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BACKGROUND The goal is to evaluate the threshold of hemoglobin A1C (HBA1c) for screening test among Chinese patients with diabetes and high-risk groups in the endocrinological department and identify the relationship between HbA1c and plasma glucose. METHODS Experimental design: This study is based on the data selected from patients without clinical intervention enrolled in the Endocrinology Department and Admission Office in our hospital. It uses the four-point plasma glucose modeling and trapezoidal integration method to analyze the relationship between HbA1c and each plasma glucose threshold in an oral glucose tolerance test (OGTT). SETTING Harbin, China, from January 1st of 2010 to December 31st of 2012. PARTICIPANTS 2,853 16 - 85 year-old patients who came to our Endocrinology Department to take venous blood measurements and OGTT. SELECTION CRITERIA The OGTT and HbA1c were performed simultaneously, unless acidosis was present, without considering past history of diabetes and oral hypoglycemic drugs or insulin treatment, or other basic combined diseases. Pregnant patients were excluded. RESULTS The area under the receiver operating characteristics curve (ROC) was 0.902 (95% confidence interval 0.890 to 0.914) for HbA1c alone and 0.915 (0.906 to 0.925) for fasting plasma glucose (FPG) alone. The HbA1c threshold of 6.5% showed the highest Youden index of 64.4%, and significantly higher sensitivity (81.1%, 79.3% to 82.7%) than FPG ≥ 7.0 mmol/L (69.8%, 67.8% to 71.8%) (p < 0.0001) and higher specificity (83.3%, 80.4% to 85.8%) than HbA1c ≥ 6.3% (76.3%, 73.2% to 79.3%) (p < 0.0001) in detecting diabetes, together with a low negative likelihood ratio of 0.2. In addition, the threshold of 1/2 hour postprandial glucose and that of 1 hour postprandial glucose are 10.6 mmol/L and 13.6 mmol/L, respectively. Thus, the relative contribution of FPG increased gradually with increasing levels of HbA1c: 15.9% in the lowest vs. 44.0% in the highest quintile (p < 0.001). The relative contribution of 1-hour postprandial glucose decreased progressively from the lowest (25.0%) to the highest quintile of HbA1c (14.2%, p < 0.001). CONCLUSIONS These findings suggest that the optimal HbA1c threshold of 6.5% as a screening criterion for diabetes and high-risk groups may be acceptable. This paper is trying to put forward the thresholds of 1/2-hour plasma glucose and 1-hour plasma glucose for diagnosing diabetes. The relative contribution of FPG increased gradually with increasing levels of HbA1c; however, the contribution of postprandial glucose decreased progressively.

Pooled participant-level data from 16 RCTs (≥ 24 weeks) were used to explore the association of demographic and clinical markers with different levels of HbA1c achieved at Week 24 in insulin-naive people with T2DM on oral agents after starting insulin glargine 100 U/mL (Gla-100). A stepwise logistic regression analysis was performed to identify potential predictive and exploratory factors for attaining an HbA1c < 7.0%. In total, 46%, 37%, and 17% of 3,415 participants (53% male) included in the analysis achieved Week 24 HbA1c < 7.0%, 7.0-8.0%, and > 8.0%, respectively. Key clinical findings and multivariate analysis results are shown in the Table. Sex, diabetes duration, baseline BMI, HbA1c, FPG, and overall 2h-PPG were significant predictors of attaining HbA1c < 7.0% at Week 24, whereas change in FPG or 2h-PPG were not. FPG and 2h-PPG levels in the HbA1c > 8.0% group remained highest despite a higher Gla-100 dose (0.52 U/kg) and lower overall hypoglycaemia (PG < 3.9 mmol/L) rate at Week 24. In people with T2DM, high baseline HbA1c, FPG, and PPG levels are important predictors of failure of basal insulin/OAD therapy to achieve desired glycaemic goals. A more active treatment strategy targeting both fasting and postprandial hyperglycaemia appears to be indicated for people with poor glycaemic control after starting basal insulin therapy. Disclosure D.R. Owens: Consultant; Self; Boehringer Ingelheim GmbH, Roche Diagnostics Corporation, Eli Lilly and Company, Sanofi, Takeda Development Centre Europe Ltd.. Speaker's Bureau; Self; Boehringer Ingelheim GmbH, Roche Diagnostics Corporation, Eli Lilly and Company, Sanofi, Takeda Development Centre Europe Ltd. W. Landgraf: Employee; Self; Sanofi-Aventis Deutschland GmbH. Stock/Shareholder; Self; Sanofi. M. Zhang: Employee; Self; Sanofi US. Stock/Shareholder; Self; Sanofi US. B.M. Frier: Advisory Panel; Self; Novo Nordisk A/S, Eli Lilly and Company. Consultant; Self; Locemia Solutions, Zucara Therapeutics. Speaker's Bureau; Self; Novo Nordisk A/S, Eli Lilly and Company, Roche Pharma, AstraZeneca. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Sanofi US, Novo Nordisk Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; American Diabetes Association. P. Home: Consultant; Self; AstraZeneca. Other Relationship; Self; Biocon, Boehringer Ingelheim GmbH. Research Support; Self; GlaxoSmithKline plc.. Consultant; Self; Hanmi Pharmaceutical. Other Relationship; Self; Janssen Research & Development. Consultant; Self; Janssen Research & Development, Merck & Co., Inc.. Other Relationship; Self; Merck & Co., Inc.. Research Support; Self; Merck & Co., Inc.. Other Relationship; Self; Novo Nordisk A/S. Consultant; Self; AntriaBio, Inc., Earlysign, Roche Diabetes Care Health and Digital Solutions. Research Support; Self; Sanofi. Consultant; Self; Sanofi. G.B. Bolli: Speaker's Bureau; Self; Menarini Group, Sanofi. Research Support; Self; Sanofi.

AIMS: To compare the effect of replacing diet beverages (DBs) with water or continuing to drink DBs in patients with type 2 diabetes during a 24-week weight loss program. The primary endpoint was the effect of intervention on weight over a 24-week period. The main secondary endpoints included anthropometric measurement and glucose and fat metabolism during the 24-week period. METHODS: A total of 81 overweight and obese women with type 2 diabetes, who usually consumed DBs in their diet, were asked to either substitute water for DBs or continue drinking DBs five times per week after lunch for 24 weeks (DBs group) during a weight loss program. RESULTS: Compared with the DBs group, the water group had a greater decrease in weight (water, -6.40 ± 2.42 kg; DBs, -5.25 ± 1.60 kg; P = .006), in BMI (water, -2.49 ± 0.92 kg/m2 ; DBs, -2.06 ± 0.62 kg/m2 ; P = .006), in FPG (water, -1.63 ± 0.54 mmol/L; DBs, -1.29 ± 0.48 mmol/L, P = .005), in fasting insulin (water, -5.71 ± 2.30 m lU/mL; DBs, -4.16 ± 1.74 m lU/mL, P = .011), in HOMA IR (water, -3.20 ± 1.17; DBs, -2.48 ± 0.99, P = 003) and in 2 hour postprandial glucose (water, -1.67 ± 0.62 mmol/L; DBs, -1.35 ± 0.39 mmol/L; P = 0.027) over the 24-week period. However, there was no significant time × group interaction for waist circumference, lipid profiles and HbA1c within both groups over the 24-week period. CONCLUSION: Replacement of DBs with water after the main meal in obese adult women with type 2 diabetes may lead to more weight reduction during a weight loss program.

Background: Galactomannan is an insoluble polysaccharide that has been shown to reduce postprandial excursions. We assessed the impact of a novel galactomannan derivative (PAZ320) on the magnitude of 2-hour postprandial glucose excursions in individuals with type 2 diabetes who were being treated with oral medication and/or insulin. Methods: Investigators recently reported findings from a single-center, open-label, prospective study that evaluated the efficacy of PAZ320 in 24 subjects with type 2 diabetes who were treated with oral antidiabetic agents and/or insulin. End points included adverse events and area under the curve during 3-hour postprandial glucose excursion (gAUC). Subjects consumed a test meal without PAZ320 at baseline and then ingested low-dose (8 g) and high-dose (16 g) PAZ320 with test meals at subsequent intervention visits. A post hoc analysis was conducted to determine changes in 2-hour postprandial glucose excursions. Results: Among the 20 subjects for whom data were available for all clinic visit test meals, 15 (75%) responded to low-dose, high-dose, or both medication dosages. Low-dose responders (n = 8) experienced clinically significant improvements in 2-hour postprandial glucose excursions from baseline excursions compared with nonresponders (–28.00 ± 25.97 mg/dL vs 23.42 ± 11.45 mg/dL, P = .005). Similar differences were seen in high-dose responders (–28.82 ± 24.26 vs 33.89 ± 20.56 mg/dL, P < .0001). Conclusions: PAZ320 was shown to be safe in all patients studied and effective in controlling postprandial glucose in a large portion of the study population. Additional studies are needed to determine its long-term effects on HbA1c and to further define which subpopulation(s) may respond to PAZ320 therapy.

Background Studies have shown that pistachios can improve blood lipid profiles in subjects with moderate hypercholesterolemia which could reduce the risk of cardiovascular disease. However, there is also a widely perceived view that eating nuts can lead to body weight gain due to their high fat content. Purpose To investigate the impact of different dosages of pistachios on body weight, blood pressure, blood lipids, blood glucose and insulin in subjects with metabolic syndrome. Methods Ninety subjects with metabolic syndrome (consistent with 2005 International Diabetes Federation metabolic syndrome standard without diabetes) were enrolled in three endocrinology outpatient clinics in Beijing. All subjects received dietary counseling according to the guidelines of the American Heart Association Step I diet. After a 4 week run-in, subjects were randomized to consume either the recommended daily serving of 42 g pistachios (RSG), a higher daily serving of 70 g pistachio (HSG) or no pistachios (DCG) for 12 weeks. Results Subjects in all three groups were matched at baseline for BMI: DCG 28.03 ± 4.3; RSG 28.12 ± 3.22; and HSG 28.01 ± 4.51 kg/m2. There were no significant changes in body weight or BMI in any groups during the study nor any change from baseline at any time point in any group. During the entire study, there were no significant differences in waist-to-hip ratio among the groups or any change from baseline in any group (DCG -0.00 ± 0.03, RSG -0.01 ± 0.02 and HSG 0.01 ± 0.04). There were no significant differences detected among groups in triglycerides, fasting glucose and 2 hour postprandial glucose following a 75 gram glucose challenge. Exploratory analyses demonstrated that glucose values 2 h after a 75 gm glucose challenge were significantly lower at week 12 compared with baseline values in the HSG group (-1.13 ± 2.58 mmol/L, p = 0.02), and a similar trend was noted in the RSG group (-0.77 ± 2.07 mmol/L, p = 0.06), while no significant change was seen in the DCG group (-0.15 ± 2.27 mmol/L, p = 0.530). At the end of study, serum triglyceride levels were significantly lower compared with baseline in the RSG group (-0.38 ± 0.79 mmol/L, p = 0.018), but no significant changes were observed in the HSG or DCG groups. Conclusion Despite concerns that pistachio nut consumption may promote weight gain, the daily ingestion of either 42 g or 70 g of pistachios for 12 weeks did not lead to weight gain or an increase in waist-to-hip ratio in Chinese subjects with metabolic syndrome. In addition, pistachio consumption may improve the risk factor associated with the metabolic syndrome.

Background: Diabetes self-management education and reinforcement are important for effective management of the disease. We investigated the effectiveness of interactive small-group education on glycemic, blood pressure, and lipid levels. Methods: For this study, 207 type 2 diabetes patients with suboptimal glycemic control (HbA1c levels >6.5%) were enrolled. The conventional education group received an existing education program from April to November in 2006, and the interactive education group received a new small-group education program from December 2006 to July 2007. The two groups were com-paratively analyzed for changes in blood sugar, glycated hemoglobin, lipid, and blood pressure at baseline, 3, 6, and 12 months and the proportion of patients achieving target goals at 12 months. Results: After 12 months of follow-up, HbA1c levels in the interactive education group were significantly lower than in the con-ventional education group (6.7% vs. 6.4%, P

Background: Both rural and urban areas in India are currently experiencing a great spurt in lifestyle diseases such as diabetes mellitus, hypertension and ischaemic heart disease. The shift in epidemiology from communicable diseases to non-communicable diseases indicates that the rural population is also at a high-risk for developing diabetes mellitus. Aims & Objective: The overall objective of present study was to estimate the prevalence of diabetes mellitus in rural population of district Sonepat, Haryana state. Material and Methods: The study was planned to estimate the prevalence of diabetes mellitus in various age groups by analysing the hospital record based data. Blood for glucose estimation was collected in a fluoride vacutainer and glucose was estimated by kit based GOD –POD method. Fasting plasma glucose ≥ 126 mg/dl and or 2 hour postprandial glucose ≥ 200 mg/dl were taken as the diagnostic criteria for diagnosis. Results: Gender specific prevalence for diabetes was 19.36% and 16.98% for male and female respectively. Maximum prevalence of diabetes 41.96% was found in the age group of 46-60 yrs. In this age group Mean fasting plasma glucose among males was 149.36 ± 19.51 and among female it was 147.43 ± 18.19. Mean 2 hour postprandial plasma glucose was 259.94 ± 51.36 & 259.65 ± 51.39 in male and female respectively. Conclusion: Rural population remains exposed to high level of blood sugar for long time due to lack of screening facility of diabetes at PHC level, and this increases the chance of developing various complication of diabetes mellitus.

Background Hyperglycaemic load has been shown to cause endothelial dysfunction in patients diagnosed with diabetes mellitus or the pre-diabetic state of glucose intolerance. In the non-disease state such as in healthy subjects, the effect of glucose loading is still uncertain with conflicting results. The aim of this study was to test the hypothesis that an oral 75 g glucose load will not adversely attenuate the endothelial function of healthy participants, 2 hours postprandial. Methods This is a prospective single arm study evaluating the brachial artery flow-mediated vasodilation of 12 healthy participants before and after a 75 g glucose loading. Participants’ age, body mass index, family history of diabetes, fasting blood glucose and 2 hour postprandial glucose levels were recorded. All data were analysed with SPSS 17.0 using Wilcoxon test. Results Primary analysis of the participants’ brachial artery flow mediated vasodilation before and 2 hours after 75 g oral glucose loading did not show any statistically significant attenuation (p > 0.05) in brachial artery flow-mediated vasodilation, although a trend for reduction in endothelial relaxation was observed. Subgroup analysis of healthy participants with a positive family history of diabetes confirmed a statistically significant attenuation (p Conclusion Acute oral glucose loading significantly attenuates endothelial relaxation in healthy subjects with positive family history of diabetes but showed no effect in those without a positive family history of diabetes. The attenuation in endothelial relaxation was observed in the presence of normal glucose metabolism, suggesting a defect in endothelium relaxation even in the non-disease state in the group predisposed to diabetes.