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Aim: To evaluate the association between changes in haemoglobin A1c (HbA1c) and the concurrent incidence of cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM) patients. Method: We conducted a retrospective cohort study among T2DM patients with HbA1c measurement after T2DM diagnosis between August 2009 and September 2010. The patients were classified into six subgroups based on baseline HbA1c (<7%; 7%–7.9%; ≥8%) and age (<65; ≥65 years), and then clustered into classes by HbA1c trajectory and CVD incidence over the 12‐year follow‐up period using joint latent class mixture models. We explored the HbA1c trajectories and CVD incidences in each latent class. Multinomial logistic regression was used to compare the baseline characteristics among different latent classes. Results: A total of 128 843 T2DM patients were included with a median follow‐up period of 11.7 years. Ten latent classes were identified in patients with baseline HbA1c ≥ 8% and age <65 years, while seven classes were identified in the other five groups. Among all the identified latent classes, patients with fluctuating HbA1c trajectories, characterized by alternating periods of increase and decrease, had higher CVD incidences. Male patients, and patients with higher baseline HbA1c and use of antidiabetic drugs were more likely to have a fluctuating HbA1c trajectory. More specifically, patients aged < 65 years with younger age or a smoking habit, and patients aged ≥ 65 years with a longer duration of T2DM were more likely to have a fluctuating HbA1c trajectory. Conclusion: We found that T2DM patients with fluctuating HbA1c trajectories could have a higher CVD risk. Different trajectory‐associated characteristics in age subgroups highlight the need for individualized management of T2DM patients. [ABSTRACT FROM AUTHOR]

Pre-diabetes (pre-DM) is a strong predictor of diabetes (DM) over time. This study investigated how much of the recent increase in pre-DM identified among Alaska Native (AN) peoples living in urban southcentral Alaska may be due to changes in diagnostic methods. We used clinical and demographic data collected at baseline between 2004 and 2006 and at follow-up collected between 2015 and 2017 from the urban southcentral Alaska Education and Research Towards Health (EARTH) cohort. We used descriptive statistics and logistic regression to explore differences in demographic and clinical variables among the identified pre-DM groups. Of 388 participants in the follow-up study, 243 had A1c levels indicating pre-DM with only 20 demonstrating pre-DM also by fasting blood glucose (FBG). Current smoking was the sole predictor for pre-DM by A1c alone while abdominal obesity and elevated FBG-predicted pre-DM by A1c+FBG. No participants had an elevated FBG without an A1c elevation. A substantial portion of the rise in pre-DM found among urban southcentral AN peoples in the EARTH follow-up study was due to the addition of A1c testing. Pre-DM by A1c alone should be used to motivate behavioural changes that address modifiable risk factors, including smoking cessation, physical activity and weight management. [ABSTRACT FROM AUTHOR]

Aim: To examine cross‐sectional associations between continuous glucose monitoring (CGM)‐derived metrics and cerebral small vessel disease (SVD) in older adults with type 2 diabetes. Materials and Methods: In total, 80 patients with type 2 diabetes aged ≥70 years were analysed. Participants underwent CGM for 14 days. From the CGM data, we derived mean sensor glucose, percentage glucose coefficient of variation, mean amplitude of glucose excursion, time in range (TIR, 70‐180 mg/dl), time above range (TAR) and time below range metrics, glycaemia risk index and high/low blood glucose index. The presence of cerebral SVD, including lacunes, microbleeds, enlarged perivascular spaces and white matter hyperintensities, was assessed, and the total number of these findings comprised the total cerebral SVD score (0‐4). Ordinal logistic regression analyses were performed to examine the association of CGM‐derived metrics with the total SVD score. Results: The median SVD score was 1 (interquartile range 0‐2). Higher hyperglycaemic metrics, including mean sensor glucose, TAR >180 mg/dl, TAR >250 mg/dl, and high blood glucose index and glycaemia risk index, were associated with a higher total SVD score. In contrast, a higher TIR (per 10% increase) was associated with a lower total SVD score (odds ratio 0.73, 95% confidence interval 0.56‐0.95). Glycated haemoglobin, percentage glucose coefficient of variation, mean amplitude of glucose excursions, time below range and low blood glucose index were not associated with total cerebral SVD scores. Conclusions: The hyperglycaemia metrics and TIR, derived from CGM, were associated with cerebral SVD in older adults with type 2 diabetes. [ABSTRACT FROM AUTHOR]

ABSTRACTPre-diabetes (pre-DM) is a strong predictor of diabetes (DM) over time. This study investigated how much of the recent increase in pre-DM identified among Alaska Native (AN) peoples living in urban southcentral Alaska may be due to changes in diagnostic methods. We used clinical and demographic data collected at baseline between 2004 and 2006 and at follow-up collected between 2015 and 2017 from the urban southcentral Alaska Education and Research Towards Health (EARTH) cohort. We used descriptive statistics and logistic regression to explore differences in demographic and clinical variables among the identified pre-DM groups. Of 388 participants in the follow-up study, 243 had A1c levels indicating pre-DM with only 20 demonstrating pre-DM also by fasting blood glucose (FBG). Current smoking was the sole predictor for pre-DM by A1c alone while abdominal obesity and elevated FBG-predicted pre-DM by A1c+FBG. No participants had an elevated FBG without an A1c elevation. A substantial portion of the rise in pre-DM found among urban southcentral AN peoples in the EARTH follow-up study was due to the addition of A1c testing. Pre-DM by A1c alone should be used to motivate behavioural changes that address modifiable risk factors, including smoking cessation, physical activity and weight management.

Summary: Objective: Rising prevalence of obesity has led to increased rates of prediabetes and diabetes mellitus (DM) in children. This study compares rates of prediabetes and diabetes using two recommended screening tests (fasting plasma glucose [FPG] and haemoglobin A1c [HbA1c]). Study Design: Data were collected prospectively from 37 multi‐component paediatric weight management programs in POWER (Paediatric Obesity Weight Evaluation Registry). Results: For this study, 3962 children with obesity without a known diagnosis of DM at presentation and for whom concurrent measurement of FPG and HbA1c were available were evaluated (median age 12.0 years [interquartile range, IQR 9.8, 14.6]; 48% males; median body mass index 95th percentile [%BMIp95] 134% [IQR 120, 151]). Notably, 10.7% had prediabetes based on FPG criteria (100–125 mg/dL), 18.6% had prediabetes based on HbA1c criteria (5.7%–6.4%), 0.9% had DM by FPG abnormality (≥126 mg/dL) and 1.1% had DM by HbA1c abnormality (≥6.5%). Discordance between the tests was observed for youth in both age groups (10–18 years [n = 2915] and age 2–9 years [n = 1047]). Conclusion: There is discordance between FPG and HbA1c for the diagnosis of prediabetes and DM in youth with obesity. Further studies are needed to understand the predictive capability of these tests for development of DM (in those diagnosed with prediabetes) and cardiometabolic risk. [ABSTRACT FROM AUTHOR]

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

To evaluate the efficacy of Dapagliflozin as add-on therapy on glycaemic and obesity parameters in type 2 diabetes patients (T2DM) with inadequate glycaemic control and the reflection of this effect on the patient’s quality of life (QoL). Methods: Patients with uncontrolled T2DM [Haemoglobin A1c 7.0%-12.0%] on sulfonylurea, metformin, and gliptin were selected to receive Dapagliflozin 5mg/day for 16 weeks (n=40). Fasting and postprandial plasma glucose, glycated hemoglobin A1c, body weight, and waist circumference were measured. Assessment of patients’ QoL was performed using the Quality of Life Scale for Iraqi Diabetic patients (QOLSID) at baseline and after administration of Dapagliflozin. Dapagliflozin showed a significant reduction in fasting and postprandial plasma glucose, glycated hemoglobin A1c (HbA1c), body mass index (BMI), and index of central obesity (ICO) (p<0.001). A significant change in the QOLSID score was also detected after treatment (p<0.001). High BMI was a negative predictor for patients’ QoL. Dapagliflozin achieved beneficial effects on Iraqi T2DM patients who were already inadequately controlled by three oral antidiabetic agents. This promising result may help physicians in prescribing Dapagliflozin as an alternative to insulin for patients who refuse injectable anti-diabetic agents. [ABSTRACT FROM AUTHOR]

Introduction: Women are on average diagnosed with diabetes mellitus at later age than men but have higher mortality. As the diagnosis of diabetes mellitus is primarily based on HbA1c, the use of a non-specific reference range and cut point for diabetes mellitus that does not account for gender differences in diabetes could potentially lead to underdiagnosis of diabetes mellitus in women and missed opportunities for intervention. We investigated whether a contributing factor to the later diagnosis in women may be a difference in distribution of HbA1c in premenopausal women versus men of the same age by comparing HbA1c values in men and women across multiple sites in the UK. Methods: We analysed the HbA1c levels of 146,907 individuals who underwent single testing only and had HbA1c ≤ 50 mmol/mol between 2012 and 2019 in one laboratory (cohort 1). This was replicated in six laboratories with 938,678 individuals tested between 2019 and 2021 (cohort 2). Results: In cohort 1, women < 50 years old had an HbA1c distribution markedly lower than that in men by a mean of 1.6 mmol/mol (p < 0.0001), while the difference in the distribution of HbA1c for individuals aged ≥ 50 years was less pronounced (mean difference 0.9 mmol/mol, p < 0.0001). For individuals under the age of 50, HbA1c in women lagged by up to 10 years compared to men. Similar findings were found in cohort 2. We estimated an additional 17% (n = 34,953) of undiagnosed women aged < 50 years in England and Wales could be reclassified to have diabetes mellitus, which may contribute to up to 64% of the difference in mortality rates between men/women with diabetes mellitus aged 16–50 years. Conclusion: The HbA1c cut point for diagnosis of diabetes mellitus may need to be re-evaluated in women under the age of 50 years. Early identification of diabetes mellitus in women has the potential to improve women's health outcomes in the longer term. [ABSTRACT FROM AUTHOR]

Aims: To develop and psychometrically test Character Strengths Use in Diabetes Self‐management Scale in people with type 2 diabetes. Design: Cross‐sectional design. Methods: Based on literature reviews and examination by experts, a 20‐item scale was developed and administered to 350 participants with type 2 diabetes who were enrolled from two endocrine clinics by convenience sampling in Taiwan. Item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), concurrent and predictive validity as well as reliability were used to examine the psychometric characteristics of the scale. Data were collected from November 2021 to March 2022. Results: EFA and CFA supported a 12‐item scale with three factors, namely learning proactively, taking on challenges and thinking positively, fit the data well. The total score of the 12‐item scale significantly and positively correlated with diabetes‐specific quality of life, and significantly and negatively correlated with baseline and 9‐month haemoglobin A1c levels. Cronbach's α for overall scale and subscales ranged between.78 and.91. Conclusion: The 12‐item Character Strengths Use in Diabetes Self‐management Scale demonstrated satisfactory validity and reliability in people with type 2 diabetes. Impact: Nurses could apply this new scale to identify the degree of using character strengths in self‐management in people with type 2 diabetes; accordingly, character strength‐based interventions could be provided to improve self‐management in such patients with diabetes. Furthermore, the 12‐item Character Strengths Use in Diabetes Self‐management Scale has the potential to be used to measure the effectiveness of strength‐based interventions in people with Type 2 diabetes. Patient or Public Contribution: Five patients with type 2 diabetes were invited to take the original 20‐item scale to evaluate the clarity, readability and comprehensiveness of the 20 items. [ABSTRACT FROM AUTHOR]

Objectives: Due to a lack of clear symptoms, type 2 diabetes (T2D) can remain undetected for many years. The aim of the study was to explore if Norwegian community pharmacies could identify individuals with a high risk of developing T2D by offering a diabetes risk assessment service. This study also investigated if the service recruited individuals that the national guideline recommends for diabetes risk assessment, and the proportion of participants who had visited their GP at least once a year. Methods: During the inclusion period (September 2016 to the middle of April 2017), pharmacy customers 45 years or older wishing to participate contacted the pharmacy staff. Included participants completed a diabetes risk test and participants with a high risk were offered an HbA1c measurement. At two months after intervention, all participants were followed up. Key findings: Of the 245 participants, 27% had a high risk of developing T2D. Of these, 46%, 43% and 9% had HbA1c values corresponding to normal (<39 mmol/mol [5.7%]), prediabetes (39–47 mmol/mol [5.7–6.4%]) or above cut-off for diabetes (≥48 mmol/mol [≥6.5%]), respectively. A total of 86% of the participants were in at least one category that the guideline recommends for a diabetes risk assessment, and 88% had visited their GP at least once a year. Conclusions: Norwegian community pharmacies can identify individuals with a high risk of developing T2D by offering a diabetes risk assessment service. Individuals who sought out the service were within the relevant demographics for testing, and a high proportion visited their GP at least once a year. [ABSTRACT FROM AUTHOR]

New onset diabetes (NOD) in people 50 years or older may indicate underlying pancreatic ductal adenocarcinoma (PDAC). The cumulative incidence of PDAC among people with NOD remains uncertain on a population-based level. This was a nationwide population-based retrospective cohort study based on the Danish national health registries. We investigated the 3-year cumulative incidence of PDAC in people 50 years or older with NOD. We further characterised people with pancreatic cancer-related diabetes (PCRD) in relation to demographic and clinical characteristics, including trajectories of routine biochemical parameters, using people with type 2 diabetes (T2D) as a comparator group. During a 21-year observation period, we identified 353,970 people with NOD. Among them, 2105 people were subsequently diagnosed with pancreatic cancer within 3 years (0.59%, 95% CI [0.57–0.62%]). People with PCRD were older than people with T2D at diabetes diagnosis (median age 70.9 vs. 66.0 years (P < 0.001) and had a higher burden of comorbidities (P = 0.007) and more prescriptions of medications used to treat cardiovascular diseases (all P < 0.001). Distinct trajectories of HbA1c and plasma triglycerides were observed in PCRD vs. T2D, with group differences observed for up to three years prior to NOD diagnosis for HbA1c and up to two years for plasma triglyceride levels. The 3-year cumulative incidence of PDAC is approximately 0.6% among people 50 years or older with NOD in a nationwide population-based setting. Compared to T2D, people with PCRD are characterised by distinct demographic and clinical profiles, including distinctive trajectories of plasma HbA1c and triglyceride levels. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is a disease of public health importance globally with an increasing burden of undiagnosed pre-diabetes and diabetes in low- and middle-income countries, Nigeria in particular. Prediabetes and diabetes are established risk factors for cardiovascular complications. However, data are scanty on the current prevalence of these conditions in Nigeria, based on haemoglobin A1c (HbA1c) diagnosis as recommended by the WHO in 2009. We aimed to determine the prevalence of pre-diabetes, diabetes, and undiagnosed diabetes among the adult population of Nigeria using HbA1c. Methodology: A cross-sectional, multi-site population study was carried out in selected states in Nigeria (namely, Ekiti, Lagos, Osun, Oyo, and Kwara states) involving 2,708 adults (≥18 years) in rural and urban community dwellers, without prior diagnosis of pre-diabetes or diabetes. Participants with ongoing acute or debilitating illnesses were excluded. Data were collected using an intervieweradministered pretested, semi-structured questionnaire. Socio-demographic, clinical (weight, height, blood pressure, etc.), and laboratory characteristics of participants including HbA1c were obtained. Data were analysed using STATA version 16. Results: The mean age of participants was 48.1 ± 15.8 years, and 65.5% were female. The overall prevalence of pre-diabetes and undiagnosed diabetes was 40.5% and 10.7%, respectively, while the prevalence of high blood pressure was 36.7%. The prevalence of pre-diabetes was the highest in Lagos (48.1%) and the lowest in Ekiti (36.7%), while the prevalence of diabetes was the highest in Kwara (14.2%) and the lowest in Ekiti (10%). There was a significant association between age of the participants (p< 0.001), gender (p = 0.009), educational status (p = 0.008), occupation (p< 0.001), tribe (p = 0.004), marital status (p< 0.001), blood pressure (p< 0.001), and their diabetic or pre-diabetic status. Independent predictors of diabetes and pre-diabetes include excess weight gain, sedentary living, and ageing. Participants within the age group 45–54 years had the highest total prevalence (26.6%) of pre-diabetes and diabetes. Conclusion: Over half of the respondents had pre-diabetes and diabetes, with a high prevalence of undiagnosed diabetes. A nationwide screening campaign will promote early detection of pre-diabetes and undiagnosed diabetes among adult Nigerians. Health education campaigns could be an effective tool in community settings to improve knowledge of the risk factors for diabetes to reduce the prevalence of dysglycaemia. [ABSTRACT FROM AUTHOR]

To assess 20-year retrospective trajectories of cardio-metabolic factors preceding dementia diagnosis among people with type 2 diabetes (T2D). We identified 227,145 people with T2D aged > 42 years between 1999 and 2018. Annual mean levels of eight routinely measured cardio-metabolic factors were extracted from the Clinical Practice Research Datalink. Multivariable multilevel piecewise and non-piecewise growth curve models assessed retrospective trajectories of cardio-metabolic factors by dementia status from up to 19 years preceding dementia diagnosis (dementia) or last contact with healthcare (no dementia). 23,546 patients developed dementia; mean (SD) follow-up was 10.0 (5.8) years. In the dementia group, mean systolic blood pressure increased 16–19 years before dementia diagnosis compared with patients without dementia, but declined more steeply from 16 years before diagnosis, while diastolic blood pressure generally declined at similar rates. Mean body mass index followed a steeper non-linear decline from 11 years before diagnosis in the dementia group. Mean blood lipid levels (total cholesterol, LDL, HDL) and glycaemic measures (fasting plasma glucose and HbA1c) were generally higher in the dementia group compared with those without dementia and followed similar patterns of change. However, absolute group differences were small. Differences in levels of cardio-metabolic factors were observed up to two decades prior to dementia diagnosis. Our findings suggest that a long follow-up is crucial to minimise reverse causation arising from changes in cardio-metabolic factors during preclinical dementia. Future investigations which address associations between cardiometabolic factors and dementia should account for potential non-linear relationships and consider the timeframe when measurements are taken. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In the context of the accreditation of medical laboratories according to the ISO 15189: 2012 standard, the optimisation of an internal quality control (IQC) schedule is an important element of analytical quality. The study focuses on an essential test for the follow-up of diabetic patients: Haemoglobin A1c (HbA1c). METHODS: The analysis was performed on three TERA® Capillarys (Sebia®) analyzers. Data were collected for 1 month calculating imprecision and analytical bias. A total error allowable (TEa) of 6% was used to calculate the Sigma metrics. A statistical quality control (SQC) procedure based on the Sigma metrics of the analytical procedure, the selected rules and numbers of control measurements were applied to determine the optimised run size and to guarantee the required quality of patient care. RESULTS: With a mean of 5-Sigma. 'Normalised Chart' showed a good/excellent performance for the HbA1c method. The SQC run size nomogram indicated a desirable event size of around 53 samples/capillary (for n=1 and 13s) and 170 samples/capillary (for n=2 and 13s). DISCUSSION AND CONCLUSION: Our study demonstrated the usefulness of the sigma metric SQC run size nomogram to determine the control strategy for HBA1c and contributes to the quality of results rendered to patients.

New Findings: What is the central question of this study?Is the impairment in heat dissipation during exercise observed in men with type 2 diabetes related to glycaemic control (indexed by glycated haemoglobin; haemoglobin A1c)?What is the main finding and its importance?No association was found between haemoglobin A1c (range: 5.1–9.1%) and whole‐body heat loss in men with type 2 diabetes during exercise in the heat. However, individuals with elevated haemoglobin A1c exhibited higher body core temperature and heart rate responses. Thus, while haemoglobin A1c is not associated with heat loss per se, it may still have important implications for physiological strain during exercise. Type 2 diabetes is associated with a reduced capacity to dissipate heat. It is unknown whether this impairment is related to glycaemic control (indexed by glycated haemoglobin; haemoglobin A1c) is unknown. We evaluated the association between haemoglobin A1c and whole‐body heat loss (via direct calorimetry), body core temperature, and heart rate in 26 physically active men with type 2 diabetes (43–73 years; HbA1c 5.1–9.1%) during exercise at increasing rates of metabolic heat production (∼150, 200, 250 W m−2) in the heat (40°C, ∼17% relative humidity). Haemoglobin A1c was not associated with whole‐body heat loss (P = 0.617), nor the increase in core temperature from pre‐exercise (P = 0.347). However, absolute core temperature and heart rate were elevated ∼0.2°C (P = 0.014) and ∼6 beats min−1 (P = 0.049), respectively, with every percentage point increase in haemoglobin A1c. Thus, while haemoglobin A1c does not appear to modify diabetes‐related reductions in capacity for heat dissipation, it may still have important implications for physiological strain during exercise‐heat stress. [ABSTRACT FROM AUTHOR]

Purpose: To examine the secular trends in the prevalence, incidence, and progression rates of diabetic retinopathy (DR) in a Japanese community. Methods: Community-dwelling Japanese residents aged ≥ 40 years with diabetes participated in comprehensive systemic and ophthalmological surveys, including an examination for DR, in 1998 (n = 220), 2007 (n = 511), 2012 (n = 515), and 2017 (n = 560). DR was assessed using colour fundus photographs after pupil dilation according to the modified Airlie House classification system. To compare the frequencies of newly developed or progressed DR between the studied decades, two eye cohorts were established (the 2000s cohort included 145 participants examined in 1998 and 2007; the 2010s cohort included 255 participants examined in 2007, 2012, and 2017). Trends in the prevalence, incidence, and progression rate of DR were tested by logistic regression analysis with a generalised estimating equation. Results: The age-adjusted prevalence of DR among individuals with diabetes decreased significantly with time from 1998 to 2017 (27.4% in 1998, 22.8% in 2007, 12.8% in 2012, and 6.4% in 2017; p for trend < 0.001). During this period, the prevalence of DR was decreasing in every haemoglobin A1c category, but it remained constant in the high systolic blood pressure category. In addition, the rates of new-onset of DR were significantly lower in the 2010s compared to the 2000s (p < 0.001). Conclusion: Our findings suggest that the prevalence and incidence of DR among diabetic people significantly decreased with time over the past two decades in a general Japanese population. [ABSTRACT FROM AUTHOR]

BackgroundType 2 diabetes mellitus (T2DM) is a disease of public health importance globally with an increasing burden of undiagnosed pre-diabetes and diabetes in low- and middle-income countries, Nigeria in particular. Pre-diabetes and diabetes are established risk factors for cardiovascular complications. However, data are scanty on the current prevalence of these conditions in Nigeria, based on haemoglobin A1c (HbA1c) diagnosis as recommended by the WHO in 2009. We aimed to determine the prevalence of pre-diabetes, diabetes, and undiagnosed diabetes among the adult population of Nigeria using HbA1c.MethodologyA cross-sectional, multi-site population study was carried out in selected states in Nigeria (namely, Ekiti, Lagos, Osun, Oyo, and Kwara states) involving 2,708 adults (≥18 years) in rural and urban community dwellers, without prior diagnosis of pre-diabetes or diabetes. Participants with ongoing acute or debilitating illnesses were excluded. Data were collected using an interviewer-administered pretested, semi-structured questionnaire. Socio-demographic, clinical (weight, height, blood pressure, etc.), and laboratory characteristics of participants including HbA1c were obtained. Data were analysed using STATA version 16.ResultsThe mean age of participants was 48.1 ± 15.8 years, and 65.5% were female. The overall prevalence of pre-diabetes and undiagnosed diabetes was 40.5% and 10.7%, respectively, while the prevalence of high blood pressure was 36.7%. The prevalence of pre-diabetes was the highest in Lagos (48.1%) and the lowest in Ekiti (36.7%), while the prevalence of diabetes was the highest in Kwara (14.2%) and the lowest in Ekiti (10%). There was a significant association between age of the participants (p< 0.001), gender (p = 0.009), educational status (p = 0.008), occupation (p< 0.001), tribe (p = 0.004), marital status (p< 0.001), blood pressure (p< 0.001), and their diabetic or pre-diabetic status. Independent predictors of diabetes and pre-diabetes include excess weight gain, sedentary living, and ageing. Participants within the age group 45–54 years had the highest total prevalence (26.6%) of pre-diabetes and diabetes.ConclusionOver half of the respondents had pre-diabetes and diabetes, with a high prevalence of undiagnosed diabetes. A nationwide screening campaign will promote early detection of pre-diabetes and undiagnosed diabetes among adult Nigerians. Health education campaigns could be an effective tool in community settings to improve knowledge of the risk factors for diabetes to reduce the prevalence of dysglycaemia.

Abstract Background This study aimed to examine associations between haemoglobin A1c (HbA1c) levels over time and all-cause and cause-specific mortality in middle-aged and older Koreans. Methods Using 16 years of follow-up data from the Korean Genome and Epidemiology Study, we analysed 9294 individuals aged 40–69 years with no history of cardiovascular disease (CVD) or cancer. Participants were divided into a known diabetes group and five groups categorized by HbA1c levels (

Objective: This study clarifies the involvement of gender and pre-existing diabetes mellitus (DM) in the clinical characteristics of polymyalgia rheumatica (PMR). Methods: The clinical records of patients diagnosed with PMR in our department between January 2011 and June 2021, especially in terms of gender and DM were retrospectively analysed. Results: We identified 89 patients with the median age of 75. 37 cases were men and 52 cases were women. Pre-existing DM was found in 21 patients (23.6%). Male PMR patients exhibited a higher complication rate of pre-existing DM and C-reactive protein (CRP) levels at diagnosis (p =.04 and p <.01, respectively) than female patients, and men were more common in the patient group with pre-existing DM (p =.04). The CRP levels of male PMR patients without pre-existing DM were higher than female PMR patients without pre-existing DM. [ABSTRACT FROM AUTHOR]

Objective: This study clarifies the involvement of gender and pre-existing diabetes mellitus (DM) in the clinical characteristics of polymyalgia rheumatica (PMR). Methods: The clinical records of patients diagnosed with PMR in our department between January 2011 and June 2021, especially in terms of gender and DM were retrospectively analysed. Results: We identified 89 patients with the median age of 75.37 cases were men and 52 cases were women. Pre-existing DM was found in 21 patients (23.6%). Male PMR patients exhibited a higher complication rate of pre-existing DM and C-reactive protein (CRP) levels at diagnosis (p = .04 and p < .01, respectively) than female patients, and men were more common in the patient group with pre-existing DM (p = .04). The CRP levels of male PMR patients without pre-existing DM were higher than female PMR patients without pre-existing DM. Conclusion: Male PMR patients might have a varying pathophysiology from female patients in terms of high inflammation levels accompanied by a high prevalence rate of pre-existing DM and need a gender-specific approach. [ABSTRACT FROM AUTHOR]

Background: Bariatric metabolic surgery is evolving as an option for the treatment of type 2 diabetes mellitus (T2DM) in patients with obesity and T2DM, warranting more studies on the efficacy of bariatric metabolic surgery on T2DM. Objective: To determine T2DM remission in patients with obesity and T2DM with up to two years follow-up after bariatric metabolic surgery. Materials and Methods: A retrospective review of prospectively maintained data was undertaken to identify patients who had T2DM and underwent bariatric surgery at a single centre in 2016. Data collected included age, gender, body mass index (BMI), fasting plasma glucose, haemoglobin A1c, hypertension, (HTN), Obstructive sleep apnea (OSA), initial weight and the weight at intervals of 6, 12, and 24 months. Data on the treatment of T2DM before the surgery was also collected. The criteria of the American Diabetes Association were used for the definition of T2DM remission. Only the data on patients in this study who had more than 12 months' follow-up information was analysed. Results: Two hundred and eighty patients with T2DM were identified. 191 patients had more than 12 months' follow-up information. Mean age and BMI were 49.58 ± 10.64 years and 44.03 ± 7.86 kg/m2 respectively. There were 29 patients on insulin, 21 (10.9%) on insulin only and 8 (4.2%) on insulin and oral hypoglycaemic agents (OHA). One hundred and forty-six patients (76.4%) were on OHA, 134 on a single OHA and 12 on more than one OHA. Twenty-six patients (13.6%) were newly diagnosed with T2DM when they came in for bariatric metabolic surgery. One hundred and fifty-six patients (81.7%) achieved complete remission. 14 (7.3%) of these patients used to be on insulin with or without OHA and 142 (74.3%) were patients either on OHA or no OHA. There were 12 (6.4%) patients in partial remission. There was improvement in 23 (12.04%). Eight patients were on insulin but at lower doses and 15 were on a single OHA. The average percentage of total weight loss at 6, 12 and 24 months was 29.7%, 33.9% and 35.6% respectively. Patients with shorter duration of T2DM had higher remission rates as compared to patients with longer duration (r = −0.874, P = 0.001). There was also a significant resolution of HTN (81.8%) and OSA (82.3%) after bariatric metabolic surgery. Conclusion: This study collaborates reports that there is significant remission of T2DM after bariatric metabolic surgery in patients with obesity and T2DM. There is a need for prospective, multi-centre, and long-term studies on bariatric metabolic surgery to treat patients with obesity and T2DM.

Haemoglobin A1c (HbA1c) is a marker of glycaemic control in type 2 diabetes mellitus (T2DM). Increased waist circumference (WC) is known to be associated with T2DM. Therefore, we investigated the relationship of WC with HbA1c and explored its optimal cutoff for identifying prediabetes and diabetes risk. This study included 2339 participants between 18 and 84 years of age [mean (SD) age, 43.5 (11.9) years] with valid data on WC, HbA1c and related variables in the Shenzhen-Hong Kong United Network on Cardiovascular Disease study. Participants on anti-diabetic medications were excluded. Multiple linear regression was used to investigate the relationship between HbA1c and WC. Cutoff values of WC indicating an HbA1c level of 5.7% and 6.5% were also assessed using optimal binning. There was a significant linear relationship between WC and HbA1c in the overall population (B = 0.261, P < 0.001), men (B = 0.206, P < 0.001) and women (B = 0.311, P < 0.001). After adjustment for smoking, alcohol consumption, physical activity, hypertension, hypercholesterolaemia and age, the association remained significant in the overall population (B = 0.201, P < 0.001), men (B = 0.186, P < 0.001) and women (B = 0.182, P < 0.001). The optimal cutoff values of WC indicating an HbA1c level of 5.7% and 6.5% was 83 cm (entropy = 0.943) and 85 cm (entropy = 0.365) in men, and 78 cm (entropy = 0.922) and 86 cm (entropy = 0.256) in women. The linear relationship between WC and HbA1c in this study suggests that addressing central obesity issue is beneficial to people with T2DM or at risk of T2DM. WC cutoff values of 85 cm for men and 86 cm for women are appropriate for recommendation to undergo diabetes screening. [ABSTRACT FROM AUTHOR]

Objectives: In the context of the accreditation of medical laboratories according to the ISO 15189:2012 standard, the optimisation of an internal quality control (IQC) schedule is an important element of analytical quality. The study focuses on an essential test for the follow-up of diabetic patients: Haemoglobin A1c (HbA1c). Methods: The analysis was performed on three TERA® Capillarys (Sebia®) analyzers. Data were collected for 1 month calculating imprecision and analytical bias. A total error allowable (TEa) of 6% was used to calculate the Sigma metrics. A statistical quality control (SQC) procedure based on the Sigma metrics of the analytical procedure, the selected rules and numbers of control measurements were applied to determine the optimised run size and to guarantee the required quality of patient care. Results: With a mean of 5-Sigma. "Normalised Chart" showed a good/excellent performance for the HbA1c method. The SQC run size nomogram indicated a desirable event size of around 53 samples/capillary (for n=1 and 13s) and 170 samples/capillary (for n=2 and 13s). Conclusion: Our study demonstrated the usefulness of the sigma metric SQC run size nomogram to determine the control strategy for HBA1c and contributes to the quality of results rendered to patients. [ABSTRACT FROM AUTHOR]

Aims: The association between haemoglobin A1c (HbA1c) and cerebral microbleeds (CMBs) remains unclear. We aimed to investigate the association between HbA1c and CMBs in community‐based individuals without stroke or transient ischaemic attack (TIA) and whether the association differs between individuals with and without diabetes mellitus (DM). Materials and Methods: All individuals were recruited from a community in Beijing, China, from January 2015 to September 2019. All individuals completed a questionnaire and underwent blood tests and brain magnetic resonance imaging. A susceptibility‐weighted imaging sequence was acquired to detect CMBs, which were defined as small, round and low‐signal lesions with <10 mm diameter. The association between HbA1c and CMBs was analysed using multivariable logistic regression adjusted for demographics, medical history and blood sample test results. Subgroup analyses stratified by history of DM were performed. Results: Of 544 recruited individuals, 119 (21.88%) had CMBs. HbA1c was independently associated with CMBs (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.03–2.22). In 87 individuals with DM, multivariable logistic analysis showed that HbA1c was significantly associated with CMBs (OR, 1.67; 95% CI, 1.04–2.69), whereas in individuals without DM, no significant association was observed between HbA1c and CMBs (OR, 1.07; 95% CI, 0.50–2.30). Conclusions: HbA1c was associated with CMBs in individuals without stroke or TIA, particularly in individuals with DM, suggesting that the status of glycaemic control warrants attention for the prevention of CMBs. It would be beneficial to manage HbA1c specifically to control the risk of CMBs, especially in individuals with DM. [ABSTRACT FROM AUTHOR]

Background: Habitual smoking and prediabetes are independent risk factors for increased oral yeasts carriage (OYC); however, no studies have compared OYC amongst cigarette smokers and nonsmokers with and without prediabetes. The aim was to fill this research gap., Methods: Ninety-two participants were included and categorised into 4 groups: group 1, prediabetic (haemoglobin A1c [HbA1c] levels, 5.7%-6.4%) cigarette smokers; group 2, cigarette smokers without prediabetes; group 3, prediabetic nonsmokers; and group 4, nonsmokers without prediabetes. Patient demographics and HbA1c levels were recorded. Data on duration of smoking habit (pack-years) and family history of smoking were collected. Information on daily toothbrushing and flossing and most recent visit to a dentist/dental hygienist was gathered. Clinical and radiographic periodontal examination was performed and unstimulated whole salivary flow rate (UWSFR) was determined. OYC was assessed using the oral rinse sampling method. Power analysis was done, and group comparisons were performed. Logistic regression analysis was performed and P values <5% reflected statistical significance., Results: Respectively, 23, 24, 22, and 23 individuals with comparable mean ages were included in groups 1, 2, 3, and 4. In groups 1 and 2, participants had a smoking history of (mean ± SD) 24.7 ± 3.2 and 10.6 ± 2.5 pack-years. Plaque index, clinical attachment loss, and probing depth were higher in groups 1 (P < .05), 2 (P < .05), and 3 (P < .05) than in group 4. Number of missing teeth was significantly higher in group 1 compared with groups 2 (P < .05), 3 (P < .05), and 4 (P < .05). There was no difference in UWSFR amongst the groups. OYC was greater in group 1 than in groups 2 (P < .05), 3 (P < .05), and 4 (P < .05). OYC was greater in groups 2 (P < .05) and 3 (P < .05) than in group 4., Conclusions: In prediabetic cigarette smokers, OYC appears to be influenced by hyperglycaemia, whilst in nondiabetic smokers, the severity of periodontal inflammation appears to be the determining factor in OYC., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of the present systematic review and meta-analysis was to assess the efficacy of non-surgical periodontal therapy (NSPT) with adjunct photodynamic therapy (aPDT) in reducing periodontal inflammation and haemoglobin A1c (HbA1c) levels in patients with diabetes mellitus (DM)., Materials and Methods: The focused question was 'Does NSPT with adjunct aPDT help reduce periodontal inflammation and HbA1c levels in patients with DM?' The PICO (patient/population, intervention, comparison and outcomes) was formatted as follows: Patients (P): Participants diagnosed with DM; Intervention (I): NSPT with adjunct PDT for the treatment of periodontitis; Control (C): NSPT alone or NSPT with adjunct systemic antibiotic therapy; and Outcome (O): Changes in HbA1c levels. The inclusion criteria comprised RCTs specifically evaluating the impact of NSPT on HbA1c levels in diabetic patients, with a specific focus on interventions involving NSPT with and without adjunct aPDT. The literature search was performed in accordance with the Preferred reporting items for systematic reviews and meta-analysis. Indexed databases were searched without time and language restrictions using various keywords. Forest plots were created to illustrate the effects of the different studies and the global estimation., Results: Five RCTs were included and processed for data extraction. The number of participants ranged from 12 to 45 patients with medically diagnosed type-2 DM. In all RCTs, aPDT was done using a diode laser with wavelengths ranging between 660 and 810 nm. Three and two RCTs had moderate and high RoB, respectively. In two RCTs, NSPT with adjunct aPDT reported no improvement in clinical periodontal parameters. Two studies reported that NSPT with adjunct aPDT significantly reduces periodontal probing depth compared to NSPT alone. Four of the five RCTs reported that NSPT+PDT does not influence HbA1c levels., Conclusions: NSPT with or without adjunct aPDT does not affect HbA1c levels in patients with type-2 DM.

Ling-Wang An,1 Xiang-Lan Li,1 Lin-Hui Chen,2 Hong Tang,3 Qun Yuan,4 Yan-Jun Liu,5 Yu Ji,6 Ju-Ming Lu1,7 1Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China; 2Department of Endocrinology, Taiyuan Diabetes Hospital, Taiyuan, 030013, People’s Republic of China; 3Department of Share-Care Center, Chengdu Ruien Diabetes Hospital, Chengdu, 610000, People’s Republic of China; 4Department of Endocrinology, Heilongjiang Ruijing Diabetes Hospital, Harbin, 150009, People’s Republic of China; 5Department of Endocrinology, Lanzhou Ruijing Diabetes Hospital, Lanzhou, 730000, People’s Republic of China; 6Department of Endocrinology, Beijing Aerospace General Hospital, Beijing, 100076, People’s Republic of China; 7Department of Endocrinology, The General Hospital of the People’s Liberation Army, Beijing, 100853, People’s Republic of ChinaCorrespondence: Ju-Ming LuDepartment of Endocrinology, The General Hospital of the People’s Liberation Army, No. 28 of Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of ChinaTel +86 10 8822 9999Email lujm666_1@21cn.comObjective: To analyse diabetes treatment, treatment change and self-management behaviours in association with 2-year glycaemic trajectories in patients with non-newly diagnosed type 2 diabetes mellitus in Chinese primary care.Methods: This was an observational, multi-centre, longitudinal, retrospective cohort study. Clinical data of 4690 subjects were extracted from electronic medical records, including serial glycated haemoglobin A1c (HbA1c) measurements, antidiabetic medication records and compliance to exercise, diet, medications and self-monitoring of blood glucose (SMBG). Patterns of longitudinal HbA1c trajectories were identified using the percentage of HbA1c measurements < 7.5% from the second available HbA1c measurement. Clinical relevance of the clusters was assessed through multivariable analysis.Results: Approximately half of the participants demonstrated good glycaemic control; of these, 34.5% demonstrated stable, good control, and 13.7% demonstrated relatively good control. About 16.2% demonstrated moderate control, and 35.6% demonstrated poor control. From the good to poor control groups, the percentage of subjects treated with insulin at baseline and during the follow-up period increased gradually, while the percentage of subjects adhering to exercise, diet, medications and SMBG decreased gradually. Compared with baseline, the adherence to exercise, diet, medications and SMBG improved significantly. Approximately 50% and 26% of subjects in the two poorest control groups, respectively, experienced treatment changes. After multivariable adjustments, baseline HbA1c ≥ 7.5%, HbA1c change ≥− 0.5% from baseline to visit 1, insulin treatment, treatment change, poor adherence to diet, exercise, SMBG during the follow-up period and HbA1c measurements < 3 per year were significantly associated with poorer glycaemic control.Conclusion: We identified four longitudinal HbA1c trajectories in patients with non-newly diagnosed type 2 diabetes. Even if baseline HbA1c is suboptimal, aggressive treatment changes, good adherence during the follow-up period, ≥ 3 HbA1c measurements per year and reducing HbA1c levels to a certain extent by the first follow-up visit were important for good, stable, long-term glycaemic control.Keywords: haemoglobin A1c, self-monitoring of blood glucose, diabetes, glycaemic trajectories, glycaemic control

Background: Prevention of hearing loss via addressing potentially modifiable risk factors may offer means of reducing the global burden of hearing loss. Prior studies reported associations between individual markers of inflammation and risk of hearing impairment. Allostatic load is an index of cumulative physiological stressors, including inflammation, to multiple biological systems. Our aims were to investigate associations between allostatic load and both audiometric and self-reported hearing impairment and examine whether associations are stronger over time due to prolonged high allostatic load. Methods: Data were taken from the English Longitudinal Study of Ageing (ELSA), a nationally representative study of people aged 50+ living in England over 3 time points between 2008 and 2014. Allostatic load score was comprised of thirteen different measures available at baseline and 4 years post-baseline (high-density lipoprotein/total cholesterol, triglyceride, fibrinogen, haemoglobin A1c, C-reactive protein, insulin-like growth factor 1 (IGF-1), systolic and diastolic blood pressure, mean arterial pressure, resting pulse rate, peak expiratory flow, BMI and waist circumference), measured using clinical cut-off points for normal biomarker parameters. Hearing acuity was measured with a simple handheld tone-producing device at follow-up 7 years post-baseline, while self-reported hearing impairment was measured at time point. Results: We included samples of 4373 and 4430 for the cross-sectional and longitudinal analysis, respectively. In the cross-sectional model high allostatic load was associated both self-reported (OR = 1.08, 95% CI 1.0,1.1; p

Background: This study aimed to examine associations between haemoglobin A1c (HbA1c) levels over time and all-cause and cause-specific mortality in middle-aged and older Koreans. Methods: Using 16 years of follow-up data from the Korean Genome and Epidemiology Study, we analysed 9294 individuals aged 40–69 years with no history of cardiovascular disease (CVD) or cancer. Participants were divided into a known diabetes group and five groups categorized by HbA1c levels (< 5.0%, 5.0–5.4%, 5.5–5.9%, 6.0–6.4%, and ≥ 6.5%). Hazard ratios (HRs) for all-cause and cause-specific mortality associated with HbA1c levels were calculated using a conventional and a time-dependent Cox proportional hazards model. Restricted cubic spline models were fitted to investigate the relationship between continuous HbA1c levels and mortality among people without known diabetes. Subgroup analyses were performed for age, sex, smoking, hypertension, liver diseases, and red blood cell counts. Results: During a median follow-up period of 15.7 years, there were 944 deaths, including 185 deaths from CVD, 359 from cancer, and 125 from all external causes. Compared with participants with HbA1c levels of 5.5–5.9%, multivariate-adjusted HRs and 95% confidence intervals for all-cause death of participants with levels < 5.0%, 5.0–5.4%, 6.0–6.4%, and ≥ 6.5% and participants with known diabetes were 1.84 (1.35–2.51), 1.13 (0.95–1.34), 1.30 (1.04–1.62), 1.37 (0.97–1.93), and 2.03 (1.70–2.44), respectively. The risk of cancer mortality was significantly increased in HbA1c < 5.0% (HR, 2.21; 95% CI 1.42–3.44) and known diabetes (HR, 1.60; 95% CI 1.18–2.15). When we performed diverse subgroup analyses, low HbA1c levels at baseline were strongly associated with mortality in participants with liver diseases. Conclusions: We found U-shaped associations between HbA1c levels at baseline and over time and all-cause mortality in middle-aged and older Koreans. Additionally, the risk of cancer mortality increased both in low and high HbA1c groups, but CVD mortality increased only in high HbA1c group. In particular, people with liver diseases and low HbA1c levels had a high risk of all-cause mortality. Therefore, more careful management of these groups is suggested to identify any deteriorating health conditions. [ABSTRACT FROM AUTHOR]

Purpose: To compare accommodative and binocular vision performance between young diabetic subjects and normal controls, and to investigate the correlation of accommodative/binocular indices with the severity of diabetes. Methods: Thirty young subjects with diabetes mellitus (DM) and 30 age‐matched normal controls were recruited in this hospital‐based cross‐sectional study. DM was diagnosed by a haemoglobin A1c (HbA1c) higher than 6.5%. The status of vision‐related symptoms was examined by the convergence insufficiency symptoms survey (CISS). All participants underwent a complete optometric examination including visual acuity measurement, objective and subjective refraction, accommodative and binocular vision assessments. Results: All study participants were between 18 and 40 years of age. There were no statistically significant differences in best‐corrected visual acuity (BCVA), sphere, cylinder and spherical equivalent refraction (SE) between the diabetes and control groups. The median near point of convergence (NPC) was significantly more remote in diabetics compared with the control group. Mean accommodative amplitude (AA) and vergence facility (VF) and the median monocular accommodative facility (AF) were significantly lower in diabetic subjects compared with normal controls. In addition, the median accommodative lag in the diabetic group was significantly higher than the control group. A significantly higher percentage of the diabetic group were symptomatic (26.6%), compared with the controls (6.6%). The NPC and accommodative lag showed a significant positive correlation with the HbA1c level, while VF, AA and AF exhibited a significant negative correlation with HbA1c. Conclusion: Aspects of accommodative and binocular vision performance are strongly affected by DM. There is also a significant correlation between accommodative and binocular disorders with the severity of DM. A significant percentage of young subjects with DM have severe vision‐related symptoms. [ABSTRACT FROM AUTHOR]

Background: Bariatric metabolic surgery is evolving as an option for the treatment of type 2 diabetes mellitus (T2DM) in patients with obesity and T2DM, warranting more studies on the efficacy of bariatric metabolic surgery on T2DM. Objective: To determine T2DM remission in patients with obesity and T2DM with up to two years follow-up after bariatric metabolic surgery. Materials and Methods: A retrospective review of prospectively maintained data was undertaken to identify patients who had T2DM and underwent bariatric surgery at a single centre in 2016. Data collected included age, gender, body mass index (BMI), fasting plasma glucose, haemoglobin A1c, hypertension, (HTN), Obstructive sleep apnea (OSA), initial weight and the weight at intervals of 6, 12, and 24 months. Data on the treatment of T2DM before the surgery was also collected. The criteria of the American Diabetes Association were used for the definition of T2DM remission. Only the data on patients in this study who had more than 12 months' follow-up information was analysed. Results: Two hundred and eighty patients with T2DM were identified. 191 patients had more than 12 months' follow-up information. Mean age and BMI were 49.58 ± 10.64 years and 44.03 ± 7.86 kg/m2 respectively. There were 29 patients on insulin, 21 (10.9%) on insulin only and 8 (4.2%) on insulin and oral hypoglycaemic agents (OHA). One hundred and forty-six patients (76.4%) were on OHA, 134 on a single OHA and 12 on more than one OHA. Twenty-six patients (13.6%) were newly diagnosed with T2DM when they came in for bariatric metabolic surgery. One hundred and fifty-six patients (81.7%) achieved complete remission. 14 (7.3%) of these patients used to be on insulin with or without OHA and 142 (74.3%) were patients either on OHA or no OHA. There were 12 (6.4%) patients in partial remission. There was improvement in 23 (12.04%). Eight patients were on insulin but at lower doses and 15 were on a single OHA. The average percentage of total weight loss at 6, 12 and 24 months was 29.7%, 33.9% and 35.6% respectively. Patients with shorter duration of T2DM had higher remission rates as compared to patients with longer duration (r = -0.874, P = 0.001). There was also a significant resolution of HTN (81.8%) and OSA (82.3%) after bariatric metabolic surgery. Conclusion: This study collaborates reports that there is significant remission of T2DM after bariatric metabolic surgery in patients with obesity and T2DM. There is a need for prospective, multi-centre, and long-term studies on bariatric metabolic surgery to treat patients with obesity and T2DM. [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]

Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic disorder associated with vascular complications that are attributable to dysregulated platelet reactivity as measured by mean platelet volume (MPV). This study aimed at determining a relationship between MPV and glycaemic control in new-onset T2DM. Methods: This was a prospective study conducted on 236 new-onset T2DM patients divided in two groups as group A, glycosylated haemoglobin A1c (HbA1c < 7.9%; n = 70) and group B, HbA1c ⩾ 8% (n = 107) who were followed up for 6 months for change in platelet and glycaemic parameters. Results: At 6-month follow-up, there was a significant decrease in HbA1c and MPV (group A (HbA1c: 7.40 ± 0.40 vs 7.03 ± 0.23%, p < 0.03; MPV: 9.65 fl ± 0.74 vs 9.46 fl ± 0.71, p < 0.001) and group B (HbA1c: 10.59 ± 1.89% vs 9.29 ± 1.50%, p < 0.001; MPV: 10.89 fL ± 1.29 vs. 10.23 fL ± 1.40, p< 0.001)). The percentage decline in HbA1c was more in group B (11.81 ± 5.87 vs 4.76 ± 4.58, p < 0.01). There was a positive correlation between ΔMPV and ΔHbA1c in group B; however, we did not observe significant correlation for group A. Conclusion: We interpret that in people with diabetes with baseline HbA1c ⩾ 8%, with improvement in glycaemic control, there is a significant decrease in MPV. We propose that a routine MPV testing can be used as a potential marker for glycaemic control in T2DM. [ABSTRACT FROM AUTHOR]

Aim: Obesity is a significant health issue for participants with type 1 diabetes undergoing intensive diabetes management. The temporal pattern and factors associated with weight gain after treatment initiation remain poorly understood including how weight gain in participants with and without type I diabetes compare. Our aim was to compare weight gain in those receiving intensive (INT) and conventional (CONV) type 1 diabetes treatment to a population without diabetes. Methods: Participants included men and women of 18 years and older in the Diabetes Control and Complications Trial (DCCT) randomized to INT (n = 562) or CONV (n = 568) and a prospective, observational cohort without diabetes from the Coronary Artery Development in Young Adults (CARDIA, controls) study (n = 2446). Body mass index (BMI) trajectories and obesity prevalence were compared between groups and candidate metabolic and therapeutic moderators investigated. Results: Annual weight gain with INT peaked 1.3 years after initiation and was greater than both CONV and controls before and after this peak. Obesity prevalence with INT was lower than controls at baseline, was similar to controls at 2 years and surpassed controls by 5 years. Obesity rates with CONV remained below controls at all time points. Greater annual weight gain in the DCCT was associated with lower haemoglobin A1c, higher insulin dose and family history of type 2 diabetes. Conclusions: Greater weight gain accompanying INT therapy occurs in two stages, leads to similar or greater obesity rates than controls after 2 years and is primarily modified by glucose control and family history, supportive of a therapeutic‐genetic influence on weight trajectories. [ABSTRACT FROM AUTHOR]

AbstractIntroduction Type II diabetes mellitus (DM) is a proinflammatory process and a known risk factor for major adverse cardiac events (MACE). The same inflammatory markers may be present in prediabetes (pDM); however, the relationship between pDM by HbA1c and MACE is not well studied. We sought to see if pDM increases one’s risk for MACE.Methods We retrospectively studied patients at Beaumont Health, Michigan between 2006 and 2020. We divided patients into groups (G1–G5) based on haemoglobin A1c (HbA1c) trends over the study period as follows: G1: pDM patients who remained pDM; G2: pDM who progressed into DM; G3: pDM who normalized their HbA1c; G4: patients who maintained a normal HbA1c; and G5: patients with HbA1c persistently in the DM range. We compared MACE between the groups by univariate and multivariate regression analyses.Results A total of 119,271 patients were included in the study (G1: N = 13,520, G2: N = 6314, G3: N = 1585, G4: N = 15,018, G5: N = 82,834). Pairwise comparison revealed a statistically significant increase in the odds of MACE in all groups compared to those with normal HbA1c values (G4; p

Introduction: Based on the hypothesis that there is a substantial rate of adults with prediabetes and undiagnosed diabetes mellitus (DM), our aim was to perform haemoglobin A1c (HbA1c)-based screening in a cohort of Croatian adults and estimate the prevalence of prediabetes and undiagnosed DM according to American Diabetes Association criteria. Materials and methods: This multi-center, cross-sectional study performed in six Croatian hospitals included 5527 patients aged 40 to 70 years admitted to the Emergency Department or undergoing a primary care check-up. Haemoglobin A1c was measured from leftover whole blood samples using the enzymatic method on either Alinity c or Architect c-series analyser (Abbott Laboratories, Chicago, USA). Haemoglobin A1c between 39-47 mmol/mol was classified as prediabetes, while = 48 mmol/mol as undiagnosed DM. Results: After exclusion of 435 patients with known DM, the final cohort included 5092 patients (median age 57; 56% males). A total of 882 (17.3%) patients had HbA1c values between 39 and 47 mmol/mol. There were 214 (4.2%) patients with HbA1c = 48 mmol/mol. Prediabetes prevalence ranged from 14.2% to 20.5%, while undiagnosed DM from 3.3% to 7.3%, with statistically significant differences among settings (P < 0.001). Agestratified analysis showed that prediabetes and undiagnosed DM prevalence increase with age (P < 0.001), being 25.4% and 5.8%, respectively, in patients aged 60 to 70 years. Conclusion: Underlying impairment of glucose metabolism was identified in about one in five adults, with significant number of patients with already overt DM. These results should serve as a starting point for further steps directed towards promotion of preventive measures for DM in Croatia. [ABSTRACT FROM AUTHOR]

Purpose: Purpose of this prospective uncontrolled single‐centre pilot study was to find an association of retinal oxygen saturation (SatO2) with acid–base balance (ABB), carboxyhaemoglobin concentration, current plasma glucose concentration (PG), mean PG and PG variability over the last 72 hr, haemoglobin A1c (HbA1c), and other conditions. Methods: Forty‐one adults (17 men) with type 1 (N = 14) or type 2 (N = 27) diabetes mellitus, age 48.6 ± 13.5 years, diabetes duration 9 (0.1–36) years, BMI 29.4 ± 6.3 kg/m2, and HbA1c 52 ± 12.7 mmol/mol completed the study. The 4‐day study comprised two visits (Day l, Day 4) including 72 hr of continuous glucose monitoring (CGM) by iPro®2 Professional CGM (Medtronic, MiniMed, Inc., Northridge, CA, USA). Retinal oximeter Oxymap T1 (Oxymap ehf., Reykjavik, Iceland) was used to assess SatO2. Results: Wilcoxon signed‐rank test showed no SatO2 difference between eyes and visits. Spearman's correlation analysis revealed a significant correlation between arterial SatO2 and PG variability in type 2 diabetes mellitus, a positive correlation of venous SatO2 with HbA1c and with finger pulse oximetry. However, no correlation of SatO2 with ABB, carboxyhaemoglobin, current PG, mean PG over the 72 hr, age, diabetes duration, BMI, lipoproteinaemia, body temperature, systolic and diastolic blood pressure, heart rate, central retinal thickness and retinal nerve fibre layer thickness was found. Conclusion: This study confirmed the association of venous SatO2 with long‐term but not with short‐term diabetes control, ABB and other conditions. The increased SatO2 and questionable impact of PG variability on retinal SatO2 is a research challenge. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to develop and illustrate an optimum variable selection approach using Multiple Linear Regression (MLR) and validation using Multi-Layer Feed Forward Neural Network (MLFF), also known as Multilayer Perceptron Neural Network (MLP) while taking bootstrapping into account. All of the factors specified will be evaluated to determine if they have a meaningful association. Objective:The goal of this study was to create a new method in making predictions for oral health data by combining a few statistical techniques. This would make the model more accurate. Material and Methods:A set of medical data that consists 30 observations was used to develop the methodology. The data descriptions of variables being used in this retrospective research including Creatinine, Fasting Blood Sugar, Haemoglobin A1C, and Urea were evaluated using advanced computational statistical modelling approaches. The medical data are used to test the R syntax that is developed in this study. The statistics for each sample are calculated using a model that incorporates bootstrapping and multiple linear regression techniques. Results:The statistical strategy which combines Bootstrap, MLFF and MLR is better than regular statistical method being used for this type of data. The hybrid model technique's accuracy was increased when the data was separated into training and testing dataset. Four variables are taken into account in this case: fasting blood sugar, creatinine, haemoglobin A1C, and urea. Fasting Blood Sugar (β1: 0.461889; p< 0.05), Creatinine (β3: 0.029761; p< 0.05) and Urea (β2:-0.454766; p< 0.05) are all significant, whereas MLFF and MLRhave the predicted mean square error (PMSE) values of 0.01226 and 0.3531 respectively. Conclusion: The value of PMSE is mainly used to diagnose the performance of MLR and MLFF. The MLFF is used to determine how close predicted values are to real data, while the model that has low PMSE value indicates that the model is accurate. The R syntax for combining Bootstrap, MLR, and MLFF is also included in this research article. In a word, this research establishes the superiority of the hybrid model method. [ABSTRACT FROM AUTHOR]

Background/objectives: Type 2 diabetes mellitus (T2DM) is one of the most common chronic illnesses in the United Kingdom accounting for approximately 15% of deaths per year. Growing evidence suggests that sleep duration and quality contributes towards this. This study aimed to determine whether there was a significant relationship between the elevation of haemoglobin A1c (HbA1c) level, sleep quality (SQ) and sleep duration (SD) in clinically diagnosed pre-diabetic patients. Subjects/methods: Following referral from a relevant healthcare professional, participants (n = 40) were registered on the National Health Service England, funded Healthier You: National Diabetes Prevention Programme and completed a Pittsburgh Sleep Quality Index questionnaire to evaluate SQ and SD. Results: A Spearman's correlation showed an association between HbA1c, SQ and SD measures. A simple linear regression showed a significant large positive association (rs = 0.913, p < 0.001) and significant regression (F (1) = 39, p < 0.001) with an R2 of 0.842 between HbA1c level and SQ. Additionally, a significant large negative association (rs = 0.757, p < 0.001) and significant regression was found (F (1) = 39, p < 0.001) with an R2 of 0.570 between HbA1c and SD. Conclusions: This study suggests a relationship between SQ, SD and the elevation of HbA1c which may contribute towards prevalence of T2DM and may help to increase adherence to diabetes prevention programmes. [ABSTRACT FROM AUTHOR]

Type II diabetes mellitus (DM) is a proinflammatory process and a known risk factor for major adverse cardiac events (MACE). The same inflammatory markers may be present in prediabetes (pDM); however, the relationship between pDM by HbA1c and MACE is not well studied. We sought to see if pDM increases one's risk for MACE. We retrospectively studied patients at Beaumont Health, Michigan between 2006 and 2020. We divided patients into groups (G1–G5) based on haemoglobin A1c (HbA1c) trends over the study period as follows: G1: pDM patients who remained pDM; G2: pDM who progressed into DM; G3: pDM who normalized their HbA1c; G4: patients who maintained a normal HbA1c; and G5: patients with HbA1c persistently in the DM range. We compared MACE between the groups by univariate and multivariate regression analyses. A total of 119,271 patients were included in the study (G1: N = 13,520, G2: N = 6314, G3: N = 1585, G4: N = 15,018, G5: N = 82,834). Pairwise comparison revealed a statistically significant increase in the odds of MACE in all groups compared to those with normal HbA1c values (G4; p <.001). After adjusting for baseline characteristics, multivariate regression revealed elevated odds of MACE in patients with persistent pDM (G1; aOR = 1.087, p =.002) and diabetes (G2/G5; aOR = 1.25 and aOR = 1.18, p <.001) compared to individuals with normal HbA1c values. Prediabetes is a risk factor for MACE. Normalization of HbA1c values appears to decrease the adjusted risk for MACE and should be the goal in patients with pDM. Patients with prediabetes (pDM) are at increased risk for major cardiovascular events. Normalization of HbA1c in pDM patients may have a clinically significant benefit, in terms of lowering the MACE risk. Prediabetes patients who progress into diabetes mellitus may represent a particularly high-risk group. [ABSTRACT FROM AUTHOR]

Abstract Background To assess whether the agreement between fasting glucose and glycated proteins is affected by chronic kidney disease (CKD) in a community-based sample of 1621 mixed-ancestry South Africans. Methods CKD was defined as an estimated glomerular filtration rate

Purpose: This retrospective observational study aimed to comprehensively analyse the clinical profile and treatment modalities of patients diagnosed with type 2 diabetes mellitus (T2DM) who were treated at a tertiary care centre., Methods: The study included a cohort of 300 individuals who sought medical care at the hospital from January 2023 to January 2024. The analysis primarily examined parameters such as the mean number of anti-diabetic medications per prescription, the proportion of various categories of anti-diabetic medications prescribed, the predominant class and type of anti-diabetic medications prescribed, and the proportion of anti-diabetic medications prescribed from the essential drug lists., Results: The age distribution demonstrated that 52.0% of participants were above 60 years old, showcasing a substantial elderly representation. Gender distribution emphasized a male predominance at 65.0%, highlighting potential gender-specific implications in type II diabetes. The blood profile analysis of patients with T2DM revealed a range of values for key parameters. Fasting blood glucose levels ranged from a minimum of 101 mg/dL to a maximum of 359 mg/dL, with a mean of 180.01 mg/dl. The comprehensive analysis of anti-diabetic drug utilization, based on the total number of units prescribed, sheds light on the diverse treatment approaches employed for managing diabetes mellitus (DM). Insulin, comprising 31.3% of the total units, plays a pivotal role in glycemic control, with both regular and biphasic formulations contributing significantly at 26.3% and 9.3%, respectively. Among the 300 patients, the overall utilization of anti-diabetic drugs reveals that 38.7% of individuals are using a combination of insulin with oral anti-diabetic drugs, while 61.3% are relying on oral anti-diabetic drugs alone. The most frequently prescribed drug combinations for diabetes management include sulphonylurea with biguanides, emerging as the most prevalent combination with 22 occurrences., Conclusion: The study's findings contribute valuable insights into the socio-demographic profiles and anti-diabetic drug utilization patterns among diabetes patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Integral Institute of Medical Sciences and research centre, Lucknow, Uttar Pradesh, India issued approval Integral Institute of Medical Sciences. This retrospective, observational Study was conducted in Integral Institute of Medical Sciences, Department of Internal Medicine, Lucknow, with prior approval from the ethics committee. . 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, Jha et al.)

Diabetes mellitus is associated with increased risk of erectile dysfunction. Penile prosthesis implantation is an efficient therapeutic option for erectile dysfunction, but not without risk, as infection remains a prominent concern. This study investigates diabetes mellitus as a risk factor for penile prosthesis implantation infection and the relationship between haemoglobinA1c levels and infection rates. All diabetic patients with erectile dysfunction who underwent penile prosthesis implantation surgery between January 2012 and November 2019 at Hamad Medical Corporation, Qatar, were included in this retrospective observational study. A total of 599 diabetic patients with erectile dysfunction had penile prosthesis implantation. Mean age was 59.69 ± 31.19. Penile prosthesis implantation infection rate was 0.83% (5/599), while the mean haemoglobinA1c level was 7.58 ± 1.45 mmol/l (range: 4.1–12.6). A comparison between diabetic patients with penile prosthesis implantation infection and those without infection revealed no significant difference in the level of haemoglobinA1c between the two groups with mean haemoglobinA1c in patients with infected implants 7.14 and 7.59 for noninfected (p = 0.491). Limitations include retrospective single‐centre design and low‐infection rates reducing sample number. Penile prosthesis implantation infection rate in a large series of diabetic patients was low with no significant association between haemoglobinA1c level and penile prosthesis implantation infection observed. [ABSTRACT FROM AUTHOR]

Aims: The aim is to study the effect of glycaemic control by canagliflozin and its effect on insulin resistance (IR) and plasma ketone in type 2 diabetes mellitus (DM). Settings and Designs: The study was done at the Diabetes Clinic, General Medicine Department of the hospital. The study designed to be a prospective observational open-label study. Subjects and Methods: The study was conducted in 60 patients for 3 months. The patients were divided into two groups test and standard. Canagliflozin is given to test over- and above-standard treatment, and standard group is given to the standard treatment. Blood samples are collected at the beginning and at the end of the study. Parameters such as body weight, waist circumference, fasting blood glucose, haemoglobin A1c (HbA1c), plasma ketone and homeostatic model assessment-IR (HOMA-IR) were analysed. Statistical Analysis Used: Data obtained from the present studies were collected and analysed statistically using software IBM SPSS version 21. Results: Various parameters such as HbA1c and weight loss showed a significant difference before and after the study in both standard and test group, respectively. Whereas, other parameters such as HOMA-IR, waist circumference and fasting blood sugar levels showed significant difference only in the test group. Conclusions: Canagliflozin provided better glycaemic control in type 2 DM patients along with decreased IR and marked weight loss. Increased plasma ketone levels were noted during the course of the therapy to an extent which can be used up by the body as a fuel and not cause ketoacidosis.

Abstract Background Excess weight is a strong risk factor for the development of dysglycaemia. It has been suggested that changes in the metabolism microRNAs, small non-coding RNAs that regulate gene expression, could precede late glycaemic changes. Vitamin E in turn may exert important functions in methylation and gene expression processes. This study aimed to determine the effect of α-tocopherol on glycaemic variables and miR-9-1 and miR-9-3 promoter DNA methylation in overweight women. Methods A randomized, double-blind, exploratory, placebo-controlled study was conducted in overweight and obese adult women (n = 44) who ingested synthetic vitamin E (all-rac-α-tocopherol), natural source vitamin E (RRR-rac-α-tocopherol) or placebo capsules and were followed up for a period of 8 weeks. Supplemented groups also received dietary guidance for an energy-restricted diet. An additional group that received no supplementation and did not follow an energy-restricted diet was also followed up. The intervention effect was evaluated by DNA methylation levels (quantitative real-time PCR assay) and anthropometric and biochemical variables (fasting plasma glucose, haemoglobin A1C, insulin, and vitamin E). Results Increased methylation levels of the miR-9-3 promoter region (P

What is known and objective: Exenatide is widely used in the treatment of type 2 diabetes mellitus (T2DM) because of its established effect on lowering glucose and promotion of weight loss. However, therapeutic response to exenatide varies considerably among patients with T2DM. The purpose of this study was to determine which variables can predict the response to exenatide and to individualize specific therapies for patients with T2DM who need treatment with exenatide. Methods: This is a retrospective cohort study of patients with T2DM who were treated with exenatide twice daily as a part of their diabetes care for at least 12 months. Patients were categorized into two cohorts based on glycaemic response to exenatide use: responders and non‐responders. Results and discussion: One hundred forty‐eight patients met the inclusion criteria; among them, 92 responded with an HbA1C reduction ≥1.0% from baseline HbA1C and 56 did not respond to exenatide after 6 months of exenatide treatment. Binary logistic regression analysis revealed that baseline HbA1C and duration of diabetes were identified as predictors of HbA1C reduction ≥1% at 6 months (P <.05). Linear regression analysis further identified that patients with a higher baseline HbA1C (≥7.4%) and shorter duration of diabetes (≤15.0 years) were likely to respond to exenatide, whereas those with a lower baseline HbA1C (<7.4%) and longer duration of diabetes (>15.0 years) were not likely to respond to exenatide. What is new and conclusion: Our data indicate that T2DM patients with a higher baseline HbA1C and a shorter duration of diabetes are more likely to have a glycaemic response to exenatide than those with a lower baseline HbA1C and a longer duration of diabetes. The identification of predictors of therapeutic response to exenatide can provide clinically useful information for characterizing the patients who could receive the greatest benefit from exenatide. [ABSTRACT FROM AUTHOR]

This study evaluated the biochemical, molecular, and histopathological mechanisms involved in the hypoglycaemic effect of zinc oxide nanoparticles (ZnONPs) in experimental diabetic rats. ZnONPs were prepared by the sol–gel method and characterised by scanning and transmission electron microscopy (SEM and TEM). To explore the possible hypoglycaemic and antioxidant effect of ZnONPs, rats were grouped as follows: control group, ZnONPs treated group, diabetic group, and diabetic + ZnONPs group. Upon treatment with ZnONPs, a significant alteration in the activities of superoxide dismutase, glutathione peroxidase, and the levels of insulin, haemoglobin A1c, and the expression of cluster of differentiation 4+ (CD4+), CD8+ T cells, glucose transporter type‐4 (GLUT‐4), tumour necrosis factor, and interleukin‐6 when compared to diabetic and their control rats. ZnONPs administration to the diabetic group showed eminent blood glucose control and restoration of the biochemical profile. This raises their active role in controlling pancreas functions to improve glycaemic status as well as the inflammatory responses. Histopathological investigations showed the non‐toxic and therapeutic effect of ZnONPs on the pancreas. TEM of pancreatic tissues displayed restoration of islets of Langerhans and increased insulin‐secreting granules. This shows the therapeutic application of ZnONPs as a safe anti‐diabetic agent and to have a potential for the control of diabetes. [ABSTRACT FROM AUTHOR]

Background: The primary aim of this study was to assess the utility of fasting plasma glucose (FPG) and HbA1c to identify diabetes by the 2‐hour plasma glucose (PG) criterion in the Korean population at high risk for diabetes. Methods: A total of 1646 participants with a body mass index of ≥23 kg/m2 without having a history of diabetes were recruited in this study. The cut‐off values of FPG and HbA1c for detecting diabetes were identified using the Youden index using receiver operating characteristic (ROC) analysis. The gold standard for diabetes prediction was defined by the 2‐hour PG level of ≥200 mg/dL. Results: The participants comprised 54.0% women, and the mean age of all participants was 55.0 ± 8.1 years. At baseline, FPG was 104.1 ± 14.2 mg/dL, the 2‐hour PG value was 162.9 ± 55.3 mg/dL, and HbA1c was 5.9% ± 0.5%. Four hundred and forty‐six subjects (27.1%) were diagnosed with diabetes and 976 subjects (59.3%) were determined to be at prediabetes. The area under the ROC curve (AUC) of FPG and HbA1c for diabetes were 0.776 and 0.802, while the AUC of FPG and HbA1c for prediabetes were 0.515 and 0.477. The optimal cut‐off value for diagnosing diabetes of FPG and HbA1c were 104.5 mg/dL (sensitivity 75.8%, specificity 67.5%) and 5.9% (sensitivity 80.6%, specificity 63.8%), respectively. Conclusions: FPG of 104.5 mg/dL and HbA1c value of 5.9% (41 mmol/mol) can be used as an optimal screening value for diabetes by 2‐hour PG criterion in the Korean population at high risk for diabetes. [ABSTRACT FROM AUTHOR]

Retinopathy of prematurity (ROP) is a potentially serious eye disorder affecting very preterm infants. Non-proliferative ROP (NP-ROP), also known as Early Stage ROP, is characterized by deficient retinal angiogenesis. Proliferative ROP (P-ROP), also known as Late Stage ROP, is characterized by pathologic angiogenesis. The use of neonatal haemoglobin A1C as a biomarker for ROP has not yet been evaluated. We modified the Haemoglobin A1C assay for use with neonatal dried blood spots (DBS) and then assessed A1C levels via Elisa immunoassay on DBS from 43 preterm infants (with gestational ages 26–28 weeks). We measured A1C on DBS collected at <1 week and 4 weeks of chronological age. Compared to matched counterparts without ROP, there is significantly lower HbA1c in infants who develop NP-ROP, this occurs at Week 4 (p=0.004), but is not seen at Week 1; there is significantly higher HbA1c in infants with P-ROP, this occurs both at Week 1 (p<0.05) and Week 4 (p=0.005). The A1C test, modified for use with DBS, is a feasible biomarker for ROP; low A1C is a potential biomarker for non-proliferative ROP and high A1C is for proliferative ROP. [ABSTRACT FROM AUTHOR]