Hemoglobin A1c Values Research Articles

Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers

While continuous glucose monitoring (CGM) has been found to improve diabetes care processes and outcomes, adoption remains low. To examine the association between CGM prescriptions and individual characteristics among patients with type 1 or 2 diabetes (T1D and T2D, respectively). Retrospective cross-sectional study using electronic health record data for patients with T1D or T1D from 275 clinic sites nationwide between January 2014 and February 2021. All participating clinics were federally qualified health centers (FQHCs), the largest US system of primary care for vulnerable populations. Data were analyzed from September 2022 to August 2024. Sociodemographic factors, clinical characteristics, and CGM prescription orders. A total of 1168 patients with T1D (mean [SD] age, 41.8 [16.0] years; 600 [51.4%] male; 372 [31.9%] Black; 262 [22.4%] Hispanic, and 750 [64.2%] White patients) and 35 216 patients with T2D (mean [SD] age, 58.4 [13.1] years; 19 772 [56.1%] female; 12 030 [34.2%] Black; 12 979 [36.9%] Hispanic, and 20 413 [58.0] White patients) were included. Overall, CGM prescriptions were infrequent (129 [11.0%] for patients with T1D and 362 [1.0%] for those with T2D) but increased throughout the study period. Among patients with T1D, those who reported Hispanic ethnicity (odds ratio [OR], 0.30; 95% CI, 0.16-0.57), Black race (OR, 0.61; 95% CI, 0.38-0.99), or were uninsured (OR, 0.42; 95% CI, 0.23-0.74) had lower multivariable odds of receiving a CGM prescription than White or insured adults, respectively. Similar findings were observed among patients with T2D reporting Hispanic ethnicity (OR, 0.43; 95% CI, 0.32-0.57), Black race (OR, 0.76; 95% CI, 0.59-0.98), or being uninsured (OR, 0.42; 95% CI, 0.31-0.58), relative to their counterparts. Among patients with T2D, hemoglobin A1c values higher than 9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. In this cross-sectional study of electronic health record data, rates of CGM prescription orders were low among FQHC patients with T1D and T2D. Disparities in CGM orders were observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Future research is needed to understand the causes of infrequent CGM orders in FQHCs and drivers of observed disparities in this vulnerable patient population.

Application of the Summary of Diabetes Self-Care Activities Questionnaire in Evaluating the Self-Care of People with Diabetes

Objectives: This uncontrolled open study aimed to measure the levels of self-care of patients before and after education, their initial knowledge, and their knowledge two months after interacting with healthcare providers using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. Methods: The data for this study were collected over 14 months from 396 patients with diabetes. This study was conducted in three phases: initial questionnaire testing, education, and retesting after two months. The education included specific diabetes-related topics: nutrition, exercise, self-monitoring of blood glucose, foot care, and smoking. Results: The results showed that all self-care activities between the first and second assessments were different. The initial assessment showed that the more successful the general diet, the specific diet, and physical activity were, the better the hemoglobin A1c value was. When considering the impact of gender on self-care effectiveness results, it was noted that women were more successful in foot care and specific diet in the initial testing, while men excelled in physical activity. The most successful age group in the scales of general diet, physical activity, and blood glucose testing was 31–45 years. Those with type 1 diabetes (36% of the study population) were more successful in self-care in the first and second measurements but without any differences in self-care in the retesting. Conclusions: our study observed a difference in self-care results between the two measurements of self-care activities in patients with diabetes, evaluated by the SDSCA questionnaire.

12469 Impact Of Covid-19 Infection On Diabetic Ketoacidosis Severity And Outcomes In Adult Population- A Retrospective Observational Study

Abstract Disclosure: E.M. Niedzialkowska: None. K. Childers: None. L. Qu: None. L. Misra: None. M.R. Brennan: Consulting Fee; Self; Insulet Corporation, Bayer, Inc., Novo Nordisk. Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM) that can be precipitated by SARS-CoV2 infection. We analyzed clinical and demographic characteristics of patients admitted with DKA to investigate if SARS-CoV2 infection affects DKA severity on admission and outcomes. Methods: We conducted a retrospective cohort study that included adult patients admitted with a diagnosis of DKA between March 1, 2020, and March 1, 2023. Patients' demographic data including age, sex, race, ethnicity, laboratory test results on admission, ICU admissions and length of hospital stay (LOS) were compared. Patient characteristics and outcomes of interest were stratified by COVID-19 test results and compared using the Kruskal-Wallis test for continuous variables and Fisher’s exact test for categorical variables. DKA severity was classified based on HCO3 values: mild 15-18 mEq/L, moderate 10-14 mEq/L, severe <10 mEq/L. Results: The study included 902 patients, of which 734 tested negative (COVID-) and 168 tested positive (COVID+) for SARS-CoV2. The mean age was significantly higher (54.09) in COVID-19+ group compared to COVID-19- group (48.25) (p<0.001). The cohort included 49.1% females, 51.7% Whites, 43.3% Blacks, 89.8% Non-Hispanic/Latino, 2.7% Hispanic/Latino. We did not find statistically significant differences in sex (p= 0.608), race (p =0.277), ethnicity (p=0.072) anion gap (p=0.783), glucose (p=0.140), hemoglobin a1c (ha1c) values on admission (p=0.876) and ICU admissions (p=0.266) between both groups. The majority (55.3%) of the patients presented with severe DKA, followed by moderate DKA in 26.6% and mild disease in 18.1% of patients without statistically significant differences between groups (p= 0.128). The mean LOS in COVID + group (11.94 days) was longer than COVID- (6.85) group (p<0.001). Mean venous pH was significantly lower in COVID-19- (7.14) compared to COVID+ (7.17) group (p= 0.016). Betahydroxybutyrate (BHB) levels on admission were higher in COVID- group (7.98 mmol/L, N 0.02-0.27 mmol/L) compared to COVID + (7.10mmol/L) cohort. Conclusion: Patients diagnosed with COVID-19 and DKA on admission did not present with more severe disease compared to patients that tested negative. COVID+ patients were older (54.09 vs 48.2) and had significantly longer LOS (11.94 vs 6.85 days). We did not identify statistically significant differences between race, ethnicity, sex, glucose, anion gap, Ha1c on admission and ICU admission rate. BHB levels on admission were higher in patients that tested negative. Interestingly, mean pH was higher in COVID-19 positive group possibly due to respiratory disorders. Presentation: 6/1/2024

A-037 A1c by separation and enzymatic methods: what's the difference?

Abstract Background Accurate values for hemoglobin A1c (HbA1c) are crucial for diagnosing and monitoring diabetes mellitus. Two common methods to measure HbA1c are capillary electrophoresis (CE) and immunoassay (IA). Many methods used to measure HbA1c are prone to interferences from hemoglobin variants and abnormalities affecting the red blood cell’s (RBC) turnover. Consequently, the average estimated glucose levels using the HbA1c value can be unreliable in diabetics with hemoglobinopathies and other RBC lifetime disorders. Separation methods such as CE can capture hemoglobinopathy information, while IA methods may not. We performed this study in a population with relatively high levels of hemoglobin disorders to evaluate the performance of HbA1c testing on the Alinity platform (IA) against the Sebia Capillarys 3 Tera instrument (CE). Methods Samples were identified retrospectively based on a search of the Electronic Medical Record for all patients with an ordered and resulted HbA1c and complete blood count in the Montefiore Medical Center the day prior to sampling. Routine HbA1c testing was performed by an Abbott Immunoassay method on the Abbott Alinity Instrument and CBC results were obtained from a Sysmex XN2100 instrument. Records were compared by patient name, medical record number, and sample collection time to identify all patients with CBC and HbA1c drawn within one hour of each other. Those samples were retrieved from storage (a 4° automated refrigerator) within 48 hours of draw and tested via the Sebia Capillarys 3 Tera instrument using HBA1c kits. Results In this large representative population study (N=2075), there was overall excellent agreement between IA and CE. The correlation coefficient (R2) of the whole dataset was 0.989, with an average bias of 2.7% between the two methods. Additional analysis was performed on those with possible RBC turnover disorder (patients with RBC counts below 4x106/uL or above 6x106/uL, MCVs above 96 fL or below 80 fL, RDW above 17%, or abnormal A2 value: total of 638 samples), those with a hemoglobin variant as detected by the Capillarys 3 instrument (162 samples), or with a measurable hemoglobin F value detected by the Capillarys 3 instrument (37 samples). Samples were sorted into these groups independently and thus there was significant overlap between groups, notably with 23 of 37 samples with elevated HbF also having a hemoglobin variant. In both the RBC disorder and hemoglobinopathies group, similar low bias and high correlations were seen. The elevated F samples showed a clear negative bias (5.6%) for all patients on the IA method as compared with CE. The IA method states that samples with HbF above 5% should not be tested. However, as this is not a separation method, there is no way to test samples for HbF before analysis, and bias was seen for samples below 5%. Conclusions The IA and CE methods showed similar performance across patients regardless of RBC lifetime or hemoglobin disorder status, though presence of HbF is a potential interference and should be considered. Further questions remain for these instruments in terms of correlation with average glucose levels as calculated through CGM instruments.

Health Literacy and Adherence to Therapy in Type 2 Diabetes: A Cross-Sectional Study in Portugal.

Therapy adherence is a key factor in the control of type 2 diabetes mellitus (T2DM). Optimal self-care requires skills in health literacy (HL). This study aims to analyze the relationship between HL and adherence to therapy and to understand the possible influence of other sociodemographic and disease variables. A multicenter, cross-sectional study was conducted in Portuguese in 13 different primary health care units in both rural and urban environments. A sociodemographic questionnaire and two validated instruments, "Medical Term Recognition Test" and "Summary of Diabetes Self-Care Activities," were applied. The last value of hemoglobin A1c (HbA1c) and the number of chronic medications were collected from clinical records. Descriptive statistics and bivariate correlations were performed as well as multivariable linear regression to assess the association between HL and adherence to therapy. Participants (n = 354) were on average age 63.67 ± 10.39 years, 57.1% male and 42.9% female, 68.4% with inadequate HL and an average HbA1c of 7 ± 1.18%. Better HL was correlated with higher adherence to the total of self-care activities, nonpharmacological therapy, and foot care. In multivariable linear regression analyses, better HL (β = 0.176, p = .003), less than minimum wage (β = -0.197, p = .001) and insulin therapy (β = 0.272, p = .001) were independently associated with increased adherence to overall self-care activities. In a representative sample of people with T2DM in Portugal, HL was a key factor for greater adherence to demanding self-care activities. [HLRP: Health Literacy Research and Practice. 2024;8(4):e194-e203.].

The Interplay between Dietary Habits and Glycemic Control in Type 1 Diabetes: A Comprehensive Prospective FGM Study.

Type 1 diabetes has become prevalent among the adult population, who have increasingly gained access to sensing technology. This study delved into the impact of diet, nutritional status, and the use of a continuous glucose monitoring system (CGM) on glycemic regulation among adults diagnosed with T1D. Employing a prospective design, data were gathered from 151 participants aged 18-60 across multiple cycles. Participants utilized the FreeStyle Libre (FSL) Flash Glucose Monitoring (FGM) System and provided dietary details via questionnaires and diaries. The findings unveiled correlations between dietary patterns and glycemic control, with higher protein intake associated with improved glycated hemoglobin A1C values (p = 0.019), yet elevated fat and protein consumption was linked to heightened rates of hyperglycemia. Conversely, no significant relationship was observed between dietary variables and hypoglycemia occurrence. Interestingly, subjects with more readings of glucose levels consumed fewer carbohydrates (p = 0.004) and more proteins (p = 0.000). Furthermore, physical activity and marital status correlated with glycemic stability, while higher education was associated with enhanced glycemic control (p = 0.021). This study confirmed the importance of structured education on glycemic regulation and the importance of dietary patterns in glucose management. Also, the educational role of the FGM system in changing dietary habits was confirmed, which is one of the key factors for improving glycemic regulation in continuous glucose monitoring system users.

Factors Affecting Arterial Stiffness and Brachial-Ankle Pulse Wave Velocity in Patients With Type 2 Diabetes.

Background We defined the progression of atherosclerosis in patients by brachial-ankle pulse wave velocity (ba-PWV) and determined the relationship between ba-PWV and body composition factors, muscle strength, and patient characteristics. Methodology The arterial stiffness index, body composition, anthropometric parameters, blood test data, and background factors were evaluated in 109 patients with type 2 diabetes mellitus (T2DM). Statistical analysis was conducted using logistic regression analysisand analysis of covariance (p < 0.05). Results The mean age of the participants was 62.87 ± 12.11 years, body mass index (BMI) was 25.72 ± 4.35 kg/m²,ba-PWV was 1653.08 ± 366.55 cm/s, systolic blood pressure was 138.87 ± 16.74 mmHg, the number of years of disease was 11.17 ± 9.51 years, and hemoglobin A1c value was 6.90 ± 0.74%. Binomial logistic regression analysis of ba-PWV divided into two groups by arterial stiffness index, ≥ (or <) 1,400 cm/s, showed systolic blood pressure (odds ratio = 1.11, 95% confidence interval = 1.05-1.18, p < 0.001), BMI, and number of years of disease were significant independent variables. The cut-off value for BMI was 26.28 kg/m². BMI was a significant explanatory factor for ba-PWV in the analysis of covariance (p < 0.001). Conclusion BMI was associated with the incidence of atherosclerosis in patients with T2DM. We proposed a cut-off value for BMIbelow which the atherosclerosis index increased, a result that may reflect the influence of the metabolic paradox.

Association between stress hyperglycemia ratio and functional outcomes in patients with acute ischemic stroke

ObjectiveThis study aimed to evaluate the association between stress hyperglycemia ratio (SHR) and poor functional outcomes at 90 days in patients with acute ischemic stroke (AIS).MethodsThis study retrospectively collected 1988 AIS patients admitted to two hospitals in the Shenzhen area between January 2022 and March 2023. A total of 1255 patients with Fasting Blood-glucose (FBG) and hemoglobin A1c (HbA1C) values at admission were included in this analysis. SHR, measured by FBG/HbA1C, was evaluated as both a tri-categorical variable (Tertile 1: ≤ 0.83; Tertile 2: 0.84 -0.95; Tertile 3: ≥ 0.96). The outcome was poor functional outcomes (modified Rankin Scale [mRS] score 2–6) at 90 days. We performed univariate analysis, multiple equation regression analysis, stratified analysis, and interactive analysis.ResultsCompared with patients in the lowest tertile of SHR, the highest tertile group had significantly lower odds of achieving poor functional outcomes (adjusted odds ratio, OR = 2.84, 95% CI: 2.02–3.99, P < 0.0001) at 90 days after adjusting for potential covariates. Similar results were observed after further adjustment for white blood cell count, neutrophil count, lymphocyte count, fasting blood glucose, stroke type, intravenous thrombolytic therapy, baseline Glasgow score, and baseline NIHSS score.ConclusionSHR, as measured by the FBG/HbA1C, was associated with an increased odds of achieving poor functional outcomes in patients with AIS at 90 days.

Clinical Presentation and Outcomes of Diabetic Ketoacidosis in Pregnancy.

To examine the presentation, management, and outcomes of pregnancies complicated by diabetic ketoacidosis (DKA) in a contemporary obstetric population. This is a case series of all admissions for DKA during pregnancy at a single Midwestern academic medical center over a 10-year period. Diabetic ketoacidosis was defined per the following diagnostic criteria: anion gap more than 12 mEq/L, pH less than 7.30 or bicarbonate less than 15 mEq/L, and elevated serum or urine ketones. Demographic information, clinical characteristics, and maternal and neonatal outcomes were assessed. Patient characteristics and clinical outcomes were compared between individuals with type 1 and those with type 2 diabetes mellitus. Between 2012 and 2021, there were 129 admissions for DKA in 103 pregnancies in 97 individuals. Most individuals (n=75, 77.3%) admitted for DKA during pregnancy had type 1 diabetes. The majority of admissions occurred in the third trimester (median gestational age 29 3/7 weeks). The most common precipitating factors were vomiting or gastrointestinal illness (38.0%), infection (25.6%), and insulin nonadherence (20.9%). Median glucose on admission was 252 mg/dL (interquartile range 181-343 mg/dL), and 21 patients (17.6%) were admitted with euglycemic DKA. Fifteen admissions (11.6%) were to the intensive care unit. Pregnancy loss was diagnosed during admission in six individuals (6.3%, 95% CI, 2.3-13.7%). Among pregnant individuals with at least one admission for DKA, the median gestational age at delivery was 34 6/7 weeks (interquartile range 33 2/7-36 3/7 weeks). Most neonates (85.7%, 95% CI, 76.8-92.2%) were admitted to the neonatal intensive care unit and required treatment for hypoglycemia. The cesarean delivery rate was 71.9%. Despite similar hemoglobin A 1C values before pregnancy and at admission, individuals with type 1 diabetes had higher serum glucose (median [interquartile range], 256 mg/dL [181-353 mg/dL] vs 216 mg/dL [136-258 mg/dL], P =.04) and higher serum ketones (3.78 mg/dL [2.13-5.50 mg/dL] vs 2.56 mg/dL [0.81-4.69 mg/dL] mg/dL, P =.03) on admission compared with those with type 2 diabetes. Individuals with type 2 diabetes required intravenous insulin therapy for a longer duration (55 hours [29.5-91.5 hours] vs 27 hours [19-38 hours], P =.004) and were hospitalized longer (5 days [4-9 days] vs 4 days [3-6 days], P =.004). Diabetic ketoacidosis occurred predominantly in pregnancies affected by type 1 diabetes. Individuals with type 1 diabetes presented with greater DKA severity but achieved clinical resolution more rapidly than those with type 2 diabetes. These results may provide a starting point for the development of interventions to decrease maternal and neonatal morbidity related to DKA in the modern obstetric population.

Three Molecular Developmental Pathways of Remnant Pancreatic Cancer after Resection: A Nationwide Project Study of Japan Pancreas Society.

This study aimed to clarify the molecular mechanism of remnant pancreatic cancer (PC) development after primary PC resection. Molecular mechanisms of the development of remnant PCs following primary PC resection are largely unknown. Forty-three patients undergoing remnant PC resection after primary PC resection between 2001 and 2017 at 26 institutes were retrospectively analyzed. Clinicopathological features and molecular alterations detected by targeted amplicon sequencing of 36 PC-associated genes were evaluated. These patients showed significantly lower body mass indices and higher hemoglobin A1c values at remnant PC resection than at primary PC resection. A comparison of the molecular features between primary and remnant PCs indicated that remnant PCs were likely to develop via three different molecular pathways: successional, showing identical and accumulated alterations (n=14); phylogenic, showing identical and distinct alterations (n=26); and distinct, showing independent distinctive alterations (n=3). The similarity of gene alterations was associated with time to the remnant PC development (r=－0.384, P=0.0173). Phylogenic pathways were significantly associated with the intraductal spread of carcinoma (P=0.007). Patient survival did not differ significantly depending on these molecular pathways. Molecular profiling uncovered three pathways for the development of remnant PCs, namely, successional, phylogenic, and distinct pathways. The vast majority of remnant PCs are likely to be molecularly associated with primary PCs either in the successional or phylogenic way. This information could impact the design of a strategy for monitoring and treating remnant PCs.

Considering the Possible Role of Pharmacists According to the Presence or Absence of Lifestyle-Related Diseases at the Time of Coronary CT Examination and Trends of Medication Use for These Diseases by Medical Doctors.

Because patients often already have coronary artery disease (CAD) at the time of a coronary artery computed tomography angiography (CCTA) examination, we examined the medications prescribed by medical doctors for lifestyle-related diseases and investigated what possible role pharmacists can play in prescribing. Patients (n = 1357) who underwent CCTA examination were divided into two groups according to the presence or absence of lifestyle-related diseases [hypertension (HTN), dyslipidemia (DL) and diabetes mellitus (DM)], and the relationship between the presence or absence of CAD was examined. The rate of CAD was significantly higher in patients with HTN, DL or DM than in patients without these diseases. The blood pressure in the HTN group was 140 ± 20/79 ± 13 mmHg, the low-density lipoprotein cholesterol value in the DL group was 119 ± 35 mg/dL, and the hemoglobin A1c value in the DM group was 7.0 ± 1.1%, all of which were poorly controlled. Anti-hypertensive drugs were used at low rates in the HTN group, statins were used in 47% and ezetimibe was used in 4% of the DL group, and dipeptidyl peptidase-4 inhibitors were used in 41% of the DM group. Since the rate of CAD (+) was high and control of the three major lifestyle-related diseases was poor, pharmacists should advise medical doctors to use combinations of drugs.

1023-P: Predictive Value of Admission Plasma Glucose and Hemoglobin A1c on Inpatient Glycemic Control Assessed by Continuous Glucose Monitoring (CGM) in Medicine and Surgery Persons with Diabetes

1023-P: Predictive Value of Admission Plasma Glucose and Hemoglobin A1c on Inpatient Glycemic Control Assessed by Continuous Glucose Monitoring (CGM) in Medicine and Surgery Persons with Diabetes

Glycemic Control and Obesity Among People With Type 2 Diabetes in Europe and Australia: A Retrospective Cohort Analysis.

In people with type 2 diabetes (PwT2D) who also have obesity, efforts targeting weight loss, including lifestyle, medication and surgical interventions, are recommended. The objective of this study was to explore the relationship between glycemic control and obesity among PwT2D in Europe and Australia using recent real-world data and applying consistent methodology across countries. Retrospective study utilizing IQVIA electronic medical records (EMR) databases grouped into panels based on specialty of contributing physicians. General practitioner (GP) and endocrinologist/diabetologist (E/D) panels were used in Germany and France, while GP panels were used in Italy, UK and Australia. The Spanish database included all physician specialties. The sample included PwT2D with glycated hemoglobin A1c (HbA1c) and body mass index (BMI) values measured within 90 days of each other between January 2015 and December 2018 (second record termed the 'index date'). PwT2D had a 1-year baseline period and a recorded HbA1c at the end of the 1-year post-index period. The final sample comprised 194,729 PwT2D. At baseline, across countries/panels, 36.8-58.0% were above HbA1c target (HbA1c ≥ 7%) and 39.4-56.7% had obesity (BMI ≥ 30.0 kg/m2). Mean HbA1c ranged from 6.9 to 7.6% and mean BMI ranged from 29.3-31.6 kg/m2. At baseline, a higher proportion of PwT2D with obesity (40.8-64.2%) were above HbA1c target compared to their counterparts without obesity (32.2-52.4%). A higher proportion of patients with obesity at baseline (38.1-60.6%) had post-index HbA1c above target compared to their counterparts without obesity (30.9-56.0%). In logistic regression, patients with obesity had substantially lower odds of post-index HbA1c below target compared to those without obesity in all countries/panels except for France (E/D), Spain and Australia. This study presents data on HbA1c and BMI among type 2 diabetes (T2D) populations in Europe and Australia. A notable proportion of PwT2D had obesity and were above HBA1c target. Higher BMI was associated with poorer glycemic control.

Progression from Prediabetes to Diabetes in a Diverse U.S. Population: A Machine Learning Model.

Objective: To date, there are no widely implemented machine learning (ML) models that predict progression from prediabetes to diabetes. Addressing this knowledge gap would aid in identifying at-risk patients within this heterogeneous population who may benefit from targeted treatment and management in order to preserve glucose metabolism and prevent adverse outcomes. The objective of this study was to utilize readily available laboratory data to train and test the performance of ML-based predictive risk models for progression from prediabetes to diabetes. Methods: The study population was composed of laboratory information services data procured from a large U.S. outpatient laboratory network. The retrospective dataset was composed of 15,029 adults over a 5-year period with initial hemoglobin A1C (A1C) values between 5.0% and 6.4%. ML models were developed using random forest survival methods. The ground truth outcome was progression to A1C values indicative of diabetes (i.e., ≥6.5%) within 5 years. Results: The prediabetes risk classifier model accurately predicted A1C ≥6.5% within 5 years and achieved an area under the receiver-operator characteristic curve of 0.87. The most important predictors of progression from prediabetes to diabetes were initial A1C, initial serum glucose, A1C slope, serum glucose slope, initial HDL, HDL slope, age, and sex. Conclusions: Leveraging readily obtainable laboratory data, our ML risk classifier accurately predicts elevation in A1C associated with progression from prediabetes to diabetes. Although prospective studies are warranted, the results support the clinical utility of the model to improve timely recognition, risk stratification, and optimal management for patients with prediabetes.

Glycemic control of once-weekly and other administration frequencies for DPP-4 inhibitor in patients with type 2 diabetes: a real-world retrospective cohort study.

To assess the glycemic control of once-weekly (QW) and other administration frequencies for dipeptidyl peptidase-4 inhibitors (DPP-4i) in patients with type 2 diabetes in a real-world setting. A retrospective cohort study used Japanese medical claims data and medical check-up data between December 2015 and February 2020. Patients with type 2 diabetes had been newly prescribed a DPP-4i regimen of once-daily (QD), twice-daily (BID), or QW administration and had hemoglobin A1c (HbA1c) values from regular medical check-ups. HbA1c values and proportion of patients achieving their HbA1c target were assessed. Multivariable analyses were conducted to examine the association between DPP-4i regimen and achievement of HbA1c target. Of the analysis population (N = 7229), 6098 patients were prescribed the QD regimen, 772 BID, and 359 QW. Mean HbA1c before exposure to DPP-4i was 7.31 ± 1.20% (mean ± standard deviation) for QD, 7.64 ± 1.47% for BID, and 7.06 ± 0.96% for QW, decreasing after DPP-4i exposure to 6.71 ± 0.78%, 6.77 ± 0.84%, and 6.59 ± 0.67%, respectively. HbA1c < 7% was achieved in 72.1% of patients for QD, 69.0% for BID, and 79.1% for QW. On multivariable analysis, the odds ratio (95% confidence interval) for HbA1c < 7.0% in patients < 65years of age was 0.97 (0.73-1.30) for BID and 0.90 (0.57-1.42) for QW compared to QD. Similar achievement of HbA1c target was noted in each regimen for patients age ≥ 65years and for age ≥ 65years with multimorbidity. In this study under real-world conditions, glycemic control for the DPP-4i QW regimen was similar to that for QD and BID. The online version contains supplementary material available at 10.1007/s13340-024-00718-5.

Immediate Impact of Switching from Dipeptidyl Peptidase4 (DPP4) Inhibitors to Low-Dose (0.3mg) Liraglutide on Glucose Profiles: A Retrospective Observational Study.

As treatment agents for diabetes, liraglutide is a long-acting glucagon-like peptide1 receptor agonist, and dipeptidyl peptidase4 (DPP4) inhibitors are widely used because of their safety and tolerability. Regular treatment with liraglutide has been reported to significantly reduce blood glucose levels, but the impact of low-dose (0.3mg) liraglutide on blood glucose levels immediately after treatment switching from a DPP4 inhibitor remains unknown. We conducted a single-arm, retrospective, observational study in 55 inpatients with type2 diabetes (T2D) to investigate the changes (Δ) in their blood glucose levels at six time points (6-point) from the day before (day-1) to the day after (day1) by switching the antidiabetic treatment from a DPP4 inhibitor to liraglutide 0.3mg (low-dose liraglutide) once daily. We also attempted to identify factors associated with the blood glucose-lowering effects of liraglutide. The median values of the changes in fasting, preprandial, and postprandial blood glucose levels and the fluctuations in the blood glucose levels expressed as the standard deviation of the 6-point blood glucose levels were significantly lower on day1 than on day-1 (P < 0.05, P < 0.0001, P < 0.0001, P < 0.01, respectively); there were no cases of severe hypoglycemia. The Δblood glucose levels were not associated with the baseline serum hemoglobin A1c values or with any markers of the insulin secreting capacity. There were no associations between the previously used blood glucose-lowering drug and the Δblood glucose levels. Switching from a DPP4 inhibitor to low-dose (0.3mg) liraglutide once daily significantly reduced the blood glucose levels and excursions of the blood glucose levels even from the very day after the treatment switch, with no serious adverse events.

The impact of grip strength, waist circumference, and body mass index on Hemoglobin A1c value: Cross-sectional study using outpatient clinical data in Japanese elderly patients with type 2 diabetes mellitus.

Grip strength (GS) as a surrogate for muscular strength, waist circumference (WC) as a surrogate marker of visceral fat, and body mass index (BMI) as a surrogate marker of obesity should also be considered markers for the management of risks associated with type 2 diabetes mellitus (T2DM). However, in terms of the management of T2DM in elderly patients, the accentuated heterogeneity of sarcopenic change might modify the associations between those factors and glycemic control. In this cross-sectional study, we aimed to clarify the impact of GS, WC, and BMI on hemoglobin A1c (HbA1c) in elderly Japanese patients with T2DM. GS, WC, and BMI were measured in 327 patients. Odds ratios (ORs) and 95% confidence intervals (CIs) for good glycemic control (HbA1c < 7.0%) were investigated to analyze the three variables as numerical values by dividing them into tertiles. All results were expressed after adjustment was made for the confounders of age, sex, and number of diabetes medications being used by the study participants. The ORs of GS, WC, and BMI for well-controlled HbA1c were 1.056 (95% CI, 1.016-1.098), 0.986 (95% CI, 0.960-1.013), and 1.032 (95% CI, 0.959-1.111), respectively. The OR of 3.726 (95% CI, 1.831-7.581) in the high tertile for GS was significantly higher than the OR in the low tertile, and no differences were observed among the tertiles for WC and BMI. Based on that result, GS was found to have more potential as an effective marker of glycemic control than WC or BMI among elderly Japanese patients with T2DM. Geriatr Gerontol Int 2024; 24: 410-414.

Determinants of gastric residual volume before elective surgery in diabetic patients: An observational study.

We investigated factors affecting the low- and high-risk groups for aspiration by measuring gastric volume with ultrasound in diabetic patients who fasted for elective surgery. The study was conducted as an observational study. Sixty-five patients scheduled for elective surgery, aged 18-86 years, with American Society of Anesthesiologists (ASA) scores II-III, and who have diabetes were included after local ethics committee approval. Written informed consent was obtained from all participants. Demographic data of cases were recorded. Patients whose gastric residual volume (GRV) was calculated using the pupils equal, round, reactive to light, and accommodation (PERLA) formula following gastric antrum measurement in the right lateral decubitus and supine position by ultrasound were categorized as low or high risk for aspiration. Thirty-one patients were in the low-risk group, and 34 patients were in the high-risk group. Sex, weight, body mass index (BMI), hemoglobin A1c (HbA1c) values, and duration of diabetes were not statistically significant (p > 0.5). Age (p = 0.006) and fasting blood glucose (FBG) (p = 0.005) were statistically significant. The risk of aspiration decreases with age. Hyperglycemia is related to delayed gastric emptying and a high risk for aspiration. The duration of fasting, GRV, and cross-sectional area (CSA) were statistically significant (p = 0.017, p = 0.000, and p = 0.000, respectively). Gastric emptying might be delayed in diabetic patients resulting in a high risk for aspiration pneumonia. The risk of aspiration increases in young diabetic patients, and preoperative FBG measurements can provide an idea about gastric emptying in diabetic patients. Gastric ultrasound (USG) may contribute to guidelines for determining more appropriate fasting times for other patient populations, such as obese, pregnant, or child patients.

Beneficial Effect of Metformin on the Five-Year Survival in about 40,000 Patients with Head and Neck Cancer.

Even in times of new therapy regimes, the overall survival of patients with head and neck cancer remains low. Since the previous studies showed the beneficial effect of metformin medication on the survival of patients with cancer, our objective was to investigate if-and in which way-metformin medication affects the overall survival of patients with head and neck cancer. Clinical data pertaining to patients diagnosed with head and neck cancer (International Classification of Diseases 10 codes C00-C14, C31, and C32) were retrospectively retrieved from the TriNetX network (TriNetX, Cambridge, MA, USA). The initial cohort extracted from the network was stratified into two groups: patients on metformin medication (cohort I), and individuals not on metformin medication (cohort II). The matching criteria included age, gender, BMI, type 2 diabetes, and risk factors, such as nicotine and alcohol abuse/dependence. Kaplan-Meier analysis, risk analysis, and the calculation of odds and hazard ratios were conducted. Additionally, the Hemoglobin A1c values were subject to analysis. Following matching, each cohort comprised 20,416 patients. Cohort I exhibited a higher five-year survival rate at 75.3%, in contrast to cohort II, which registered a rate of 69.8%. The odds ratio was 0.79 (95% CI = 0.75-0.83), and the hazard ratio was 0.78 (95% CI = 0.75-0.82). Metformin medication may correlate with improved five-year survival rates in patients with head and neck cancer. Since potentially influencing factors such as comorbidities and the initial tumor stage were not available, the results of our retrospectively conducted study must be interpreted with caution.

Impact of haemoglobin A1c on wound infection in patients with diabetes with implanted synthetic graft.

The aim of this study was to assess the relationship between haemoglobin A1c (HbA1c) values and operative wound infection. During the period from 2013-2016, consecutive patients with type 2 diabetes were prospectively evaluated. Data were retrospectively analysed. All included patients were admitted for an elective surgical procedure, requiring the use of prosthetic graft in a groin wound. The patients were divided into two groups according to their preoperative HbA1c values. The main outcome was groin wound infection. The association between preoperative long-term glycoregulation and wound infection was evaluated, as well as the impact of postoperative glycaemic values, regardless of the level of HbA1c. Of the 93 participating patients, wound infection occurred in 20 (21.5%). Wound infection occurred in 28.2% of patients with uncontrolled diabetes (HbA1c >7%) and 16.7% of patients with controlled diabetes (HbA1c <7%); however, the difference did not reach statistical significance (p=0.181). In regression modelling, operative time (p=0.042) was a significant predictor of wound infection, while patients' age (p=0.056) was on the borderline of statistical significance. Females had a higher probability for wound infection (odds ratio (OR): 1.739; 95% confidence interval (CI):0.483-6.265), but there was no statistical significance (p=0.397). Patients with elevated levels of HbA1c had a higher chance of wound infection compared with patients with controlled diabetes (OR: 2.243; 95% CI: 0.749-6.716), nevertheless, this was not statistically significant (p=0.149). We found no statistically significant correlation between elevated values of preoperative HbA1c and postoperative groin wound infection.