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Aims Materials and Methods Results Conclusions When administered in early type 2 diabetes (T2DM), the strategy of ‘induction’ with short‐term intensive insulin therapy (IIT) followed by ‘maintenance’ with metformin thereafter can yield outstanding glycaemic control, with some patients achieving A1c in the normal range of its assay. We thus sought to identify determinants of sustained normalisation of A1c in response to this treatment strategy.In this study, adults with T2DM of mean duration 1.7 ± 1.4 years received induction IIT (glargine, lispro) for 3 weeks, followed by metformin maintenance either with or without periodic 2‐week courses of IIT every 3 months for 2 years. Sustained glycaemic normalisation was defined by A1c <6.0% at 2 years.Of 101 participants, 26 achieved A1c <6.0% at 2 years. At baseline, these individuals had lower A1c and fasting glucose than the other participants, along with better beta‐cell function. During maintenance therapy from 3 weeks to 2 years, they had greater reduction of adiposity (body mass index: p = 0.02; waist circumference: p = 0.02), hepatic insulin resistance (HOMA‐IR: p = 0.02) and ALT (p = 0.005), coupled with relative stabilisation of beta‐cell function and glycaemia. On logistic regression analyses, significant independent predictors of normalisation of A1c at 2 years were baseline A1c (adjusted odds ratio [aOR] = 0.01 [95% CI 0.001–0.16], p = 0.001) and the changes in waist circumference (aOR = 0.77 [0.63–0.94], p = 0.012) and ALT (aOR = 0.90 [0.82–0.98], p = 0.019) during maintenance therapy from 3 weeks to 2 years.While lower baseline A1c and greater reduction in central adiposity predicted A1c <6.0% at 2 years as anticipated, the emergence of greater reduction in ALT as a concomitant determinant highlights the role of the liver in the achievement of sustained glycaemic normalisation. [ABSTRACT FROM AUTHOR]

Abstract The available evidence on the impact of specific non-pharmacological interventions on glycaemic control is currently limited. Consequently, there is a need to determine which interventions could provide the most significant benefits for the metabolic health of young individuals with type 1 diabetes mellitus. The aim of this study was to identify optimal nonpharmacological interventions on glycaemic control, measured by glycated haemoglobin (HbA1c), in children and adolescents with type 1 diabetes. Systematic searches were conducted in PubMed, Web of Science, Scopus, and SPORTDiscus from inception to July 1, 2023. Randomised clinical trials (RCT) investigating nonpharmacological interventions (e.g., physical activity, nutrition, and behavioural therapies) were included. Primary outcome was change in HbA1c levels. Secondary outcome was change in daily insulin dose requirement. Seventy-four RCT with 6,815 participants (49.43% girls) involving 20 interventions were analysed using a network meta-analysis. Most interventions showed greater efficacy than standard care. However, multicomponent exercise, which includes aerobic and strength training (n = 214, standardised mean difference [SMD] =– 0.63, 95% credible interval [95% CrI] – 1.09 to – 0.16) and nutritional supplements (n = 146, SMD =– 0.49, – 0 .92 to – 0.07) demonstrated the greatest HbA1c reductions. These interventions also led to the larger decreases in daily insulin needs (n = 119, SMD =– 0.79, 95% CrI – 1.19 to – 0.34) and (n = 57, SMD =– 0.62, 95% CrI – 1.18 to – 0.12, respectively). The current study underscores non-pharmacological options such as multicomponent exercise and nutritional supplements, showcasing their potential to significantly improve HbA1c in youth with type 1 diabetes. Although additional research to confirm their efficacy is required, these approaches could be considered as potential adjuvant therapeutic options in the management of type 1 diabetes among children and adolescents.

Background: Aims: This study has been taken up to establish the possible relationship of Glycosylated Haemoglobin (HbA1c) which can be used as a marker to predict the extend of target organ damage that may have already taken place at the time of diagnosis in a case of newly detected type 2 diabetes mellitus. Materials and methods: This was a hospital-based, cross-sectional observational study. 84 cases of newly diagnosed T2DM were studied over a period of two years from May 2017 to April 2019, for the prevalence of Retinopathy and Nephropathy and their relationship with HbA1C. Results: Out of 84 cases, 17(21.3%) cases were found to have Retinopathy out of which 13 patient had Mild NPDR and 4 patient had moderate NPDR. Most of the patients were with age between 41-60 years (77.4%) which was significantly higher (Z=7.74; p<0.0001). Most of the patients were with over weight (88.1%) which was significantly higher (Z=11.11; p<0.0001). 9.5% of them were having Class-I obesity. Diabetic retinopathy was present in 20.3% of patients with Mild NPDR being the most common form of diabetic retinopathy and a significant positive correlation was observed between level of HbA1C and prevalence of diabetic retinopathy in the newly diagnosed cases of T2DM. 3.6% cases had macroalbuminuria and a significant positive correlation was observed between HbA1C and prevalence of diabetic nephropathy in the newly diagnosed cases of T2DM. Conclusions: Our study can suggest that estimation of HbA1C should be done in all newly diagnosed Type 2 diabetes mellitus cases so that we can easily assess the degree of chronic hypergycaemia and also to assess the presence of progression of these complications as eye and renal changes by optimum glycaemic control. [ABSTRACT FROM AUTHOR]

The available evidence on the impact of specific non-pharmacological interventions on glycaemic control is currently limited. Consequently, there is a need to determine which interventions could provide the most significant benefits for the metabolic health of young individuals with type 1 diabetes mellitus. The aim of this study was to identify optimal nonpharmacological interventions on glycaemic control, measured by glycated haemoglobin (HbA1c), in children and adolescents with type 1 diabetes. Systematic searches were conducted in PubMed, Web of Science, Scopus, and SPORTDiscus from inception to July 1, 2023. Randomised clinical trials (RCT) investigating nonpharmacological interventions (e.g., physical activity, nutrition, and behavioural therapies) were included. Primary outcome was change in HbA1c levels. Secondary outcome was change in daily insulin dose requirement. Seventy-four RCT with 6,815 participants (49.43% girls) involving 20 interventions were analysed using a network meta-analysis. Most interventions showed greater efficacy than standard care. However, multicomponent exercise, which includes aerobic and strength training (n = 214, standardised mean difference [SMD] =– 0.63, 95% credible interval [95% CrI] – 1.09 to – 0.16) and nutritional supplements (n = 146, SMD =– 0.49, – 0.92 to – 0.07) demonstrated the greatest HbA1c reductions. These interventions also led to the larger decreases in daily insulin needs (n = 119, SMD =– 0.79, 95% CrI – 1.19 to – 0.34) and (n = 57, SMD =– 0.62, 95% CrI – 1.18 to – 0.12, respectively). The current study underscores non-pharmacological options such as multicomponent exercise and nutritional supplements, showcasing their potential to significantly improve HbA1c in youth with type 1 diabetes. Although additional research to confirm their efficacy is required, these approaches could be considered as potential adjuvant therapeutic options in the management of type 1 diabetes among children and adolescents. [ABSTRACT FROM AUTHOR]

Aim: This Bayesian network meta‐analysis of randomized controlled trials assessed the effect of adjuvant periodontal treatment in both periodontal and HbA1c outcomes in adult individuals with type 2 diabetes (T2DM). Materials and Methods: A systematic search was done up to February 2023 comparing sub‐gingival debridement (SD) in combination with local or systemic adjuvant treatment with SD alone for individuals with T2DM. The primary outcomes were changes in absolute HbA1c levels and full‐mouth probing depth reported at 3‐ to 6‐month post‐treatment. Results: Seventy‐two eligible publications evaluating 27 adjuvant treatments were retrieved. The combination of SD and systemic antibiotic metronidazole or SD and antioxidant alpha lipoic acid provided, respectively, 1.4% (95% credible interval [CrI] 0.48; 2.20) and 2.4% (95% CrI 1.50; 3.30) more significant improvement on HbA1c levels, and 0.89 mm (95% CrI 0.23; 1.50) and 0.92 mm (95% CrI 0.02; 0.92) greater periodontal probing depth reductions. Other adjuvant treatments provided added benefit to the periodontal outcomes without discernible effects on HbA1c. Conclusions: Adjuvant use of metronidazole or alpha lipoic acid was the best adjunct option to provide clinically meaningful HbA1c levels and probing depth reductions. However, no strong recommendation can be drawn due to the scarcity of studies for each adjuvant treatment and the low certainty of the resultant evidence. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is defined as abnormal or excessive fat accumulation that may impair health. Body Mass Index (BMI) is a simple index of weight for height (kg/m2) that is commonly used to classify overweight and obesity in adults. Mini Gastric Bypass (MGB) leads to improved quality of life, reduction in episodes of Gastroesophageal Reflux Disease (GERD), high patient acceptance, early safety, and efficacy. Laparoscopic Sleeve Gastrectomy (LSG) is a restrictive, irreversible procedure in which stomach capacity is markedly reduced by creating a lesser curvature tube. MGB is mildly restrictive but importantly, a malabsorptive operation. Many observational studies have concluded that better weight loss and diabetes remission are the advantages of MGB. However, comparative studies of outcomes and complications between Laparoscopic Sleeve Gastrectomy (LSG) and MGB are still scarce. Aim: To compare the effectiveness and outcomes regarding weight loss after LSG and MGB in morbidly obese patients. Materials and Methods: This prospective cohort study was carried out in the Department of Surgery of SPS Hospital, Ludhiana, Punjab, India from 1st June 2018 to 31st May 2019. Adults between 20-70 years of age and with BMI >37.5 without co-morbidities, and BMI >32.5 with co-morbidities Type II Diabetes Mellitus (T2DM) were included. The authors included 59 patients; 34 patients underwent MGB (22 were female and 12 were male) and 25 patients underwent LSG (18 were female and 7 were male). A comparison of continuous variables between the study groups was done using the Student’s t-test. For comparing categorical data, a Chi-square (χ2) test was performed. Results: The overall % Excess Weight Loss (EWL) after MGB ranged from 27.74 to 62.32% with a mean of 44.88±17.44%. The overall % EWL after LSG ranged from 26.62 to 45.8% with a mean of 36.21±9.59%. (p0.05). None of the patients required readmission post LSG, while 3% (1/34) required readmission post MGB. None of the patients had postoperative leakage in both groups. Conclusion: The better outcome was associated with MGB in terms of the percentage of Excess Weight Loss (EWL).

Background: The objective was to assess the association between early HbA1c levels and pregnancy complications and whether this relationship is affected when HbA1c thresholds are greater than or less than 39 mmol/mol (5.7%). Methods: Electronic searches of the MEDLINE and EMBASE databases up to October 2022 were conducted. We included retrospective and prospective observational studies. The inclusion criteria were as follows: HbA1c measurements taken at <20 weeks' gestation, singleton pregnancy, and no pre-existing diabetes mellitus. Results: We assessed the certainty of the evidence with the GRADE system. We determined the proportion of patients in each group who met the criteria for obstetrical outcomes and pooled data into two subgroups according to the HbA1c threshold: <39 mmol/mol or >39 mmol/mol (5.7%). Sixteen studies with a total of 43,627 women were included. An association between elevated early HbA1c levels and pre-eclampsia, large for gestational age (LGA), macrosomia, and preterm delivery (RR 2.02, 95% CI 1.53–2.66; RR 1.38, 95% CI 1.15–1.66; RR 1.40, 95% CI 1.07–1.83; and RR 1.67, 95% CI 1.39–2.0, respectively) was shown, with a moderate–high grade of certainty. According to the subgroup analysis of all studies, LGA, pre-eclampsia, and labour induction were associated with elevated HbA1c levels only in studies using an HbA1c threshold >39 mmol/mol (5.7%). The association between HbA1c levels and premature birth was statistically significant in studies using both higher and lower HbA1c thresholds. Conclusions: Women with high early HbA1c levels below the range of diabetes presented an increased risk of pregnancy complications such as macrosomia, LGA, and pre-eclampsia. An early HbA1c threshold of >39 mmol/mol (5.7%) showed the strongest association with pregnancy complications. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is defined as abnormal or excessive fat accumulation that may impair health. Body Mass Index (BMI) is a simple index of weight for height (kg/m2) that is commonly used to classify overweight and obesity in adults. Mini Gastric Bypass (MGB) leads to improved quality of life, reduction in episodes of Gastroesophageal Reflux Disease (GERD), high patient acceptance, early safety, and efficacy. Laparoscopic Sleeve Gastrectomy (LSG) is a restrictive, irreversible procedure in which stomach capacity is markedly reduced by creating a lesser curvature tube. MGB is mildly restrictive but importantly, a malabsorptive operation. Many observational studies have concluded that better weight loss and diabetes remission are the advantages of MGB. However, comparative studies of outcomes and complications between Laparoscopic Sleeve Gastrectomy (LSG) and MGB are still scarce. Aim: To compare the effectiveness and outcomes regarding weight loss after LSG and MGB in morbidly obese patients. Materials and Methods: This prospective cohort study was carried out in the Department of Surgery of SPS Hospital, Ludhiana, Punjab, India from 1st June 2018 to 31st May 2019. Adults between 20-70 years of age and with BMI >37.5 without co-morbidities, and BMI >32.5 with co-morbidities Type II Diabetes Mellitus (T2DM) were included. The authors included 59 patients; 34 patients underwent MGB (22 were female and 12 were male) and 25 patients underwent LSG (18 were female and 7 were male). A comparison of continuous variables between the study groups was done using the Student's t-test. For comparing categorical data, a Chi-square (Χ2) test was performed. Results: The overall % Excess Weight Loss (EWL) after MGB ranged from 27.74 to 62.32% with a mean of 44.88±17.44%. The overall % EWL after LSG ranged from 26.62 to 45.8% with a mean of 36.21±9.59%. (p<0.05) in % EWL at nine months in both procedures as MGB resulted in more % EWL than LSG. Perioperative results regarding the mean operative time for MGB was 3.24 hours and for LSG, 2.43 hours (p<0.05). A total of 50% (5/10) of patients who underwent MGB had remission, and 25% (1/4) of patients who underwent LSG had remission of T2DM after nine months (p>0.05). None of the patients required readmission post LSG, while 3% (1/34) required readmission post MGB. None of the patients had postoperative leakage in both groups. Conclusion: The better outcome was associated with MGB in terms of the percentage of Excess Weight Loss (EWL). [ABSTRACT FROM AUTHOR]

Introduction: Type 1 Diabetes Mellitus (T1DM) is one of the most common paediatric endocrine illnesses. It is a chronic condition that involves regular administration of insulin, meal planning, strict adherence to physical activity and home-based sugar monitoring. Regular follow-up is essential to prevent short-term and long-term complications. Telemedicine has been extensively used in the management of multiple chronic conditions in adults. However, there are limited studies showing the impact of telemedicine in T1DM paediatric patients in the Indian population. Aim: To compare the glycaemic control in paediatric T1DM patients, before and after the use of telephonic reinforcement. Materials and Methods: A prospective, interventional study was conducted at Shree Krishna Hospital, Karamsad, Gujarat, India with no sub-specialty clinic. The duration of the study was one year and five months, from November 2017 to April 2019. Paediatric patients upto the age of 18 years, diagnosed with T1DM (by paediatricians/physicians) were included in the study. The records of 64 patients were traced, 27 were enrolled prospectively for the study (who could be contacted and consented to the present study). The baseline weight, height, age, duration of T1DM, insulin dosage and baseline Glycosylated Haemoglobin (HbA1c) were recorded. Majority of the patients 24 (89.4%) from rural area belonged to lower socioeconomic class, belonging to lower socioeconomic class. After receiving due consent, the patients/parents were provided telephonic reinforcement by a paediatrician to ensure regular sugar monitoring, solve queries of parents and to ensure regular follow-up. The clinical profile and parameters were repeated at three monthly intervals and compared. A paired t-test was used with a p-value=0.05 as a cut-off to compare data before and after intervention. Results: The mean and median ages of the study participants at diagnosis were found to be 8.9 years and 10.5 years, respectively. Average duration of T1DM was four years. On telephone, three things were reinforced: 1) To take insulin regularly as advised; 2) To come for follow-up regularly and 3) If any difficulties faced by them while taking insulin or coming for follow-up then to contact us. The patients were followed-up as per routine, diabetic care protocol every three months and value of HbA1c was reduced significantly during follow-up. The (p-value

Introduction: Type 2 Diabetes Mellitus is one of the most common metabolic endocrine disorder characterised by hyperglycemia. It is caused by a complex interaction of genetics and environmental factors. In DM, lipid abnormalities, anaemia, alteration of liver and kidney functional indices have been implicated as major risk factors to the progression of Diabetic complications. Ferritin is an index of body iron stores & acts as an iron overload marker. The relationship between iron metabolism and type 2 DM is bidirectional. Iron is a potent pro-oxidant that increases cell oxidative stress causing decreased insulin internalization and actions resulting in hyperinsulinemia and insulin resistance. Serum Ferritin, an acute phase reactant is a marker of iron stores in the body. Increased serum ferritin, reflecting body iron overload, is often associated with measures of insulin resistance, such as elevated blood glucose and insulin levels. Aims and Objectives a) To measure the level of Serum Ferritin and glycosylated hemoglobin in patient with Type-2 Diabetes mellitus b) To measure the level of Serum Ferritin and glycosylated hemoglobin in controls. Materials and Methodology: This is a case control study.The study duration is 2 years. The study was carried out on 75 cases of clinically diagnosed type 2 diabetes mellitus in the age group 40-60 years, attending department of medicine, KIMS, Koppal. Seventy five age and sex matched healthy subjects were taken as controls. Ethical clearance was obtained from institutional ethical clearance committee.Venous sample was collected and serum biochemical parameters( FBS, PPBS, HbA1C, Ferritin) were measured. Statistical Test: Data is expressed in terms of mean ± SD. Chi- square test was applied to estimate the difference between the two groups of population. Unpaired ‘t’-test was used to study the changes in serum ferritin levels between the study groups. p value <0.05 was considered statistically significant. Results: The study showed statistically significant increase(p<0.05) in serum ferritin levels in cases compared to controls. Our study showed a positive correlation between ferritin and blood sugar levels. Conclusion: Type 2 Diabetes mellitus is associated with increased ferritin levels .Reliable and sensitive methods need to be developed to precisely measure catalytic iron that participates in oxidative injury. [ABSTRACT FROM AUTHOR]

Evidence suggests that low carbohydrate dietary (LCD) approaches can improve glycaemic control and may result in type 2 diabetes mellitus (T2DM) remission. This systematic literature review (SLR) aimed to assess the effectiveness of technology-enabled LCD interventions in the management of people with prediabetes or T2DM. Data sources included Medline, Embase, CINAHL, and Web of Science. Randomised (RCTs) or non-randomised (non-RCTs) controlled trials investigating the effect of technology-enabled LCDs (<130 g/day) or very low carbohydrate diets (VLCDs < 50 g/day) on glycosylated haemoglobin A1c (HbA1c) for at least three months and published in English between 2009 and 2023 were included. Risk of bias assessment, data extraction, and synthesis were conducted using standard tools and procedures. Six studies (two RCTs and four non-RCTs, total sample, n = 1519) were identified and included in the SLR. Two studies examining LCDs reported significant reductions in mean HbA1c (0.4% and −1.2%) and weight loss (−3.8 kg and −7.5 kg) at one year. Three studies examining VLCDs reported significant reductions in mean HbA1c (−0.8% to −1.3%) and weight loss (−12 kg to −14 kg) up to two years. Technology-enabled LCD or VLCD interventions can be a novel approach in helping people with prediabetes or T2DM self-manage their condition and possibly achieve remission. However, further research is required to determine the sustainability, effectiveness, and safety of this approach. [ABSTRACT FROM AUTHOR]

Diabetes is a complex, chronic metabolic disorder affecting approximately 10% of the adult population worldwide (International Diabetes Federation, 2021) with the estimated number of adults with diabetes having more than tripled since 2000. This increase has largely been attributed to global urbanization and lifestyle changes. Over 323,000 operations take place in the UK each year in people with diabetes, 15% of all operative procedures (Centre for Perioperative Care). These patients are frequently elderly, have complex medical co-morbidities and present for both high-risk elective and emergency surgery. This multisystem disease poses a significant challenge to both anaesthesia and surgery with patients with diabetes demonstrating higher morbidity and mortality rates compared to their non-diabetic counterparts. It is crucial that good glycaemic control is maintained throughout the perioperative period as this has been shown to correlate with positive patient outcomes. It is well-recognized that a coordinated, multidisciplinary approach aimed at optimizing every point in the patient pathway from GP referral to post-discharge care is required to obtain the best outcomes for the surgical patient with diabetes. The anaesthetist has a key role in the perioperative diabetes multidisciplinary team. Patients themselves are well experienced in managing their own diabetes and should be involved in doing so whenever possible. [ABSTRACT FROM AUTHOR]

Background: Diabetic patients are known to have gastroparesis and consequent delayed gastric emptying which predisposes them to an increased risk of aspiration as compared to the general population. This study compares the gastric volumes in diabetic and non-diabetic patients using point-of-care ultrasound and correlates it with the HbA1c levels in diabetic patients. Methods: This cross-sectional study included 180 patients, 90 diabetic (>5 years) and 90 nondiabetic, aged >40 years, American Society of Anaesthesiologists' physical status I–II kept fasting for 8 hours. Before induction, gastric ultrasound was performed to measure craniocaudal (CC) and anteroposterior (AP) diameters followed by calculation of antral cross-sectional area (CSA) and gastric volume (GV) in right lateral decubitus (RLD) position using curved array probe. In diabetic patients, the gastric volumes were correlated with HbA1c values. Results: In the RLD, the mean CC and AP diameters were higher in diabetic Group. The calculated CSA in RLD in diabetics (8.014 ± 2.412 cm2) were significantly higher than non-diabetic (6.314± 2.894 cm2) (p < 0.0001). The calculated GV of 71.501 ± 35.937 ml in the diabetic group was significantly higher than 48.0022± 41.587 ml in the non-diabetic group (p < 0.0001). In diabetics, the gastric volumes showed significant correlation with HbA1c. Conclusion: Diabetic patients show higher residual gastric volume as compared to non-diabetic patients indicating gastroparesis. The gastric volumes are further increased in those with poorly controlled disease with high HbA1C levels. Ultrasound is an effective tool in assessing the risk of aspiration and altering anaesthetic management accordingly.

Aim: To examine the preliminary effects of a culturally tailored, family‐supported, community‐based diabetes self management education and support (DSMES) programme for Ethiopian people with type 2 diabetes on glycosylated haemoglobulin (HbA1c), blood pressure, body mass index and lipid profiles. Methods: A two‐arm pilot randomised controlled trial (RCT) was conducted involving 76 participant–caregiver dyads from Western Ethiopia, which were randomly allocated to the intervention arm to receive 12 h of DSMES intervention guided by social cognitive theory on top of usual care, or to the control group, which received usual care. While HbA1c was a primary outcome, the blood pressure, body mass index and lipid profiles were secondary outcomes. Primary outcome was the change in HbA1c between baseline and 2‐month follow‐up between the groups. Generalised estimating equations was used to test the preliminary effect of the DSMES programme on the outcomes at baseline, post‐intervention and at 2‐month follow‐up for secondary outcomes. Cohen's d was used to estimate the between‐group effect sizes of the intervention. Results: The DSMES produced significant improvement in HbA1c with large effect size (β = −1.667, p < 0.001, d = −0.81) and triglycerides with medium effect size (d = −0.50). HbA1c in the intervention group was decreased by 12 mmol/mol (1.1%). Although nonsignificant, the DSMES also had small to moderate effects (d = −0.123 to 0.34) on blood pressure, body mass index, total cholesterol, low‐density and high‐density lipoproteins when compared with usual care. Conclusion: A culturally tailored, social cognitive theory‐guided, family‐supported, community‐based DSME programme could have a benefit on HbA1c and triglycerides. A full RCT is warranted to test the effectiveness of the DSMES programme. [ABSTRACT FROM AUTHOR]

Introduction: Type 1 Diabetes Mellitus (T1DM) is one of the most common paediatric endocrine illnesses. It is a chronic condition that involves regular administration of insulin, meal planning, strict adherence to physical activity and home-based sugar monitoring. Regular follow-up is essential to prevent short-term and long-term complications. Telemedicine has been extensively used in the management of multiple chronic conditions in adults. However, there are limited studies showing the impact of telemedicine in T1DM paediatric patients in the Indian population. Aim: To compare the glycaemic control in paediatric T1DM patients, before and after the use of telephonic reinforcement. Materials and Methods: A prospective, interventional study was conducted at Shree Krishna Hospital, Karamsad, Gujarat, India with no sub-specialty clinic. The duration of the study was one year and five months, from November 2017 to April 2019. Paediatric patients upto the age of 18 years, diagnosed with T1DM (by paediatricians/physicians) were included in the study. The records of 64 patients were traced, 27 were enrolled prospectively for the study (who could be contacted and consented to the present study). The baseline weight, height, age, duration of T1DM, insulin dosage and baseline Glycosylated Haemoglobin (HbA1c) were recorded. Majority of the patients 24 (89.4%) from rural area belonged to lower socioeconomic class, belonging to lower socioeconomic class. After receiving due consent, the patients/parents were provided telephonic reinforcement by a paediatrician to ensure regular sugar monitoring, solve queries of parents and to ensure regular follow-up. The clinical profile and parameters were repeated at three monthly intervals and compared. A paired t-test was used with a p-value=0.05 as a cut-off to compare data before and after intervention. Results: The mean and median ages of the study participants at diagnosis were found to be 8.9 years and 10.5 years, respectively. Average duration of T1DM was four years. On telephone, three things were reinforced: 1) To take insulin regularly as advised; 2) To come for follow-up regularly and 3) If any difficulties faced by them while taking insulin or coming for follow-up then to contact us. The patients were followed-up as per routine, diabetic care protocol every three months and value of HbA1c was reduced significantly during follow-up. The (p-value<0.001) showed a significant difference after telephonic reinforcement. Conclusion: Telephonic reinforcement improves control of T1DM, by improving laboratory parameters and compliance with regular follow-up. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is among the most serious public health problems worldwide, whose incidence is steadily increasing and is now posing a global epidemic danger. Major secondary complications are associated with diabetes that impacts the normal functioning of major organs such as the pancreas, liver, kidney, and eye and is characterized by a high rate of inflammation, oxidative stress, and apoptosis. Indole phytoalexins such as Brassinin exhibit a variety of biological properties, including antimicrobial, oviposition stimulant, antitumor, and cytotoxic. Materials and Methods: The 35mg/kg STZ was intraperitoneally injected to the rats for stimulating the diabetes. Then rats were treated with 25mg/kg of brassinin. The Glibenclamide was used as a positive control. The impact of Brassinin on water and food uptake, body weight, and kidney and liver weight were assessed. The levels of blood glucose, insulin, and glycosylated Haemoglobin (HbA1c), hepatic marker, carbohydrate metabolic enzymes, antioxidants, and inflammatory markers in untreated and treated rats were examined. The histological examination of the pancreas, kidney, and liver were also performed to understand the salutary properties of the Brassinin. Results: Brassinin and Glibenclamide treatment remarkably decreased the glucose and HbA1c levels in diabetic rats, while the insulin levels were substantially elevated. They also increased the antioxidant enzymes in the STZ-stimulated rats and considerably decreased the inflammatory marker and hepatic marker enzyme levels. Histological observations established the protective potential of Brassinin on diabetes-associated injury in the pancreas, liver, and kidney. Conclusion: It can be inferred that Brassinin is an antihyperglycemic, antioxidant, and anti-inflammatory compound that protects the liver, kidney, and pancreas during the onset of diabetes. [ABSTRACT FROM AUTHOR]

Abstract Aim To validate the psychometric properties of a questionnaire to measure adherence to treatment among people with type 1 diabetes mellitus and to evaluate its relationship with metabolic control. Design A cross‐sectional study of 167 adult people with type 1 diabetes mellitus recruited from the Endocrinology Service of University Hospital Doctor Peset (Spain). Methods The validity of the content, construct and reliability of the instrument were evaluated and the results correlated with levels of glycosylated haemoglobin. Results The questionnaire was composed of 25 items and 5 dimensions, with a score of 25–150 points and an internal consistency of 0.92, according to Cronbach's coefficient α. The content of validity ratio and the construct (exploratory functional analysis, Kaiser–Meyer–Olkin index and Barlett's spherical test) were adequate. We observed a significant correlation between glycosylated haemoglobin levels and treatment adherence. Conclusion The questionnaire to measure adherence to treatment in type 1 diabetes mellitus is consistent, reliable and valid, showing an excellent association with degree of metabolic control.

Back ground and Objectives: India has the largest number of diabetic patients turning it a capital for Diabetes in recent days. Depression is a major public health problem associ¬ated with chronic disease like diabetes and co existence of Diabetes and depression is as¬sociated with significantly increases risk of morbidity and mortality. This study was conducted to determine the prevalence and the level of depression and to identify the associated factors related with the disease among the study population attending the Diabetic OPD of SSKM Hospital. Methodology: A cross-sectional study was conducted among 406 diabetic patients attending diabetic OPD of SSKM Hospital using a pre-designed, pre-tested, structured schedule by face-to-face interview method and reviewing of investigation records. Data were analysed using SPSS v16.0. Multi-variable binary logistic regression was performed to find the factors associated depression. Results: The prevalence of depression among adult diabetic patient in this study was found to be 44.4 %. Statistically significant factors associated with depression were fasting sugar, post pandial sugar, HbA1c, medication socioeconomic class, gender and duration of diabetes. Conclusion: This study confirms the link between depression and Diabetes where the prevalence of depression was inevitable as a co-morbid condition with Diabetes. Universal screening for depression and management of depres¬sion in Diabetes can improve the health status and reduce the economic burden of the community.

Objective: To study the effect of aloe vera extract on glycosylated haemoglobin (HbA1C) and blood glucose levels in albino rats. Study Design: Laboratory-based experimental study. Place and Duration of Study: Army Medical College, Rawalpindi and National Institute of Health, Islamabad Pakistan, from Oct 2018 to Mar 2019. Methodology: Ninety male Sprague Dawley rats, aged 10-12 weeks, weighing 250±50 grams, were divided into three Groups. In Group-A, non-diabetic rats were given a standard lasb diet. In Groups B and C, diabetic rats were given a standard laboratory diet. In Group-C, an extract of Aloe Vera at 300mg/kg body weight was also given once daily. Before the commencement of the experiment, blood glucose was measured, and then after injection, STZ on the fourth-day record of blood glucose was taken. At the end of the experiment, a blood sample was taken from the tail vein to analyze glycosylated haemoglobin levels and blood glucose. Results: The difference in blood glucose levels at the start of the experiment was significant statistically (p-value

Background: The study was prompted by the high prevalence of hyperglycaemia first detected in pregnancy (HIP) which is classified into diabetes mellitus in pregnancy (DIP) and gestational diabetes mellitus (GDM). This study aimed to determine the usefulness of Glycosylated Haemoglobin (HBA1c) in the diagnosis of HIP in the first trimester of pregnancy. Methodology: The study was of a prospective cross-sectional design carried out between January 2020 and August 2020 at the University of Port Harcourt Teaching (UPTH) and Rivers State University Teaching Hospital (RSUTH). Three hundred and five consecutive pregnant women attending the antenatal clinic at 8 to 13 +6 weeks of pregnancy were recruited for the study. Patients' socio-demographic information, anthropometric measurements, and medical, obstetric, and gynaecological history were recorded on a predesigned proforma. Blood was taken for an oral glucose tolerance test (OGTT) and glycosylated haemoglobin (HBA1c) levels. Ethical approval for the study was obtained from the Research Ethics Committee of the UPTH and RSUTH. Results: The prevalence of DIP, GDM, and HIP in the study was 2.62%, 28.85%, and 31.48% respectively. The ROC curve for HbA1c in the study showed a significant area under the Curve (AUC) value of 0.653%, 95% CI = 0.59 - 0.72, p = 0.001. The Youden index reached 2.50 and the optimal cut-off for HBA1c for diagnosis of diabetes was 5.25%. The sensitivity, specificity, PPV, and NPV for HbA1c against the Gold standard OGTT in the diagnosis of GDM were 36.5%, 88.5%, 59.3, %, and 75.2% respectively. HbA1c had high specificity and moderately high NPV. Conclusion: Glycosylated haemoglobin was a fairly good tool for diagnosis of HIP in the first trimester, but it could not replace OGTT which is the gold standard. [ABSTRACT FROM AUTHOR]

Introduction: Haptoglobin (Hp), an acute phase protein, is a plasma inflammatory marker. It is important in both infectious and non infectious illnesses. When intravascular haemolysis occurs, the dead red blood cells are discharged into the circulation and link to Hp to form the haemoglobin (Hb)-haptoglobin (Hb-Hp) complex that is recognised by the macrophage scavenger receptor CD163. The Hp1 and Hp2 are its two alleles. The Hp2 is formed by a partial duplication of the Hp1 gene. The Hp1 has five exons, but Hp2 has seven exons owing to the duplication of Hp1 third and fourth exon. There are three genotypes of Hp: Hp1-1, Hp2-1, and Hp2-2. The encoded products of genotypes are attached to haemoglobin with varying degrees of affinity: Hp1-1 has the most affinity, Hp2-1 has medium affinity, and Hp2-2 has the lowest affinity. Hp allelic and genotypic variation differs amongst populations and different geographic regions of the world. Aim: To study the haptoglobin 2-2 genotype in type 2 diabetes and cardiovascular patients in north Indian population. Materials and Methods: It was a case-control study and a total of 200 participants were recruited randomly including 50 participants of type 2 Diabetes Mellitus (DM), 50 participants of Cardiovascular Disorders (CVD), 50 participants with Cardiovascular Disorders With type 2 Diabetes Mellitus (CVDWDM) and 50 normal healthy controls from Punjab Institute of Medical Sciences (PIMS) Hospital and clinics and Aashirwad laboratory of Jalandhar, Punjab, India in February 2021 to January 2022. Anthropometric variables were determined by using standard methods and biochemical parameters were measured by commercial available kits. Allele specific Polymerase Chain Reaction (PCR) or Amplification Refractory Mutation System (ARMS) PCR was used to detect Hp genotypes. Data were represented as mean±Standard Deviation and the statistical difference i.e. p<0.05 between all parameters was determined by using the Mann-Whitney U test. Results: Anthropometric parameters i.e. Body Mass Index (BMI) was found to be statistically significant in CVDWDM as compared to CVD, N and T2DM i.e. p=0.023, p=0.01 and p=0.014. Waist Circumference (WC) was found to be statistically significant in CVDWDM as compared to CVD, N and T2DM i.e. p=0.02, p=0.013 and p=0.012 and Hip Circumference (HC) was found to be statistically significant in CVDWDM as compared to CVD, N and T2DM i.e. p=0.02, p=0.017 and p=0.014. However, Apolipoprotein A1 mean value was found to be higher and statistically significant i.e. p=0.03 in Type 2 Diabetes Mellitus (T2DM) as compared to healthy participants. Triglycerides mean value was increased in T2DM as compared to CVD, CVD as compared to N and CVDWDM as compared to healthy controls (p-value=0.012,0.04,0.015, respectively). The findings had shown that a 349 bp band was detected in patients with T2DM, CVD and CVDWDM, implying that the Hp2-2 genotypes were observed but not in healthy controls. Conclusion: The study finds that people with DM, CVD, or CVDWDM all have a 349bp band. It means that the genotypes of the Hp2-2 allele were found in patients of diabetes, CVD and diabetics with CVD but not in the healthy individuals. [ABSTRACT FROM AUTHOR]

Abstract Background Glycosylated haemoglobin (HbA1c) is considered reliable for diagnosing and monitoring diabetes mellitus (DM). It also indicates cardiovascular complications related to DM. However, only a few studies have been conducted on this topic. Methods We conducted a cross-sectional study to investigate the association between newly diagnosed hypertension and HbA1c among non-diabetic Sudanese adults. The sociodemographic characteristics of the participants in the sample were gathered using a questionnaire, and HbA1c was measured using an Ichroma machine. Results Three hundred and eighty-four healthy participants were enrolled in this study. The median (interquartile range [IQR]) age was 56.0 (14.0) years, and 72.1% of the participants were female. The median (IQR) body mass index (BMI) was 31.2 (8.7) kg/m2. One hundred and fifteen (29.9%) participants presented newly diagnosed hypertension. The results of the multivariate analysis showed that age (adjusted odd ratio [AOR] = 1.03; 95% confidence interval [CI] = 1.01‒1.05); BMI (AOR = 1.09; 95% CI = 1.05‒1.14); HbA1c levels (AOR = 2.18; 95% CI = 1.29‒3.67) was positively associated with newly diagnosed hypertension. For an HbA1c level of 5.0% or more, the sensitivity and specificity of newly diagnosed hypertension were 91.3% and 28.2%, respectively (area under the curve = 0.61; 95% CI = 0.55–0.67; P ˂ 0.001). Participants who presented HbA1c levels of 5.0% or more were found to be at higher risk for newly diagnosed hypertension (AOR = 2.53; 95% CI = 1.14‒5.61). Conclusion The results of this study indicated a high prevalence of newly diagnosed hypertension, and HbA1c levels were positively associated with newly diagnosed hypertension.

INTRODUCTION: We aimed to demonstrate probable neuronal benefits derived from glycemic control in diabetic patients without diabetic retinopathy (DRP) by using multifocal electroretinography (mfERG). METHODS: Forty patients with HbA1c level >8% were included in this study. Baseline mfERG measurement (first kernel order) of patients were done. The study group consisted of patients existed 1 unit decrease in HbA1c relative to baseline and the control group consisted of patients with an insufficient decrease (n=16). The control mfERG measurements of the study group were done after HbA1c decrease is obtained (mean 13.6 months) and in the first year follow-up in the control group. RESULTS: Baseline HbA1c level was 8.7+-0.6 in the study group and 8.4+-0.5 in the control group and the levels were 7.5+-0.5 and 8.35+-0.4 respectively after glycemic control. Decrease of HbA1c levels in the study group was significant. Comparing baseline and follow up measurements the difference between P1 and N1 wave amplitude and implicit time values weren't statistically significant in the study group in which glycemic control was good relative to baseline. DISCUSSION AND CONCLUSION: We have determined no significant changes in mfERG parameters after approximately 1 year follow up in both good and insufficient glycemic control groups. The reasons for this could be the progression of retinopathy in diabetic patients despite glycemic control or inadequacy of first kernel orders in revealing functions of inner retina layers.

The risk of developing any complications of diabetes is significantly reduced by monitoring and correcting blood glucose levels and blood pressure, as well as by observing healthy lifestyle rules. Early detection and treatment of type 2 diabetes contribute to the prevention of disease progression and the development of complications. The aim is to study the hypoglycemic effect of «Glyphasonorm» tablets and «Glyphasolin» capsules in a rat model of streptozotocin-induced diabetes. Materials and methods. The studies were carried out on Wistar rats injected intraperitoneally with nicotinamide at a dose of 230 mg/kg 15 minutes before intravenous injection of streptozotocin at a dose of 65 mg/kg. The dynamics of body weight of rats, glucose and glycosylated haemoglobin levels under the impact of long-term administration of metformin, «Glyphasonorm» tablets and «Glyphasolin» capsules were investigated. Results and discussion. The studies on a streptozotocin-induced diabetic model have established that under the action of «Glyphasonorm» tablets and «Glyphasolin» capsules, the level of glycosylated haemoglobin, which decreased along with the level of glucose in the blood of animals, was significantly reduced in comparison with diabetic control. After 14 days of research, the «Glyphasolin» capsules showed more pronounced hypoglycemic activity (4.4 % and 8.0 % more) than the «Glyphasonorm» tablets and the reference drug metformin. The «Glyphasolin » capsules on the 12th day of the study showed a marked decrease in glycosylated haemoglobin in the blood of animals (3.1 % and 5.6 % more) than the «Glyphasonorm» tablets and metformin. Conclusions. In the experimental model of streptozotocin diabetes in rats, "Gliphasolin" capsules showed a more pronounced hypoglycemic effect, which was manifested by a decrease in the content of glycosylated haemoglobin in the blood and prevailed over the effect of the comparative drug metformin and "Gliphasonorm" tablets. «Glyphasolin» capsules and «Glyphasonorm» tablets based on bioflavonoid complex from bean show promise in the treatment of type 2 diabetes on the background of obesity and reducing the risk of micro- and macroangiopathy. [ABSTRACT FROM AUTHOR]

Introduction: In India, diabetes is turning into an epidemic as currently, more than 62 million individuals suffer from the disease. To our knowledge, very few studies have evaluated the correlation between lipid profiles and glycated hemoglobin (HbA1c) in newly diagnosed type II diabetes patients with hypertension. The early detection of lipid abnormalities in these patients will help prevent the cardiovascular outcomes. Material and Methods: The study was conducted in the Department of General Medicine, Sapthagiri Institute of Medical Sciences & Research Center, Bangalore. In our study 70 patients of Type 2 diabetes mellitus were taken for the study after applying inclusion and exclusion criteria. Biochemical data such as fasting plasma glucose (FPG), HbA1c and lipid profile, along with the patient's age, BMI and gender, were also taken from the electronic file system. The inclusion criteria allowed for only patients who were regularly seeing their physician and whose electronic file was up to date. Results: In our study, among 80 Type 2 diabetic individuals included in this study, 47 were male and 33 were female. Distribution of Glucose Triad results of FBS, PPBS and HbA1c levels of patients presented as Mean±SD, mean FBS was 201.49±41.84, mean PPBS was 273.39±91.48 and mean HbA1c was 8.83±0.83. Mean total cholesterol was 201.38 ± 11.48, mean total triglyceride was 198.48 ± 12.39, Mean HDL was 36.48 ± 4.62, mean LDL was 140.09 ± 9.63 and VLDL was 24.81 ± 2.47. HbA1c positively and significantly correlated with total cholesterol (r=0.223), LDL (r=0.243), HbA1c negatively and significantly correlated with HDL (r= - 0.126), and did not show any show correlation with VLDL (r=0.039) and total triglycerides (r=0.17). Conclusion: This study showed a significant correlation between levels of glycosylated hemoglobin (HbA1c) and lipid profile. This may help in predicting the lipid profile levels from the degree of glycemic control and therefore, identifying the patients with increased risk of diabetic complications. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes today is a global health issue, posing a risk to several organ systems. Besides complications like cataracts, diabetic retinopathy (DR), glaucoma and refractive errors, anatomical parameters like central corneal thickness (CCT), which is a crucial indicator of corneal endothelium function and keratometry parameters, have also been noticed to be altered in diabetes. Variations in these parameters may affect the accuracy of applanation tonometry in measuring intraocular pressure. This study aims to investigate variations in CCT and keratometry across different stages of DR, as prior research has yielded inconsistent results. The study also intends to explore the relationship between glycosylated hemoglobin (HbA1C) levels and changes in keratometry and CCT., Materials and Methods: This observational cross-sectional study was conducted from July 2022 to June 2024. A total of 204 subjects, aged 35-70 years, were included in the study. All participants were evaluated for DR, and those showing fundus findings were graded into five classes based on the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. CCT, keratometry parameters (K1 and K2) and HbA1C levels were measured for all participants. The clinical parameters were correlated across different grades of diabetes mellitus and compared using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 23.0, Armonk, NY) software., Results: The patient population consisted of 130 males (63.7%) and 74 females (36.3%). It was found that there was a trend indicating that the presence of DR increased with age, which was statistically significant (p=0.036). However, the differences in the mean duration of diabetes across DR groups were not statistically significant. Findings suggested that individuals with DR generally possess a higher CCT compared to the control group, particularly in the earlier stages of the disease, i.e. no DR and mild non-proliferative diabetic retinopathy (NPDR). However, as the severity of DR increases, the CCT tends to decrease slightly in moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR) stages. The study notes that the variations in CCT across these groups were not statistically significant (p-value of 0.29). The study also found that changes in corneal curvature, as indicated by keratometry values, were more pronounced in the proliferative stage of DR, with a statistically significant increase in k2 values of the left eye (p-value = 0.025). The study concluded that there was no statistically significant relationship between CCT and keratometry values of both eyes with HbA1c levels., Conclusion: While there were some clear patterns, especially concerning age, most variations in ocular parameters were not statistically significant, suggesting that other factors might need an in-depth study in the development of DR and its correlation with ocular parameters. Similarly, while HbA1c has often been stated to be a prognostic factor in diabetes mellitus, significant correlations were neither noted with ocular parameters like CCT and keratometry, nor the stage of retinopathy., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institute Ethics Committee, Ophthalmology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar issued approval KIIT/KIMS/IEC/955/2022. This observational cross-sectional study was carried out in the Ophthalmology Department at Pradyumna Bal Memorial Hospital, KIMS in Bhubaneswar from July 2022 to June 2024, following the approval. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yousuf et al.)

Aims and Objectives: To evaluate the effectiveness of a nurse‐led online educational programme based on patients with diabetes mellitus treated with initial basal insulin therapy. Background: Patients with type 2 diabetes mellitus (T2DM) need to be treated with insulin to control hyperglycaemia and reduce the risk of diabetic complications when oral hypoglycaemic drugs are not effective or contraindicated. Current practices emphasise the leading role of nurses in patients treated with initial basal insulin therapy after discharge. The introduction of nurse‐led online education within this area is a relatively new programme. Design: This study was a quasi‐experimental, nonequivalent, two‐group, comparison group design. Methods: The study selected 800 patients with T2DM hospitalised in the Department of Endocrinology at a Chinese hospital from July 2018 to June 2020 who were initially treated with insulin. According to the time sequence, 400 patients from July 2018 to June 2019 were divided into the control group and 400 patients from July 2019 to June 2020 into the intervention group. The control group received routine health education and doctor‐led follow‐up based on routine health education. The intervention group received systematic health education and online insulin injection activities led by nurses. The effects were evaluated after 3 and 6 months of intervention. The TREND checklist was followed to ensure rigour in the study. Results: In total, 339 patients were enrolled in the intervention group and 333 patients within the control group. According to the analysis, 3 months after the intervention, the compliance rate of fasting blood glucose (FBG) (rate difference: 0.078, 95% CI: 0.006–1.150, p <.05) and HbA1c (%) (rate difference: 0.070, 95% CI: 0.001–0.137, p <.05) between the intervention and control groups were statistically significant; 6 months after the intervention, the compliance rate of FBG (rate difference: 0.077, 95% CI: 0.007–0.14, p <.05) and HbA1c (%) (rate difference: 0.106, 95% CI: 0.324–0.180, p <.01) between the intervention and the control groups were statistically significant. The total score of the 'My Opinion on Insulin' scale in the intervention group was (80.18 ± 6.68), and in the control group was (71.15 ± 8.17), there was a significant difference in the scale between the two groups (mean difference: 9.03, 95% CI: 7.900–10.160, p <.01). Through a multivariable regression model, in order to correct the important baseline characteristics, the daily insulin dosage, and the total score of the 'My Opinion on Insulin' scale after 6 months of intervention were independent risk factors for the two intervention methods in diabetic patients treated with initial basal insulin therapy (p <.05). Conclusions: A nurse‐led online programme was feasible and effective for patients with diabetes mellitus treated with initial basal insulin therapy. This programme could effectively be used to reduce the patient's daily insulin dose, as well as improve the patients' compliance using insulin therapy. Relevance to clinical practice: Nurse‐led online education has a role in implementing a safe, standardised, and sustained approach to patients with diabetes mellitus treated with initial basal insulin therapy during follow‐up after discharge. [ABSTRACT FROM AUTHOR]

Aims: To determine whether a net decline in glycosylated haemoglobin (HbA1c) from early to late pregnancy is associated with lower risk of adverse perinatal outcomes at delivery among women with pregestational diabetes. Methods: A retrospective analysis from 2012 to 2016 at a tertiary care centre. The exposure was the net change in HbA1c from early (<20 weeks gestation) to late pregnancy (≥20 weeks gestation). Primary outcomes were large for gestational age (LGA) and neonatal hypoglycaemia. The association between outcomes per 6 mmol/mol (0.5%) absolute decrease in HbA1c was evaluated using modified Poisson regression, and adjusted for age, body mass index, White Class, early HbA1c and haemoglobin and gestational age at HbA1c measurement and delivery. Results: Among 347 women with pregestational diabetes, HbA1c was assessed in early (9 weeks [IQR 7,13]) and late pregnancy (31 weeks [IQR 29,34]). Mean HbA1c decreased from early (59 mmol/mol [7.5%]) to late (47 mmol/mol [6.5%]) pregnancy. Each 6 mmol/mol (0.5%) absolute decrease in HbA1c was associated with a 12% reduced risk of LGA infant (30%, aRR:0.88; 95% CI:0.81,0.95), and a 7% reduced risk of neonatal hypoglycaemia (35%, aRR:0.93; 95% CI:0.87,0.99). Preterm birth (36%, aRR:0.93; 95% CI:0.89,0.98) and neonatal intensive care unit admission (55%, aRR:0.95; 95% CI:0.91,0.98) decreased with a net decline in HbA1c, but not caesarean delivery, pre‐eclampsia, shoulder dystocia and respiratory distress syndrome. Conclusions: Women with pregestational diabetes with a reduction in HbA1c may have fewer infants born LGA or with neonatal hypoglycaemia. Repeated assessment of HbA1c may provide an additional measure of glycaemic control. [ABSTRACT FROM AUTHOR]

Aim: To validate the psychometric properties of a questionnaire to measure adherence to treatment among people with type 1 diabetes mellitus and to evaluate its relationship with metabolic control. Design: A cross‐sectional study of 167 adult people with type 1 diabetes mellitus recruited from the Endocrinology Service of University Hospital Doctor Peset (Spain). Methods: The validity of the content, construct and reliability of the instrument were evaluated and the results correlated with levels of glycosylated haemoglobin. Results: The questionnaire was composed of 25 items and 5 dimensions, with a score of 25–150 points and an internal consistency of 0.92, according to Cronbach's coefficient α. The content of validity ratio and the construct (exploratory functional analysis, Kaiser–Meyer–Olkin index and Barlett's spherical test) were adequate. We observed a significant correlation between glycosylated haemoglobin levels and treatment adherence. Conclusion: The questionnaire to measure adherence to treatment in type 1 diabetes mellitus is consistent, reliable and valid, showing an excellent association with degree of metabolic control. [ABSTRACT FROM AUTHOR]

Background: Glycosylated haemoglobin (HbA1c) is considered reliable for diagnosing and monitoring diabetes mellitus (DM). It also indicates cardiovascular complications related to DM. However, only a few studies have been conducted on this topic.Methods: We conducted a cross-sectional study to investigate the association between newly diagnosed hypertension and HbA1c among non-diabetic Sudanese adults. The sociodemographic characteristics of the participants in the sample were gathered using a questionnaire, and HbA1c was measured using an Ichroma machine.Results: Three hundred and eighty-four healthy participants were enrolled in this study. The median (interquartile range [IQR]) age was 56.0 (14.0) years, and 72.1% of the participants were female. The median (IQR) body mass index (BMI) was 31.2 (8.7) kg/m2. One hundred and fifteen (29.9%) participants presented newly diagnosed hypertension. The results of the multivariate analysis showed that age (adjusted odd ratio [AOR] = 1.03; 95% confidence interval [CI] = 1.01‒1.05); BMI (AOR = 1.09; 95% CI = 1.05‒1.14); HbA1c levels (AOR = 2.18; 95% CI = 1.29‒3.67) was positively associated with newly diagnosed hypertension. For an HbA1c level of 5.0% or more, the sensitivity and specificity of newly diagnosed hypertension were 91.3% and 28.2%, respectively (area under the curve = 0.61; 95% CI = 0.55-0.67; P ˂ 0.001). Participants who presented HbA1c levels of 5.0% or more were found to be at higher risk for newly diagnosed hypertension (AOR = 2.53; 95% CI = 1.14‒5.61).Conclusion: The results of this study indicated a high prevalence of newly diagnosed hypertension, and HbA1c levels were positively associated with newly diagnosed hypertension. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic Retinopathy (DR) is a major complication of Diabetes Mellitus (DM), which remains a leading cause of visual loss in working age populations. The most common cause of vision loss in patients with DR is Diabetic Macular Oedema (DME). Intravitreal administration of anti-Vascular Endothelial Growth Factor (anti-VEGF) agents is currently the mainstay of therapy for both early and advanced stages of DR. Aim: To compare long-term change in Central Macular Thickness (CMT) and Best Corrected Visual Acuity (BCVA) in patients with Non Proliferative Diabetic Retinopathy (NPDR) with Clinically Significant Macular Oedema (CSME) after receiving Intravitreal Ranibizumab (IVR) following monthly, Pro Re Nata (PRN) protocol and Treat and Extend (T&E) protocol. Materials and Methods: This is a hospital based longitudinal prospective cohort study conducted on patients attending the Out Patient Department (OPD) of the Opthalmology Department at Midnapore Medical College and Hospital, West Bengal, India. from October 2018 to February 2021. Institutional Ethical clearance was obtained prior to the initiation of the study. Among 93 patients, 31 were chosen each for IVR PRN Monthly (Group A), (Group B) and T&E protocol (Group C) over a period of nine months. CMT and BCVA were measured at baseline and followed-up monthly for 12 months after last injection using Spectral Domain Optical Coherence Tomography (SD-OCT), while Glycated Haemoglobin (HbA1c) level was maintained below 7.4. Statistical analyses were performed using Statistical Package of Social Sciences (SPSS) statistics version 20 software. Chi-square test was used to find out the association between categorical variables. Pre and post comparisons were done using Wilcoxon sign rank test. A p-value less than 0.05 were considered as statistically significant. Results: There was significant decrease in CMT and betterment of BCVA in all groups at the end of treatment compared to baseline. At six months and one year of last injection there was no significant change in CMT in group A and C while group B at one year (p=0.0487) showed significant increase. There was no significant worsening of BCVA in group A and group C while group B (p=0.01) showed significant worsening at one year longterm follow-up. Conclusion: Thus, the present study concludes that, even though monthly protocol T&E protocol are equally good compared to PRN protocol on the basis of long-term beneficial effect, T&E protocol needed comparatively fewer doses of IVR compared to monthly protocol making it the choice of protocol for long-term control in NPDR with DME patients. [ABSTRACT FROM AUTHOR]

Adiponectin plays an important role in glucose metabolism and released in response to insulin. It helps to decrease glucose levels and insulin resistance; however, this relation is not been studied in pregnant ladies. Objective was to determine serum adiponectin level and glycaemic status in pregnant women belonging to Peshawar, Khyber Pakhtunkhwa (KPK) and to find any possible relationship between them. Methods: Hundred pregnant women with gestational diabetes mellitus (GDM) and 100 healthy pregnant women without GDM were randomly selected in a cross-sectional study. After an overnight fast, their blood samples were taken for determination of serum adiponectin, glycosylated haemoglobin (HbA1c) and fasting blood glucose (FBG). The relationship of adiponectin with glycaemic status was determined with Pearson Correlations coefficient (r). Results: Pregnant women with GDM when compared to healthy pregnant women showed significantly low levels of serum adiponectin (µg/mL) (2.2±0.2 vs. 11.25±4.8, p<0.05) and significantly high level of FBG (mg/dl) (182.7±64.2 vs. 93.6±5.9, p<0.05) and HbA1c (%) (7.4±0.1 vs. 5.4±0.1, p<0.05). Serum adiponectin level showed a statistically significant negative correlation with FBG (r = -0.203, p=0.042) and HbA1c (r = -0.744, p=0.000) in pregnant women with GDM. Conclusion: Serum adiponectin concentration is markedly decreased in pregnant women with GDM which concludes that Hypoadiponectinemia is related with deranged (elevated) glycaemic status in pregnancy. Moreover, adiponectin is associated negatively with FBG and HbA1c in the studied population. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic Retinopathy (DR) is a major complication of Diabetes Mellitus (DM), which remains a leading cause of visual loss in working age populations. The most common cause of vision loss in patients with DR is Diabetic Macular Oedema (DME). Intravitreal administration of anti-Vascular Endothelial Growth Factor (anti-VEGF) agents is currently the mainstay of therapy for both early and advanced stages of DR. Aim: To compare long-term change in Central Macular Thickness (CMT) and Best Corrected Visual Acuity (BCVA) in patients with Non Proliferative Diabetic Retinopathy (NPDR) with Clinically Significant Macular Oedema (CSME) after receiving Intravitreal Ranibizumab (IVR) following monthly, Pro Re Nata (PRN) protocol and Treat and Extend (T&E) protocol. Materials and Methods: This is a hospital based longitudinal prospective cohort study conducted on patients attending the Out Patient Department (OPD) of the Opthalmology Department at Midnapore Medical College and Hospital, West Bengal, India. from October 2018 to February 2021. Institutional Ethical clearance was obtained prior to the initiation of the study. Among 93 patients, 31 were chosen each for IVR PRN Monthly (Group A), (Group B) and T&E protocol (Group C) over a period of nine months. CMT and BCVA were measured at baseline and followed-up monthly for 12 months after last injection using Spectral Domain Optical Coherence Tomography (SD-OCT), while Glycated Haemoglobin (HbA1c) level was maintained below 7.4. Statistical analyses were performed using Statistical Package of Social Sciences (SPSS) statistics version 20 software. Chi-square test was used to find out the association between categorical variables. Pre and post comparisons were done using Wilcoxon sign rank test. A p-value less than 0.05 were considered as statistically significant. Results: There was significant decrease in CMT and betterment of BCVA in all groups at the end of treatment compared to baseline. At six months and one year of last injection there was no significant change in CMT in group A and C while group B at one year (p=0.0487) showed significant increase. There was no significant worsening of BCVA in group A and group C while group B (p=0.01) showed significant worsening at one year long-term follow-up. Conclusion: Thus, the present study concludes that, even though monthly protocol T&E protocol are equally good compared to PRN protocol on the basis of long-term beneficial effect, T&E protocol needed comparatively fewer doses of IVR compared to monthly protocol making it the choice of protocol for long-term control in NPDR with DME patients.

Background: Diabetes Mellitus (DM) is a disease with multi-system complications. Left ventricular diastolic dysfunction (LVDD) is an early stage of diabetic cardiomyopathy that can develop to heart failure. It has no clinical symptoms and can be easily diagnosed with echocardiography. Objectives:The study aims to evaluate the LVDD in Type-2 DM with no symptoms of cardiovascular disease and its association with glycaemic control(HbA1c), DM duration, and microangiopathy. Methods: The cross-sectional hospital-based study included 100 asymptomatic patients with type2 DM without evidence of cardiovascular involvement were studied. LVDD was evaluated by doppler echocardiography, which included E/A ratio, assessed in relation with age, sex, duration of diabetes and HbA1c level. Results:LVDD was present in 57 %of the type 2 DM patientswith males accounting for the majority of cases (63.2%). Diastolic dysfunction was more common in patients on oral hypoglycaemic agents (78%), insulin (2%) and/or both (19%).There was a linear progression of diastolic dysfunction with the increase age group (P = 0.001).LVDD was significantly associated with uncontrolled diabetes as measured by HbA1c levels with higher number patients among HbA1c >8.5 (71.9%; P = 0.001) and a longer duration of DM with highest among 6 -10 years (38.6%; P = 0.001) Conclusion:Overall, the prevalence of diastolic dysfunction was 57% in asymptomatic type 2 DM subjects. Our study indicates that myocardial damage in patients with diabetes affect diastole function before systolic function in asymptomatic diabetes patients.Doppler Echocardiography identifies large percentage of diabetes subjects before abnormalities are detected with clinical examination and ECG. [ABSTRACT FROM AUTHOR]

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Abstract Background Diabetes is common in patients with rheumatoid arthritis (RA). Interleukin (IL)-6 is implicated in both the pathogenesis of RA and in glucose homeostasis; this post hoc analysis investigated the effects of IL-6 receptor vs. tumour necrosis factor inhibition on glycosylated haemoglobin (HbA1c) in patients with RA with or without diabetes. Methods Data were from two placebo-controlled phase III studies of subcutaneous sarilumab 150/200 mg q2w + methotrexate or conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and a phase III monotherapy study of sarilumab 200 mg q2w vs. adalimumab 40 mg q2w. Patients with diabetes were identified by medical history or use of antidiabetic medication (patients with HbA1c ≥ 9% were excluded from all three studies). HbA1c was measured at baseline and weeks 12/24. Safety and efficacy were assessed in RA patients with or without diabetes. Results Patients with diabetes (n = 184) were older, weighed more and exhibited higher RA disease activity than patients without diabetes (n = 1928). Regardless of diabetes status, in patients on background csDMARDs, least squares (LS) mean difference (95% CI) in change from baseline in HbA1c for sarilumab 150 mg/200 mg vs. placebo at week 24 was − 0.28 (− 0.40, − 0.16; nominal p

ABSTRACT Objective: The objective of this study is to study association between testosterone and diabetes in Kashmiri males. Subjects and methods: A total of 300 males with Type 2 diabetes visited an outpatient and inpatient clinic at Shri Maharaja Hari Singh (SMHS) hospital, Srinagar, J&K India. The blood sugar and HbA1c, which are the markers of diabetes, and sérum testosterone levels were measured. The blood samples from both the cases and controls were collected. Results: Out of 300 subjects, 42% had a testosterone deficiency. A relationship between type 2 diabetic males and healthy males was observed, and testosterone levels were determined to be significantly lower among diabetic males (p < 0.001) when compared to healthy males. Then, we compared diabetic markers among testosterone deficient and normal testosterone level groups; the mean fasting plasma glucose (p = 0.0019) and glycated haemoglobin (HbA1c; p = 0.0449) levels were significantly higher in the testosterone deficient group than in the control group. To elucidate the relationship between the serum total testosterone level and fasting plasma glucose and HbA1c values, Pearson's correlation test was performed. Fasting plasma glucose levels (r = −0.252, p = 0.001) and HbA1c values (r = −0.697, p = 0.001) showed a significant negative correlation with serum testosterone levels among diabetic males. Conclusions: This study shows that diabetes causes low testosterone levels among males, and lower testosterone levels can act as a marker for diabetes. Thus, with timely intervention, mortality and co-morbidity associated with diabetes can be prevented.

Introduction: Patients with type 2 diabetes mellitus have increased incidence of obesity and are prone to dyslipidaemia which in turn is the key ingredient of Cardiovascular Disease (CVD). The lifestyle, environment and eating habits significantly vary in urban industrialised areas compared to rural countryside in the same ethnic group. Aim: To compare the pattern of dyslipidaemia among urban and rural type 2 diabetes mellitus population attending a diabetes follow-up clinic in a tertiary care hospital in eastern Odisha. Materials and Methods: The cross-sectional study included patients who attended the diabetes follow-up clinic from July 2017 to December 2017 and included adults (≥18 years) suffering from type 2 diabetes. Type 2 diabetics, 300 each from the urban and rural countryside were included in the study. Sociodemographic characteristics, medical history and laboratory investigations like fasting and Postprandial Blood Sugar (PPBS), lipid parameters and HbA1c were recorded. Anthropometric measurements like height, weight, waist circumference and blood pressure were measured. The laboratory values were calculated as mean±standard deviation and correlation analysis with the Pearson coefficient. Z-test was used to compare data at 95% confidence level. Results: Hypertension was detected in 71% of patients in the urban study sample compared to 34.3% in rural. Obesity was prevalent in 34% of patients in the urban study sample compared to 12.3% in rural. Dyslipidaemia was observed in 86.0% of patients in the urban study sample compared to 66.67% in rural. Finally, physical inactivity was identified in 67.7% of patients in the urban study sample compared to 36.67% in rural. Conclusion: Blood sugar, both fasting and postprandial was significantly higher in the urban study population as compared to rural. The same variation in HbA1c level was also observed. Incidence of obesity along with dyslipidaemia was more pronounced in urban as compared to the rural population. Obesity and lipid profile showed a positive correlation with HbA1c in both but were significantly stronger in the urban study group as compared to the rural. All the CVD risk factors like hypertension, obesity, dyslipidaemia and physical inactivity were statistically higher in the urban study population as compared to rural.

Introduction: Despite many challenges, the benefit of bariatric surgery in super-obese population remains irrefutable with significant improvement in metabolic syndrome and quality of life. There are currently no published data from Malaysia on this topic. Objective and Methodology: A single-centre retrospective study aimed at analysing the outcome of laparoscopic bariatric surgery on super-obese Malaysians with type 2 diabetes mellitus (T2DM) at 12 months following surgery. Demographic details, glycaemic control and weight-loss parameters were analysed.P < 0.01 was considered statistically significant. Results: Of the 33 patients, 55% were women and 45% were men with a mean age of 40 ± 11 years and body mass index (BMI) of 59.3 ± 9.0 kg/m2. Majority of patients were of Malay ethnicity (82%). Malaysian-Indians and Malaysian-Chinese each accounted for 9% of total case volume. The three types of laparoscopic bariatric surgery recorded in this study were sleeve gastrectomy (82%), Roux-en-Y gastric bypass (9%) and mini-gastric bypass (9%) with operative time of 103.5 ± 31.1, 135.8 ± 32.6 and 116.2 ± 32.3 min, respectively. Percentage total body weight loss was 33.11% ± 9.44% at 12 months following surgery (P < 0.01). BMI change and percentage excess BMI loss showed similar improvement. Glycosylated haemoglobin and fasting blood sugar decreased from pre-operative values of 7.0% ± 1.0% and 7.0 ± 0.9 mmol/L to 5.6% ± 0.4% and 5.0 ± 0.6 mmol/L at 12 months (P < 0.01). Remission of T2DM was noted in 93% of patients. There was no correlation between weight loss and improvement in glycaemic status. Conclusion: There are significant weight loss and improvement of glycaemic control at 12 months post-laparoscopic bariatric surgery among super-obese Malaysians.

Introduction Diabetes mellitus is one of the most common metabolic disorders. Hypomagnesemia is a common feature in patients with type 2 diabetes mellitus (T2DM). This study aims to assess the serum magnesium level and its association with chronic complications in patients with T2DM. Methods A total of 173 T2DM patients at Tribhuvan University Teaching Hospital were evaluated from July 2016 to August 2017. Patients were investigated for fasting serum magnesium level, fasting plasma glucose (FPG), postprandial plasma glucose (PPG), Glycosylated haemoglobin (HbA1c) and also target organ evaluation for diabetes. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 20. Results Hypomagnesemia was found in 86 patients out of the 173 enrolled patients. Observations revealed significant association between hypomagnesemia and various microvascular complications viz. retinopathy (p=0.001), neuropathy (p<0.001) and nephropathy (p<0.001). There was also a significant association between hypomagnesemia and FPG (p=0.008) and HbA1c (p=0.009). The overall prevalence of hypomagnesemia among T2DM patients was 49.7% and the prevalence of hypomagnesemia was significantly higher (74%) among diabetic patients with microvascular complications (p=0.001) compared to diabetics with no microvascular complications. Conclusion There was a high prevalence of hypomagnesemia among T2DM patients. A significant association was seen between hypomagnesemia and various microvascular complications like retinopathy, neuropathy and nephropathy. Routine surveillance and timely treatment of hypomagnesemia is advisable for patients with T2DM. [ABSTRACT FROM AUTHOR]

Type 1 diabetes is a lifelong condition which affects all age ranges, for reasons unknown, and the UK has one of the highest incidences of this complex condition in the world. Type 1 diabetes is caused by autoimmune damage to the insulin-producing β-cells found in the pancreatic islet cells, leading to severe insulin deficiency. People with diabetes need to achieve a target glyosylated haemoglobin level to avoid macro- and microvascular complications, but there is the associated risk of hypoglycaemic events. These can vary in severity and consequences but will likely always cause worry for the person living with diabetes. There are many risk factors and reasons to be explored when looking at hypoglycaemia. This case study explores the nursing interventions that can be safely worked through and prioritised, within the community setting, to allow people with diabetes to be safe from severe hypoglycaemia, thus improving their quality of life and safety, as well as reducing costs for the NHS. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES We analysed the Veteran Affairs data to evaluate the association of pre-operative glycated haemoglobin (HbA1c) and long-term outcome after isolated coronary artery bypass grafting (CABG). METHODS Veterans with diabetes mellitus and isolated CABG (2006–2018) were divided into 4 groups (I: HbA1c <6.5%, II: HbA1c 6.5–8, III 8–10% and IV: HbA1c >10%). The relationship of pre-operative HbA1c and long-term survival was evaluated with a multivariable Cox proportional hazards model and reported as hazard ratios (HR). The cumulative incidence of secondary end-points [myocardial infarction (MI) and repeat revascularization (percutaneous intervention)] for each group was modelled as competing events with cause-specific Cox proportional hazards models. RESULTS Overall, 16 190 patients (mean age 64.9 years, male 98%; insulin dependent 53%) with diabetes mellitus underwent isolated CABG. We observed 19.4%, 45.4%, 27% and 8.2% patients in groups I, II, III and IV, respectively. Patients with HbA1c >10% were the youngest (mean age 60.9 years) and had high rates of Insulin dependence (78%). In patients with HbA1c >10%, improvement in levels was observed in 76%. The median follow-up observed was 5.8 (3.2–8.8) years. Compared to the study mean HbA1c (7.3%), mortality rate increased with HbA1c levels >8%, and especially with pre-operative HbA1c levels >9%. Compared to patients with HbA1c <8%, HbA1c 8–10% and >10% were associated with increased MI (HR 1.24 and HR 1.39, respectively) and need for reintervention (HR 1.20 and HR 1.24, respectively). CONCLUSIONS In patients undergoing CABG, pre-operative HbA1c >8% is associated with the increased risk of mortality and adverse cardiac events. [ABSTRACT FROM AUTHOR]

Introduction. The aim of this study was to investigate the effectiveness of low level laser therapy (extravascular laser blood irradiation) on glycaemic levels in type 2 diabetes mellitus patients. Methods. Sixty patients with type 2 diabetes mellitus lasting more than 1 year, aged 45–60 years, receiving 2 types of medication (metformin and sulphonylurea) were randomly divided into 2 equal groups. The laser group received laser therapy (low level laser therapy, 3 sessions/week for 12 weeks) combined with their prescribed hypoglycaemic medications, while the comparative group received the prescribed hypoglycaemic medications only. Glycated haemoglobin (HbA1c), fasting plasma glucose, 75-g oral glucose tolerance, and fasting C-peptide were evaluated before and after the therapy in both groups, while the glycaemic level was checked before and after each laser session to determine the acute effect of laser. Results. All variables were tested with mixed MANOVA, with a statistical significance level at p < 0.05. There was a significant post-treatment decrease in HbA1c, fasting plasma glucose, and oral glucose tolerance in the laser group compared with the control group (p < 0.05), but no significant difference for post-treatment fasting C-peptide between the groups (p > 0.05). Regarding the acute effect of laser, a significant decrease was observed in the blood glucose level after the laser sessions (p = 0.0001), with a mean difference of 22.73 mg/dl. Conclusions. The study showed a considerable positive effect of extravascular low level laser therapy on the glycaemic levels in type 2 diabetes mellitus patients. [ABSTRACT FROM AUTHOR]

Purpose: To compare the HbA1c levels in nondiabetic subjects with periodontitis and periodontally healthy controls and to evaluate the effect of nonsurgical periodontal therapy on the glycaemic control in nondiabetic subjects with periodontitis. Materials and Methods: A total of 220 nondiabetic subjects between 35 and 60 years old were selected and divided into two groups: group A (case group), comprised of subjects with chronic periodontitis, and group B (control group), comprised of subjects with healthy periodontium. Periodontal clinical parameters (plaque index, modified sulcular bleeding index, probing depth and clinical attachment level) were used to assign the subjects into the respective groups. The HbA1c level was estimated for both groups using a commercially available kit. Subjects in group A underwent nonsurgical periodontal therapy in two to four sessions along with oral hygiene instructions. The periodontal parameters and HbA1c levels were again evaluated in the test group three months following periodontal therapy. Results: The HbA1c levels were higher in the case group (A) than the control group (B). Three months following periodontal therapy in group A, there was improvement in periodontal parameters. The HbA1c levels decreased signifi-cantly from baseline to 3 months. Conclusion: The results of this study found chronic periodontitis to be associated with a significant increase in glycosylated haemoglobin levels in nondiabetic periodontitis subjects. Furthermore, with improvement of periodontal status, the glycaemic levels return to near normal values. [ABSTRACT FROM AUTHOR]

Introduction: Autoimmune diseases concomitant with diabetes may complicate the treatment and adversely affect the prognosis. The most common is Hashimoto's disease (HD). We compared diabetes control and prevalence of chronic complications in type 1 diabetes patients differing in the coexistence of HD.Material and Methods: Medical records of 188 type 1 diabetics were analysed. Hashimoto's disease was diagnosed based on medical history, as well as determination of the levels of thyroid peroxidase antibodies, hormones and ultrasound examination. Statistical analysis was performed using Statistica 10PL.Results: HD was diagnosed in 43 (23%) patients. The mean HbA1c was 8.8 ±1.5% in the group with HD, and 9 ±1.6% in the group without HD (ns). The prevalence of diabetes complications was similar in both groups: ischaemic heart disease was diagnosed in 19% of patients with HD and 19% without HD, cerebral vascular insufficiency - 8% and 7%, peripheral neuropathy - 14% and 12%, sensory polyneuropathy - 47% and 46%, diabetic foot - 7% and 8%, Charcot osteoarthropathy - 7% and 2%, cardiovascular neuropathy - 21% and 28%, neuropathy of the gastrointestinal tract - 5% and 6%, nephropathy - 12% and 19%, retinopathy - 42% and 43%, and cataract in 28% and 19%, respectively. Impaired hypoglycaemia perception was rarer in the group with HD: 9% vs. 25% (p ≈ 0.04).Conclusions: Hashimoto's disease does not significantly affect the level of type 1 diabetes control or the development of its complications. Only autonomic neuropathy in the form of impaired awareness of hypoglycaemia is rarer in patients with that thyroiditis. [ABSTRACT FROM AUTHOR]

BackgroundThere is limited evidence that among HIV-infected patients haemoglobin A1c (HbA1c) values may not accurately reflect glycaemia. We assessed HbA1c discordance (observed HbA1c - expected HbA1c) and associated factors among HIV-infected participants in the Multicenter AIDS Cohort Study (MACS).MethodsFasting glucose (FG) and HbA1c were measured at each semi-annual MACS visit since 1999. All HIV-infected and HIV-uninfected men for whom at least one FG and HbA1c pair measurement was available were evaluated. Univariate median regression determined the association between HbA1c and FG by HIV serostatus. The relationship between HbA1c and FG in HIV-uninfected men was used to determine the expected HbA1c. Generalized estimating equations determined factors associated with the Hb1Ac discordance among HIV-infected men. Clinically significant discordance was defined as observed HbA1c - expected HbA1c ≤-0.5%.ResultsOver 13 years, 1500 HIV-uninfected and 1357 HIV-infected men were included, with a median of 11 visits for each participant. At an FG of 125 mg/dL, the median HbA1c among HIV-infected men was 0.21% lower than among HIV-uninfected men and the magnitude of this effect increased with FG >126 mg/dL. Sixty-three percent of HIV-infected men had at least one visit with clinically significant HbA1c discordance, which was independently associated with: low CD4 cell count (

Abstract Background Glycosylated hemoglobin (HbA1c) has a detrimental impact on the myocardium with left ventricular (LV) diastolic dysfunction. Obesity is a risk factor of type 2 diabetes. To understand the relationships between HbA1c, body mass index (BMI) and LV diastolic dysfunction, we performed this interaction analysis in patients with type 2 diabetes. Methods Total 925 type 2 diabetes patients were selected from the patients who were diagnosed and treated at the First Affiliated Hospital of Shenzhen University. Patients’ BMI levels were defined as normal (BMI

Introduction: Bus drivers are more vulnerable to health complications due to the nature of their occupation. There is less information available on the role of occupational stress and metabolic syndrome as the risk factors for Cardiovascular Diseases (CVD) among them. Metabolic syndrome is described by clustering of hypertension, hyperglycaemia, obesity, and dyslipidemia. Aim: To investigate the relationship between occupational stress and metabolic syndrome and assess its role among bus drivers as a predictive risk factor for CVD. Materials and Methods: A cross-sectional study was conducted from June 2014 to March 2015, at the Department of Biochemistry, BLDE (DU) Shri BM Patil medical college, Vijayapura, Karnataka, with randomly selected bus drivers (n=90) and age, sex-matched healthy participants (n=110) serving as controls. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) was used to describe metabolic syndrome. Data on sociodemographic features, anthropometric indexes, blood pressure, and biochemical parameters, including serum cortisol, were obtained. The questionnaire related to working patterns and Perceived Stress Scale (PSS) was used to assess the psychosocial hazards, and the Framingham Risk Score (FRS) model was used to predict the subsequent 10-year possible risk of developing CVD in bus drivers. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 16.0. Results: The mean age of bus drivers was 44.60±6.74 years. According to the PSS, with 28 as the cut-off value, 36 (40%) bus drivers were under stress. As per FRS, 51 (56.7%) of bus drivers were at low CVD risk, 27 (30%) were at intermediate risk, and 12(13.3%) were at higher CVD risk. Statistically significant values for parameters such as Fasting Blood Sugar (FBS), glycosylated haemoglobin (HbA1c), serum triglyceride, serum cortisol, and PSS were seen among bus drivers with metabolic syndrome (p

Introduction: Bus drivers are more vulnerable to health complications due to the nature of their occupation. There is less information available on the role of occupational stress and metabolic syndrome as the risk factors for Cardiovascular Diseases (CVD) among them. Metabolic syndrome is described by clustering of hypertension, hyperglycaemia, obesity, and dyslipidemia. Aim: To investigate the relationship between occupational stress and metabolic syndrome and assess its role among bus drivers as a predictive risk factor for CVD. Materials and Methods: A cross-sectional study was conducted from June 2014 to March 2015, at the Department of Biochemistry, BLDE (DU) Shri BM Patil medical college, Vijayapura, Karnataka, with randomly selected bus drivers (n=90) and age, sex-matched healthy participants (n=110) serving as controls. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) was used to describe metabolic syndrome. Data on sociodemographic features, anthropometric indexes, blood pressure, and biochemical parameters, including serum cortisol, were obtained. The questionnaire related to working patterns and Perceived Stress Scale (PSS) was used to assess the psychosocial hazards, and the Framingham Risk Score (FRS) model was used to predict the subsequent 10-year possible risk of developing CVD in bus drivers. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 16.0. Results: The mean age of bus drivers was 44.60±6.74 years. According to the PSS, with 28 as the cut-off value, 36 (40%) bus drivers were under stress. As per FRS, 51 (56.7%) of bus drivers were at low CVD risk, 27 (30%) were at intermediate risk, and 12(13.3%) were at higher CVD risk. Statistically significant values for parameters such as Fasting Blood Sugar (FBS), glycosylated haemoglobin (HbA1c), serum triglyceride, serum cortisol, and PSS were seen among bus drivers with metabolic syndrome (p<0.001). A positive correlation between Waist Circumference (WC) and Triglycerides (TG) (r=0.215, p<0.001), WC and diastolic blood pressure (r=0.329, p<0.001), WC and HbA1c (r=0.409, p<0.001) was observed. Conclusion: The stress at work in the bus driver's occupation is a crucial factor associated with metabolic syndrome, a significant risk factor for CVD. The awareness program in health camps and regular physical activity will prompt lifestyle modification that reduces diseases and moderate future cardiovascular events. [ABSTRACT FROM AUTHOR]