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Aims: 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). Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

Immunosenescence (age-related immune dysfunction) and inflamm-aging contribute to suboptimal immune responses in older adults to standard-dose influenza vaccines, which may be exacerbated in those with metabolic co-morbidities. We sought to investigate metabolic factors/predictors of influenza vaccine immune response in an older adult (age ≥65 years) cohort in Singapore, where influenza typically circulates year-round. The primary outcome for the DYNAMIC prospective cohort study was haemagglutination-inhibition titer (HAI) response to each of the trivalent inactivated influenza vaccine strains at day 28 (D28) compared to baseline (D0), as assessed by seroconversion and D28/D0 log2 HAI fold rise. Baseline blood samples were tested for total Vitamin D (25-(OH) D) levels. We enrolled 234 participants in June–Dec 2017. Two hundred twenty completed all study visits. The median age was 71 [IQR 68–75] years, 67 (30.5%) had diabetes mellitus (DM), and the median BMI was 24.9 [IQR 22.2–27.8] kg/m2. Median baseline totals 25-(OH) D was 29 [IQR: 21–29] ng/ml. Age, DM, obesity, and baseline 25-(OH) D were not associated with HAI fold rise in multivariable analysis. More recent prior influenza vaccination and higher baseline HAI titers were associated with lower HAI fold rise for influenza A/HK/H3N2. Physical activity was associated with a higher HAI fold rise for influenza A/HK/H3N2 in a dose-response relationship (p-test for trend = 0.015). Older adults with well-controlled metabolic co-morbidities retain HAI response to the influenza vaccine, and physical activity had a beneficial effect on immune response, particularly for influenza A/HK/H3N2. [ABSTRACT FROM AUTHOR]

Occupational irritant hand dermatitis is the most common occupational skin disease, which is highly prevalent among healthcare workers (HCWs)c.[[1]] Use of moisturizers before, during and after work prevent hand dermatitis by restoring the disrupted skin barrier and providing a thin layer of protection from irritants.[[3]] Existing studies had used various regimes and types of moisturizers, and some were conducted in a simulated or non-healthcare setting which do not represent HCWs' real-life irritants exposure and use of moisturizers.[[4], [6]] We aimed to study the effectiveness of an oil-based moisturizer applied twice daily in preventing skin dryness among HCWs, while not disrupting their work activities. Effectiveness of twice daily oil-based moisturizer in preventing skin dryness among healthcare workers More frequent moisturizer application or combination with water-based moisturizer use during work may be required to protect healthcare workers from hand dermatitis. [Extracted from the article]