HbA1c Values Research Articles

International co-validation of glycated hemoglobin A1c certified reference materials.

Accurate quantification of glycated hemoglobin A1c (HbA1c) is essential for the diagnosis and glycemic control in diabetic patients. The validation of HbA1c certified reference material (CRM) enhances the accuracy and comparability of HbA1c measurements. An international co-validation of HbA1c CRMs was conducted among the National Institute of Metrology, P.R. China (NIM), the Korea Research Institute of Standards and Science (KRISS), and the National Metrology Institute of Japan (NMIJ). Candidate reference materials (RMs) of VHLTPE, glycated VHLTPE, and two levels of HbA1c were developed and supplied by NIM. NIM investigated the homogeneity and stability of these materials, finding no inhomogeneity and confirming stability throughout the co-validation period. Isotope dilution mass spectrometry was employed for the quantitation of both hexapeptides in solution and HbA1c in amatrix. All three national metrology institutes (NMIs) were involved in the quantification of hexapeptides in solution, whereas only NIM and KRISS were involved in the quantification of HbA1c in thematrix. En values for both hexapeptides and HbA1c in the matrix were calculated, all being less than 1, indicating good agreement with the certified values. The successful co-validation of these CRMs demonstrates the reliability of the certified values, thereby benefiting the accuracy and comparability of HbA1c measurements.

Efficacy of Ma'aljobon Aftimouni (Cuscuta Reflexa and Whey) on HbA1c and Blood Glucose Levels in Patients with Type 2 Diabetes: A Randomized Triple-Blind Clinical Trial

Introduction and ObjectiveType 2 Diabetes is a common and chronic metabolic disease. Complementary and alternative medicine can provide a suitable option for demands for new treatments. Therefore, the present study aimed to investigate the effect of Persian medicine on the glycemic status of patients with Type 2 Diabetes. MethodThis randomized, controlled, and triple-blind trial study was conducted from November 2021 to August 2022 on 102 diabetic patients referred to the diabetes clinic in Iran. In this regard, patients with inclusion criteria were randomly divided into three groups Ma'aljobon with Aftimoun (n = 34), Ma'aljobon without Aftimoon (n = 34), and the control group (n = 34). The control group received a placebo of medicinal salt, light calcium carbonate, lactose, and carboxymethyl cellulose. In contrast, the treatment groups received 25 grams of drug powder (in 250 cc of lukewarm water) on an empty stomach for 8 consecutive weeks. Patients' fasting blood sugar (FBS) levels and HbA1c were measured at the beginning and end of the intervention. Data were analyzed using SPSS 23, employing paired t-tests, ANOVA, and chi-square tests for comparison between groups. ResultsData analysis was conducted on 90 patients with Type 2 Diabetes. The findings revealed a significant reduction in fasting blood sugar levels post-intervention in the Ma'aljobon Aftimouni group (134.27± 21.79 vs. 152.3± 31.37, mean difference 18.03± 5.63, 95% CI: 6.53 to 29.53, p = 0.003). Additionally, a significant difference in HbA1c values was observed post-intervention in both the Ma'aljobon Aftimouni group (7.88± 0.77 vs. 8.09± 0.73, mean difference 0.21± 0.09, 95% CI: 0.03 to 0.39, p = 0.031) and the Ma'aljobon without Aftimoun group (7.97± 0.84 vs. 8.25± 0.78, mean difference 0.28± 0.08, 95% CI: 0.11 to 0.45, p = 0.002). ConclusionThe findings showed that daily consumption of Ma'aljobon supplements on an empty stomach before breakfast may have a beneficial effect on the glycemic indices of patients. However, further studies seem to be necessary in this regard.

O-12 A CASE OF DIABETES ASSOCIATED WITH A DE NOVO PAX4 MUTATION AND CONCURRENT SMAD6 GENE MUTATION

Abstract Introduction Monogenic diabetes constitutes approximately 1-5 % of all diabetes cases. While there is substantial information available about the more common MODY subtypes, the rarer subtypes remain much less understood. In this report, we present a rare case of diabetes with no family history, characterized by a pathogenic mutation in the PAX4 gene, which has been previously linked to MODY 9, along with a concurrent SMAD6 mutation. Clinical Case A 24-year-old male patient presented to our clinic for the management of diabetes mellitus. He was initially diagnosed with diabetes at the age of 17 and was initially managed with metformin alone. However, due to inadequate blood sugar control, basal insulin was later added to his treatment regimen. At his most recent visit, his treatment included a combination of sitagliptin+metformin (50/1000 mg, BID) and insulin glargine (16 units per day). His medical history revealed a childhood operation for congenital heart disease. Physical examination revealed nasal speech, a syndromic facial appearance (with downward-pointing ears and a flattened nasal root), and a limitation of internal rotation in the forearms. His BMI was 27.8 kg/m², and he had maintained a stable weight since the time of diagnosis. Laboratory evaluations revealed that anti-GAD was negative, with a C-peptide level of 0.6 ng/mL, HbA1c of 10.1%, and fasting blood glucose of 118 mg/dL. Kidney function tests and liver enzyme tests were within normal limits. Since diagnosis, HbA1c values have generally not been within the target range, fluctuating widely between 6.6% and 14%. The patient exhibited no microalbuminuria, no neuropathic findings, and no signs of retinopathy. Additionally, there was no family history of diabetes. Given the patient’s atypical diabetes history and syndromic findings, genetic analysis was undertaken. Whole exome sequencing, performed using next-generation sequencing, identified a PAX4 (c.1013C>T) mutation, which is potentially pathogenic (Figure 1 and Figure 2) and a homozygous pathogenic mutation in the SMAD6 gene. The patient’s diabetes history was attributed to the PAX4 gene mutation, which has been previously associated with MODY9, while the cardiac and extremity abnormalities were believed to be linked to the SMAD6 gene mutation. The 3D structures of the wild-type and mutant protein for PAX4 variant was predicted (Figure 2). Conclusion Diabetes cases resulting from PAX4 gene mutations are quite rare and often involve a form of diabetes that requires insulin. While most cases reported in the literature include a family history, there are instances, such as in our case, where a de novo mutation is identified. The presence of the SMAD6 gene mutation has contributed to the additional syndromic findings. Increasing the reporting of monogenic forms of diabetes, will enhance the recognition of diabetes-related genes and contribute to advances in understanding its etiopathogenesis.Figure 1-a:Visualization of the PAX4 c.1013C>T;p.A338V variant region using VarSome Figure 1-b:3D structures of PAX4 created using Swiss-Model and visualized with Chimera. A) Presents the mutated protein (Purple) superimposed on the WT protein (Pink). (B) The amino acid substitution is shown, with the wild-type amino acid in pink and the mutant amino acid in purple

Machine Learning-driven Identification of the Honeymoon Phase in Pediatric Type 1 Diabetes and Optimizing Insulin Management.

The honeymoon phase in Type 1 Diabetes (T1D) presents a temporary improvement in glycemic control, complicating insulin management. This study aims to develop and validate a machine learning-driven method for accurately detecting this phase to optimize insulin therapy and prevent adverse outcomes. Data from pediatric T1D patients aged 6-17 years, including continuous glucose monitoring (CGM) data, Glucose Management Indicator (GMI) reports, HbA1c values, and patient medical history, were used to train machine learning models. These models Long Short-Term Memory (LSTM) networks, Transformer models, Random Forest, and Gradient Boosting Machines were designed to analyze glucose trends and identify the honeymoon phase in T1D patients. The Transformer model achieved the highest accuracy at 91%, followed by Gradient Boosting Machines at 89%, LSTM at 88%, and Random Forest at 87%. Key features such as glucose variability, insulin adjustments, GMI values, and HbA1c levels were critical in model performance. Accurate identification of the honeymoon phase enabled optimized insulin adjustments, enhancing glucose control and reducing hypoglycemia risk. The machine learning-driven approach provides a robust method for detecting the honeymoon phase in T1D patients, demonstrating potential for improved personalized insulin management. The findings suggest significant benefits in patient outcomes, with future research focused on further validation and clinical integration.

Genetic Variants of SLC22A1 rs628031 and rs622342 and Glycemic Control in T2DM Patients from Northern Mexico

Background: Type 2 diabetes mellitus (T2DM) and its associated complications are of public health concern. Metformin is the most common pharmacological T2DM treatment, distributed through organic cation transporters (OCTs). The solute transporter family 22A1 (SLC22A1) gene encodes OCT1, and its variants may play a role in glycemic control. This study analyzed seven SLC22A1 gene variants and their potential association with glycemic control in patients from Northern Mexico with T2DM undergoing metformin monotherapy. Methods: This cross-sectional study included 110 patients. We analyzed HbA1c values as a continuous variable and according to glycemic control categories (<7% vs. ≥7%). DNA from blood samples was genotyped using genotyping assays based on real-time PCR and PCR-RFLP. Results: Patients with GG or AA rs628031 genotypes were 2.7 times more likely to have inadequate glycemic control than those with the GA genotype (p = 0.042). We analyzed the combination of rs628031 and rs622342 as diplotypes. The relation between HbA1c and these diplotypes was influenced by BMI and the metformin dose. Carriers of at least one minor allele of A-rs628031 and C-rs622342 had lower HbA1c values than individuals homozygous for the major allele in both genes. Conclusions: The rs628031 and rs622342 variants are associated with lower HbA1c levels in T2DM patients. Larger studies are needed to confirm these associations.

Diabetes Risk After Treatment for Childhood and Young Adult Cancer.

Diabetes is a potential late consequence of childhood and young adult cancer (CYAC) treatment. Causative treatments associated with diabetes have been identified in retrospective cohort studies but have not been validated in population-based cohorts. Our aim was to define the extent of diabetes risk and explore contributory factors for its development in survivors of CYAC in the United Kingdom. Cancer registration data (n = 4,238) were linked to electronic health care databases to identify cases of diabetes through clinical coding or HbA1c values. Total effect of prespecified treatment exposures on diabetes risk was estimated using flexible parametric modeling and standardized cause-specific cumulative incidence functions (CIFs). After median follow-up of 14.4 years, 163 individuals (3.8%) were identified with diabetes. Total body irradiation (TBI) increases diabetes risk over time, with a 40-year CIF reaching 21.0% (95% CI 13.8-31.9) compared with 8.4% (95% CI 6.1-11.5) without TBI. Survivors treated with corticosteroids had a 7.7% increased risk at 40 years after cancer diagnosis. Hematopoietic stem cell transplant (HSCT) survivors had markedly higher risk, with a 40-year CIF of 19.6% (95% CI 13.4-28.6) versus 8.2% (95% CI 6.0-11.3) for patients who had not undergone HSCT. Among patients who received allogeneic HSCT, the 40-year CIF of diabetes was 25.7% (95% CI 17.4-38.0), compared with 7.9% (95% CI 3.3-19.1) in patients who received autologous transplants. This evaluation of a hospital-based cohort of patients with CYAC identifies these patients' increased long-term risk of developing diabetes and how this varies temporally according to treatment modalities. Notable contrasts in risk by treatment were detected as early as 10 years after cancer diagnosis. Findings should inform the development of risk-stratified evidence-based screening.

Novel indicator of microvascular complications in patients with type 2 diabetes mellitus and shortened erythrocyte lifespan: a multicenter cross-sectional analysis

IntroductionIn this study, we assessed whether the ratio of glucose management index (GMI) to glycated albumin (GA) was linked to microvascular complications in patients with type 2 diabetes mellitus (T2DM) who also possessed a shortened erythrocyte lifespan.MethodsThis study encompassed individuals from the Tianjin Diabetic Retinopathy Screening Cohort who completed continuous glucose monitoring and had an erythrocyte lifespan of under 90 days. Differences in GMI/GA were compared between the T2DM patients with or without microvascular complications, including diabetic kidney disease (DKD) and diabetic retinopathy (DR). The relationship between GMI/GA and microvascular complications (DKD and/or DR) was assessed by dividing GMI/GA into three groups based on tertiles.ResultsOur study comprised 140 participants with T2DM (62 men and 78 women, with a median age of 67 years) with a median DM duration of 9.68 years, a mean glycated hemoglobin A1c (HbA1c) value of 7.10%, and a median GA value of 16.10%. As expected, the lower GMI/GA group exhibited higher HbA1c and GA (P < 0.001) with similar mean glucose levels (P = 0.099). GMI/GA values were significantly higher in participants without microvascular complications than in those with microvascular complications, including DKD and/or DR (P < 0.05). After adjusting for confounders, the lowest GMI/GA group (T1) had a 3.601-fold increased risk of microvascular complications (95% CI, 1.364–9.508, P = 0.010) and a 3.830-fold increased risk of DKD, specifically (95% CI, 1.364–12.222, P = 0.023) relative to the highest group (T3).ConclusionGMI/GA serves as a novel risk indicator for microvascular complications in T2DM, independent of HbA1c.

Will controlled monitoring of biochemical profile help in better prognosis of diabetic foot ulcer?

Diabetes Mellitus affects more than 400 million people worldwide and that number is growing rapidly. India is the country with largest number of diabetic patients in the world. Diabetic foot ulcer is one of the common causes of hospital admissions among diabetics in India.This study was aimed at creating a database on biochemical profile of diabetic foot ulcer patients and to see if they can be used to detect and prevent progressing complications and also to monitor treatment progress. A cross sectional study was conducted amongst 50 diabetic foot ulcer patients, biochemical parameters such as HbA1c, S. urea, S. creatinine, S. electrolytes, S. protein, S. albumin, S. SGPT, S. acetone, S. cholesterol, S. triglycerides and S. HDL were estimated from the time of hospital admission and in successive follow up. The population study group age was between 40 to 65 years with 60 percent being males. Among 50 patients there was a relative and gradual increase in values of HbA1c, Creatinine, Cholesterol and Triglycerides. whereas there is a decrease in values observed in parameters like Protein, Albumin and Sodium. Novel diagnostics are able to rapidly detect some of the most dangerous consequences of diabetic foot ulcer and can help to guide therapy. Therefore, preventive and evidence -based guidelines should be followed for diabetic wound management. Diabetic foot ulceration is a major health problem along with wound healing. Its management must also focus on identifying and correction of these biochemical changes and other contributing factors.

A pilot study on screening for aminoacidurias using paper chromatography in subjects with type 2 diabetes and healthy subjects: Cross-sectional study

Diabetes is a heterogeneous chronic dysglycemic and dyslipidemic metabolic disorder principally characterized by persistent hyperglycemia resulting from defects in insulin action and/or insulin secretion. This pilot study is indented detect type of Aminoacidurias and number of amino acids detected in the urine and correlate number of amino acids detected with glycemic control marker glycated hemoglobin (HbA1c) in type 2 diabetic subjects and healthy controls. This present study included 40 subjects with type 2 diabetes and 40 age and gender matched healthy controls in the age group 25-60 years. Early morning first voided mid-stream urine sample of 5 mL was collected into the urine container and subjected to centrifugation to remove cell debris and the clear supernatant was used for preforming paper chromatography for detecting aminoacidurias. In type 2 diabetic subjects two or more than two amino acids up to seven are detected in the urine sample in comparison to healthy controls. The most commonly detected amino acids were valine (60%), glycine (45%), leucine (32.5%), alanine (22.5%) and histidine (25%). There was statistically significant strong correlation existed between HbA1c levels and number of amino acids detected in type 2 diabetic subjects (r=0.901). We found statistically significantly elevated levels of HbA1c and fasting plasma glucose levels in type 2 diabetic subjects compared to healthy controls.In type 2 diabetic subjects two or more than two amino acids were excreted in comparison to controls. It was observed that those patients with inadequate glycemic control had more number of amino acids detected in the urine evidenced by strongly correlation with HbA1c values. Detection of amino acids in the urine can be used as a non-invasive tool to predict glycemic control in type 2 diabetic patients. In addition to this, in type 2 diabetic subjects we get an information about the deficient amino acids and increased amino acids which can open the gateway for therapeutic modalities using amino acids.

Clinical study on the effect of jejunoileal side-to-side anastomosis on metabolic parameters in patients with type 2 diabetes.

At present, the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent, to explore the efficacy of laparoscopic jejunoileal side to side anastomosis in the treatment of type 2 diabetes, the report is as follows. To investigate the effect of jejunoileal side-to-side anastomosis on metabolic parameters in patients with type 2 diabetes mellitus (T2DM). We retrospectively analyzed the clinical data of 78 patients with T2DM who were treated via jejunoileal lateral anastomosis. Metabolic indicators were collected preoperatively, as well as at 3 and 6 months postoperative. The metabolic indicators analyzed included body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), 2-hour blood glucose (PBG), glycated hemoglobin (HbA1c), fasting C-peptide, 2-hour C-peptide (PCP), fasting insulin (Fins), 2-hour insulin (Pins), insulin resistance index (HOMA-IR), β Cellular function index (HOMA-β), alanine aminotransferase, aspartate aminotransferase, serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein, and uric acid (UA) levels. SBP, DBP, PBG, HbA1c, LDL-C, and TG were all significantly lower 3 months postoperative vs preoperative values; body weight, BMI, SBP, DBP, FBG, PBG, HbA1c, TC, TG, UA, and HOMA-IR values were all significantly lower 6 months postoperative vs at 3 months; and PCP, Fins, Pins, and HOMA-β were all significantly higher 6 months postoperative vs at 3 months (all P < 0.05). Side-to-side anastomosis of the jejunum and ileum can effectively treat T2DM and improve the metabolic index levels associated with it.

Assessing the Risks and Cultural Relativity of Diabetes in Black Individuals of African Caribbean Ancestry (ACB) Aged 18-39 Years in Toronto.

Context: Diabetes rates are high in Black and some other ethnic communities, often leading to more severe complications. We conducted a study to identify the prevalence and risk of diabetes among African Caribbean Black (ACB) individuals aged 18-39 and to assess the sensitivity of glycated hemoglobin (HbA1c) compared to an oral glucose tolerance test (OGTT) to diagnose diabetes. Methods: In this mixed-methods study, maximum variation sampling was used to recruit 272 ACB participants from fourteen African and five Caribbean countries from Toronto. Participants' height, weight, waist circumference, HbA1c, OGTT, demographic, and behavioural data were collected. SPSS was used to analyze the quantitative data. This study used descriptive statistics for frequency distribution and cross-tabulation while inferential statistics (regression, ANOVA, factor analysis, etc.) were used for relational analysis. Because of the small sample size, qualitative data were analyzed manually using the charting technique. Results: This study found that 1.5% of participants had diabetes, 9.2% had prediabetes, and 44.9% were at risk of developing diabetes. The mean value of HbA1c, FBS, and 2hPG was 5.5%, 4.8 mmol/L, and 5.7 mmol/L, respectively. The mean BMI was 28.2 kg/m2, and the waist circumference was 85.8 cm. This study found a correlation between glucose intolerance and increasing body mass index (BMI) and waist circumference (WC). Dietary habits, physical inactivity, and mental health challenges were risk factors among the participants. HbA1c was found to be a more sensitive and culturally acceptable screening measure than OGTT in diagnosing diabetes. Conclusions: ACB individuals are at high risk of having diabetes, requiring culturally tailored peer-based health promotion strategies to reduce diabetes prevalence and risk. HbA1c is a culturally acceptable and statistically more capable measure than OGTT in identifying individuals with prediabetes. Further longitudinal research is needed.

Impact of Ketogenic and Mediterranean Diets on Gut Microbiota Profile and Clinical Outcomes in Drug-Naïve Patients with Diabesity: A 12-Month Pilot Study.

Background/Objectives: Managing type 2 diabetes mellitus (T2DM) and obesity requires a multidimensional, patient-centered approach including nutritional interventions (NIs) and physical activity. Changes in the gut microbiota (GM) have been linked to obesity and the metabolic alterations typical of T2DM and obesity, and they are strongly influenced by diet. However, few studies have evaluated the effects on the GM of a very-low-calorie ketogenic diet (VLCKD) in patients with T2DM, especially in the mid-term and long-term. This longitudinal study is aimed at evaluating the mid-term and long-term impact of the VLCKD and Mediterranean diet (MD) on the GM and on the anthropometric, metabolic, and lifestyle parameters of 11 patients with T2DM and obesity (diabesity). This study extends previously published results evaluating the short-term (three months) impact of these NIs on the same patients. Methods: At baseline, patients were randomly assigned to either a VLCKD (KETO group) or a Mediterranean diet (MEDI group). After two months, the KETO group gradually shifted to a Mediterranean diet (VLCKD-MD), according to current VLCKD guidelines. From the fourth month until the end of the study both groups followed a similar MD. Previous published results showed that VLCKD had a more beneficial impact than MD on several variables for 3 months of NI. In this study, the analyses were extended until six (T6) and twelve months (T12) of NI by comparing data prospectively and against baseline (T0). The GM analysis was performed through next-generation sequencing. Results: Improvements in anthropometric and metabolic parameters were more pronounced in the KETO group at T6, particularly for body mass index (-5.8 vs. -1.7 kg/m2; p = 0.006) and waist circumference (-15.9 vs. -5.2 cm; p = 0.011). At T6, a significant improvement in HbA1c (6.7% vs. 5.5% p = 0.02) and triglyceride (158 vs. 95 mg/dL p = 0.04) values compared to T0 was observed only in the KETO group, which maintained the results achieved at T3. The VLCKD-MD had a more beneficial impact than the MD on the GM phenotype. A substantial positive modulatory effect was observed especially up to the sixth month of the NI in KETO due to the progressive increase in bacterial markers of human health. After the sixth month, most markers of human health decreased, though they were still increased compared with baseline. Among them, the Verrucomicrobiota phylum was identified as the main biomarker in the KETO group, together with its members Verrucomicrobiae, Akkermansiaceae, Verrucomicrobiales, and Akkermansia at T6 compared with baseline. Conclusions: Both dietary approaches ameliorated health status, but VLCKD, in support of the MD, has shown greater improvements on anthropometric and metabolic parameters, as well as on GM profile, especially up to T6 of NI.

Diabetes Glycemic Control in Adults With Type 2 Diabetes Mellitus and ADHD

Introduction: Persistence in treatment is important in balancing diabetes and preventing complications. ADHD impairs quality of life and functioning in many areas of life. The aim of this study is to evaluate the possible association of ADHD and diabetes glycemic control among adults with type 2 diabetes mellitus (T2DM). Methods: All data were obtained from Maccabi Healthcare Services (MHS) automated databases. This retrospective cross-sectional study uses electronic medical records from the Maccabi Healthcare Services database during the years 2010 to 2020. Using a propensity score with the variables of age, gender, and duration of diabetes, we compared a group of 1,582 patients with T2DM and ADHD to 1,582 patients with T2DM and without ADHD. We used a t-test to compare continuous variables and a Mann-Whitney U test for non-parametric testing. In addition, we used multivariate logistic regression with a cutoff of several HbA1c values in T2DM patients with and without ADHD during 2019 to 2020. The proportion of patients with HbA1c values above 10%, 9%, and 8% in the group of patients with ADHD was 4.7 to 5.9 times higher than in patients without ADHD. In addition, the OR in the multivariate logistic regression was 4.2 (95% CI [2.5, 6.8]), 4.3 (95% CI [3.1, 6.1]), and 2.7 (95% CI [2.2, 3.4]) for cutoff of HbA1c of 10%, 9%, and 8%, respectively. Conclusion: Patients with co-morbid ADHD and T2DM have a higher incidence of poor glycemic control. The findings extend the knowledge on the relationship between ADHD and diabetes and highlight the need for further research to improve treatment.

The Limited Utility of Hemoglobin A1c as a Predictor for Periprosthetic Joint Infection Following Total Joint Arthroplasty: A Continuous Variable Analysis.

Patients who have poorly controlled diabetes mellitus are at increased risk of periprosthetic joint infection (PJI). Nevertheless, an optimal preoperative hemoglobin A1c (HbA1c) threshold has not been established. This study sought to identify preoperative HbA1c thresholds that were predictive of adverse outcomes for total hip (THA) and total knee arthroplasty (TKA) patients. A healthcare database was used to identify primary THAs or TKAs performed from 2016 to 2021 with a preoperative HbA1c value within 28 days of surgery. The primary outcome was PJI within 90 days postoperatively. Secondary outcomes included aggregate medical and surgical complications. Restricted cubic splines (RCSs) were generated using logistic regression to quantify the impact of HbA1c as a continuous variable on the risk of PJI. Between HbA1c values of 5% and 12%, relevant sensitivity and specificity measurements were calculated at intervals of 0.5%. A Youden's J statistic identified clinically relevant preoperative HbA1c thresholds. In total, 17,481 elective arthroplasty patients who had a preoperative HbA1c were identified. The mean preoperative HbA1c was 6.5%. For TKA, a PJI threshold of 9.7% was identified (sensitivity: 19.4%, specificity: 99.1%), while for THA, a PJI threshold of 7.8% was identified (sensitivity: 22.7%, specificity: 89.9%). The threshold for aggregate medical complications was 6.8% for TKA (sensitivity: 53.7%, specificity: 59.1%) and 6.5% for THA (sensitivity: 45.5%, specificity: 66.5%). No association was observed between HbA1c and aggregate surgical complications for either THA or TKA. This study identified PJI and medical complication HbA1c thresholds above which patients were at a significantly increased risk of early postoperative complications. While our findings suggest that HbA1c has limited predictive utility for postoperative complications, it remains an accessible biomarker that can aid in preoperative risk stratification. Future studies should explore other promising or complementary biomarkers that may be more effective for preoperative risk stratification.

Comparing ADA and IDF diagnostic criteria for intermediate hyperglycaemia and diabetes in the SHiDS study.

This study aimed to assess the prevalence of IH and diabetes, as well as insulin secretion, insulin sensitivity, and related curve patterns in subjects with different glucose tolerance categories according to the diagnostic criteria established by the American Diabetes Association (ADA) and the more recently published International Diabetes Federation (IDF) guidelines. We used data of 5,387 adult participants from the Shanghai High-risk Diabetic Screen (SHiDS) study. All participants underwent a five-point 75 g oral glucose tolerance test (OGTT). Glycemic states were then classified according to the ADA/IDF diagnostic criteria, while OGTT-derived indices were employed to evaluate insulin secretion and sensitivity. Overall, 3,729 subjects were diagnosed consistently under ADA/IDF criteria; while 941 and 717 subjects exhibited inconsistencies in the diagnostic classification for diabetes and IH, respectively. Notably, all of these individuals with discrepant diagnoses displayed β-cell dysfunction and/or insulin resistance compared to the NGT/NGT group. The ADA criteria can identify individuals with elevated haemoglobinA1c (HbA1c) levels when the 1-hour plasma glucose (1-h PG) stay within the normal range, while the IDF criteria can identify subjects with impaired insulin sensitivity and secretion when fasting plasma glucose (FPG), 2-hour plasma glucose (2-h PG) and HbA1c values are in the normal range.

The usefulness of HbA1c measurement in diabetic mouse models using various devices

In most cases, the diagnosis of diabetes in animal models is based solely on blood glucose levels. While hemoglobin A1c (HbA1c) is widely used in the diagnosis of diabetes in humans, it is rarely measured in mice in diabetes research. This is thought to be because there are no established reference values for mouse HbA1c, as well as the fact that there are very few reports on the variability and reproducibility of measurements taken using different devices. In this study, we measured HbA1c levels in diabetic mouse models using different devices based on different principles, including capillary electrophoresis, high-performance liquid chromatography, and enzymatic methods, and compared the results. A positive correlation was observed between blood glucose and HbA1c levels in all measurement methods, and high reproducibility was confirmed in the measurement of HbA1c. However, HbA1c levels measured using the enzymatic method were slightly higher than those measured using the other two methods. In addition, an examination of diabetic mice given a sodium-glucose cotransporter 2 inhibitor, which is used to treat diabetes, revealed that there was a 2-week difference in the fluctuation of mouse HbA1c levels compared with the fluctuation of blood glucose levels. Based on these results, it is thought that HbA1c can be a reliable indicator in diabetic mouse models, and it is expected to make the evaluation of abnormal glucose metabolism in mice more reliable.

Advanced glycation end products association with diabetic retinopathy severity

Aims/Purpose: Advanced glycation end products (AGEs) are proteins or lipids that become glycated as a result to exposure to sugars and diabetes (DM) can accelerate its usually slow accumulation. Higher levels of AGEs are associated with microvascular complications as diabetic retinopathy (DR). AGEs can be measured in human skin using ultra‐violet light to excite autofluorescence. The purpose of this study was to determine the association between AGEs levels and DR severity.Methods: A total of 152 patients were enrolled. DR severity was determined by an ophthalmologist. AGEs concentrations were measured with non‐invasive AGE Reader device.Results: 69 men and 83 women with type 1 (50.7%) and type 2 (49.3%) diabetes were included in the analysis. Age median was 51.85 (min.18, max. 85) years with duration of diabetes 15.99 ± 11.18 years. Mean HbA1C was 8.34 ± 1.99%. 43.7% had no signs of DR, 40.4% had non‐proliferative DR (NPDR), 15.9% – proliferative DR (PDR). Age and HbA1C did not differ between different severity DR groups (p = 0.081 and p = 0.196). AGEs concentration increases with age (r = 0.498, p &lt; 0.001) and duration of diabetes (r = 0.308, p &lt; 0.001). Mean concentration of AGEs were higher in type 2 DM group (p = 0.015). The concentration of AGEs did not differ between DR groups (p = 0.473), thought in type 1 DM subgroup mean concentration of AGEs was higher in PDR patients compared to no DR patients (1.89 vs. 2.43, p = 0.006), whereas no significant difference was found between type 2 DM patients in different DR groups (p = 0.343). There was no significant correlation between HbA1C and AGEs concentration (p = 0246) in all DM patients, but in type 1 DM, AGEs concentration significantly increases with higher HbA1C values (r = 0.309, p = 0.007), but not significantly in type 2 DM (p = 0.282).Conclusions: The levels of AGEs might have association with the severity of DR in type 1 diabetes, but not type 2. More investigations regarding the association of AGEs and DR severity should be performed.

Effects of the Stanford Chronic Conditions Model on Behavioral and Clinical Indicators in Saudi Arabia: A Prospective Quasi-Experimental Study.

This study aimed to evaluate the 6-month impact of the Chronic Disease Self-Management Program based on the Stanford chronic condition model on behavioral and clinical indicators in individuals with chronic illnesses. This prospective, quasi-experimental study was conducted in primary healthcare centers located in Riyadh, Saudi Arabia. A total of 110 adults aged 18 years or older, living with at least one chronic disease, and receiving treatment at a primary healthcare center were included. We compared patients who received the Chronic Disease Self-Management Program with those who received the usual care from primary healthcare centers. Data analysis included analysis of descriptive and covariance statistics. The analysis of covariance indicated that individuals who received the Chronic Disease Self-Management Program had significantly lower systolic (F=5.60, p<0.05) and diastolic blood pressure (F=7.60, p<0.01). These patients were more likely to adopt healthy behaviors to manage their chronic illnesses (F=11.17, p<0.01). However, no significant differences were observed in the HbA1c values of the patients. We recommend incorporating the Stanford Chronic Disease Self-Management Program into patient education to foster peer support for effective chronic disease management.

Review on the laboratory analysis and patient monitoring of generic and branded drug for type 2 diabetes melitus: a focus on efficacy, lipid profile and sugar level.

Context: Insulin resistance and poor glucose metabolism are hallmarks of Type-2 Diabetes Mellitus (T2DM), a chronic illness that calls for long-term pharmaceutical treatment. A common prescription drug used to control blood glucose levels is metformin. It is critical to evaluate the safety and effectiveness of branded and generic formulations, particularly with regard to glycemic management, lipid profiles, and renal function, given the growing availability of generic medications. Evaluation test for tablets: The purpose of this study was to analyze and assess the efficacy of several marketed brands of metformin pills, both branded and generic. Two 500 mg tablets Glumetza (branded) and okamet 500mg (generic) were chosen, and their chemical and physical properties were assessed. Official standards, such as thickness, hardness, weight fluctuation, friability, disintegration time, and dissolution studies, PH measurement, Assay of API, Identification of impurities, were used to assess each brand’s physicochemical equivalency. Objective: The objective of this study was to compare the safety and effectiveness of branded and generic forms of metformin in patients with Type-2 Diabetes Mellitus over a six-month period, with an emphasis on lipid profiles, renal function, and glycemic control. Materials &amp; Procedures: Patients with type 2 diabetes were split into two groups and given either generic or branded versions of diabetes medications. At baseline, three months, and six months, fasting blood sugar (FBS) and HBA1C values were used to measure glycemic control. The safety and possible effects on renal function were assessed by measuring serum creatinine and lipid profiles, which include cholesterol levels. Outcomes: Over a six-month period, both branded and generic Metformin shown notable drops in HBA1C, with the former going from 8.00% to 6.80% and the latter from 8.00% to 6.90%. FBS levels dropped from 190 mg/dl to 177 mg/dl for branded products and 182 mg/dl for generic products. The branded group experienced a greater drop in cholesterol (from 198 mg/dl to 180 mg/dl) than the generic group (to 185 mg/dl). The levels of serum creatinine stayed constant. Conclusion: There was no discernible difference in the safety profiles of branded and generic forms of metformin, and both were equally successful in enhancing lipid profiles and glycemic management.

Differences in Serum Creatinine Levels in Controlled and Uncontrolled Type 2 Diabetes Mellitus Patients

Diabetes Mellitus is in the top 10 causes of death in the world. Indonesia ranks 5th out of 10 countries in the number of diabetes mellitus sufferers in adults aged 20-79 years. Type 2 Diabetes Mellitus is the most common type of Diabetes Mellitus. Examination of the HbA1c value is the gold standard examination for Type 2 Diabetes Mellitus. In PERKENI 2021, the risk of suffering from Type 2 Diabetes Mellitus increases with increasing age and it is recommended to screen for Type 2 Diabetes Mellitus at the age of &gt; 40 years. The second most common complication of Diabetes Mellitus in Indonesia is nephropathy. Diabetic nephropathy is the main cause of end-stage renal failure which is the 5th stage of chronic renal failure. Examination of creatinine in the blood is an important parameter to determine kidney function. The aim of this study was to determine the average difference between serum creatinine levels in controlled and uncontrolled type 2 diabetes mellitus. This research was an analytical observational study with a cross-sectional design using secondary data from Type 2 Diabetes Mellitus sufferers without Chronic Kidney Failure from medical records at Hospital X in Jakarta in January-December 2023. The research data consisted of 368 respondents. The result was p-value = 0.688. The conclusion of this study is that there is no difference in mean between serum creatinine levels in controlled and uncontrolled Type 2 Diabetes Mellitus sufferers. Furthermore, research can be carried out using respondents with a duration of Diabetes Mellitus ≥ 10 year.