software (Bio-Rad, Hercules, USA) with graphics recognition function were carriers for the autoverification system. A total of 105,126 HbA1c results, including 98,249 HbA1c matching fast plasma glucose (FPG) results of real-world data from May 2019 to June 2020, were collected to determine autoverification rules including flags, delta checks, reporting limits, and logical rules. The validation database was composed of 48,045 HbA1c results and 41,083 matching FPG results. Autoverification passing rate and the reduction of turnaround time (TAT) were evaluated. Four autoverification systems (A, B, C, D) were established by two types of delta check rules, 28 flags, one reporting limits, and two kinds of logical rules. The autoverification passing rates were 80.6%, 78.8%, 83.7%, and 81.3%, and the average time saved in TAT were 117.5 min, 116.7 min, 121.1 min, and 121.7 min, respectively. Autoverification system C was the optimal one. Application of distribution of FPG corresponding to HbA1c groups had better performance as logical rules. Established HbA1c autoverifcation system shortened the auditing report time and improved work efficiency.

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

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

Liver damage in patients hospitalized with acute decompensated heart failure, depending on the degree of glucose metabolism disorder

Aim. To study the frequency of cardiohepatic syndrome and steatosis by the value of controlled attenuation parameter (CAP), fibrosis, and their combination, depending on the degree of glucose metabolism disorder in patients with acute decompensated heart failure (ADHF).Materials and methods. The study included 280 patients (53% men, average age 70.1 ± 10.8 years) with ADHF: 72.5% of patients had a history of arterial hypertension, 60% of patients had coronary heart disease. The HbA1c test was performed in all patients to assess the status of glucose metabolism. The patients were divided into groups depending on the results obtained: at HbA1c values &lt; 5.7%, patients were included in the group without glucose metabolism disorders, at HbA1c 5.7–6.4% – in the prediabetes group, at HbA1c ≥ 6.5% – in the type 2 diabetes group. All patients underwent a standard physical examination at admission and at discharge. Clinical and comprehensive assessments of congestion were performed – NT-proBNP, lung ultrasound, liver fibroscan with CAP, and bioelectrical impedance analysis of body composition.Results. The frequency of glucose metabolism disorders in patients hospitalized with ADHF was 57.5% (n = 161), while prediabetes was detected in 17.1% (n = 48) and type 2 diabetes – in 40.4% (n = 113) of patients. We revealed significantly higher incidence of steatosis by CAP value (69 vs. 42%, p &lt; 0.001), fibrosis (80 vs. 64%, p &lt; 0.001), and their combination (59 vs. 30%, p &lt; 0.001), as well as cardiohepatic syndrome (87 vs. 61%, p &lt; 0.001) in patients with ADHF and glucose metabolism disorders compared to individuals with ADHF without glucose metabolism disorders, respectively. The group of ADHF patients with glucose metabolism disorders and a combination of steatosis / fibrosis was characterized by more pronounced manifestations of metabolic syndrome, impaired kidney and liver function, and more pronounced manifestations (both clinical and laboratory) of congestion.Conclusion. In patients with ADHF with glucose metabolism disorders, liver function test and liver fibroscan with CAP allow for identifying the most severe group of patients with a combination of steatosis/fibrosis and pronounced congestion.

Influence of High-Altitude Residential History on Optimal HbA1c Cutoff for Detecting Abnormal Glucose Metabolism.

Aims: To explore the influence of recent high-altitude residential history on the optimal cutoff of glycosylated hemoglobin (HbA1c) for detecting abnormal glucose metabolism. Methods: The study included 505 self-reported healthy Han participants of age 18-65 years, recruited in Chengdu and categorized based on recent (within 3 months) high-altitude (>2,500 m) residential history. The 1999 WHO criteria was used as the gold standard for defining prediabetes and diabetes. HbA1c test performance was assessed using receiver operating characteristic curve, with the optimal cutoff determined by Maximum Youden index. Propensity score matching with 0.02 calipers and nearest neighbor method was used to balance confounding factors between groups. Results: Of the participants, 238 (47.13%) were populations with recent high-altitude residential history (HA group), and 267 (52.87%) were low-altitude dwellers (LA group). The HA group had slightly higher HbA1c levels (p > 0.05) and higher erythrocyte and hemoglobin levels (p < 0.05), compared to the LA group. Weak correlations between prediabetes and HbA1c levels were observed in the HA group (rs = 0.21, p < 0.05) and the LA group (rs = 0.07, p = 0.25). The optimal cutoff for the detection of diabetes was 6.5% (area under the curve [AUC] 0.94) in the HA group and 5.9% (AUC 0.97) in the LA group, which remained unchanged after adjustment for confounders. Conclusions: The optimal cutoff of HbA1c for the detection of diabetes in populations with recent history of living at high altitude was higher than that in general populations living at low altitude, and the diagnostic value of HbA1c for prediabetes was also inadequate.

6861 Pre- And Peri-Operative Predictors Of Glycemic Outcomes From Total Pancreatectomy And Islet Auto-Transplantation

Abstract Disclosure: E.N. Haddad: None. M. Lansang: None. H. Xiao: None. R. Walsh: None. R. Simon: None. B.A. Hatipoglu: None. K. Zhou: None. Background: There is a lack of information regarding the immediate post-operative period as a predictor of early and long-term insulin independence after total pancreatectomy and islet auto-transplantation (TPIAT). This study examined the baseline and peri-operative variables that are associated with one-year and longer-term insulin independence following TPIAT. Methods: This was a retrospective study of 46 TPIAT patients in a single hospital system between 2010 and 2022. Perioperative variables were compared between short- (one year) and long-term (last follow up outside of year one) insulin-independent versus dependent patients. Multivariable models were used to adjust for clinically important variables. Results: The median age of the cohort at time of TPIAT was 38.5 years (IQR 30, 49). Patients were predominantly white (91%) and 50% were female. Nine (20%) and seven (15%) patients achieved short- and long-term insulin independence, respectively. The patients were followed for a median of 2.8 years (IQR 1.0, 4.7). There were no significant differences in patient demographics (age, sex, ethnicity), duration of pancreatitis, HbA1c, or mixed meal testing results (area under c-peptide curve from 0 to 4 hours) between those achieving insulin independence and those who did not. Short term insulin-independence was associated with higher median transplanted islet equivalents (IEQ)/kg (6,981 vs 4,493, p=0.02), lower units of basal insulin on discharge (7 vs 12, p=0.009), and lower rates of discharge from the hospital with an insulin regimen (67% vs 100%, p=0.006). Short-term insulin independence was also associated with decreased median insulin use in the immediate 24-hour post-operative period (14.3 vs 45.3 units, p=0.03), though this was not statistically significant when adjusting for patient weight (0.23 vs 0.56 units/kg, p=0.13). The odds of having short term insulin independence increased by 80% for every 1,000 increase in IEQ/kg (OR 1.80, CI 1.18 to 3.12, p=0.005) and decreased by 32% for every additional basal unit of insulin on discharge (OR 0.68, CI 0.42 to 0.91, p=0.003). This was no longer statistically significant after adjusting for sex, age, mixed meal testing area under c-peptide curve at 4 hours, and HbA1c. Long-term insulin independence was also associated with transplanted IEQ/kg and basal insulin units at discharge in univariable analysis. None of the patients on insulin or any other antihyperglycemic medication prior to surgery achieved short- or long-term insulin independence. Conclusion: Short- and long-term insulin independence after TPIAT is associated with a higher transplanted IEQ/kg and fewer units of basal insulin at discharge. Immediate post-operative variables can be used to inform the discussions clinicians have with their patients regarding glycemic prognosis following TPIAT. Presentation: 6/2/2024