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Intermittent fasting (IF) regimens have emerged as a dietary tool to improve the glycemic profile, but a critical appraisal of clinical studies assessing the effects of IF regimens in patients with diabetes is needed. Thus, this review encompasses clinical studies examining the impact of different IF regimens on markers of glycemic control in patients with diabetes. Furthermore, clinical nuances relative to pharmacological treatment are also addressed, mainly insulin therapy, to discuss the risk of hypoglycemic events. Only a handful of clinical studies have investigated the effects of IF on patients with diabetes. Overall, IF regimens may elicit modest benefits on glycemic parameters in patients with diabetes, but their effects are not necessarily greater than those of control diets. Last, although IF regimens may be considered safe for patients receiving insulin therapy within interventional and observational research, markers of glycemic control must be constantly monitored in clinical practice to reduce the risk of hypoglycemia and its related complications. [ABSTRACT FROM AUTHOR]

Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by impaired glucose regulation. This study aimed to compare the effectiveness of Acceptance-Based Emotion Regulation Therapy (ABERT) and Acceptance and Commitment Therapy (ACT) on HbA1c levels and self-care behaviors in patients living with T2D. Participants were randomly assigned to ABERT (n = 16), ACT (n = 17), and control (n = 17) groups. The treatment groups received therapy based on treatment manuals, while the control group received treatment as usual (i.e., standard medical treatment). Assessments were conducted pre- and post-treatment, with a six-month follow-up, measuring HbA1c levels and self-care behaviors. Results from repeated-measures ANOVAs and post-hoc analysis demonstrated that both ABERT and ACT led to significant improvements compared to the control group. However, ABERT was more effective than ACT in reducing HbA1c levels and enhancing self-care behaviors, with sustained benefits observed in the long term. At the individual level, a higher percentage of participants in the ACT and ABERT groups experienced a global improvement in HbA1c compared to the control group during the post-test assessment. Furthermore, a higher percentage of participants in the ABERT group showed global improvement compared to both the ACT and control groups in the post-test to follow-up period. No statistically significant differences in self-care behaviors were observed between the groups at the individual level. These findings suggest that the ABERT may be a valuable intervention for individuals living with T2D, though more studies are needed to examine this subject. [ABSTRACT FROM AUTHOR]

Background: Health of children plays an indispensable role in the development of the country. Nutrition and health of the tribal children continue to be a pressing concern in India. Biochemical and hematological examination of children is an essential tool for assessment of health status, early identification of preventable risk factors and for diagnosis of various diseases. Objective: To assess the health status of Hakki Pikki tribal school children by evaluating the biochemical and haematological parameters. Materials and Methods: This was a community based cross sectional study of 76(Boys-32 and Girls-44) Hakki Pikki tribal children studying at Government Higher Primary School, Hakki Pikki Colony, Gowripura, Bengaluru Karnataka, India. Biochemical and haematological parameters were determined in accordance with standard operating procedures followed by good laboratory practices. Results: The study group consisted of children aged between 6 to 17 years, among them 32 students were males and 44 were females.21(11-boys and 10-girls) children were under weight and 02 girls were overweight. The common ailments found were, dental carries (2.63%), ear discharge (2.63%), anaemia (3.94%), Impetigo (7.89%). Comparing between Boys and Girls less than or equal to 10 years of age there was a significant difference in Creatinine as p-value< 0.05. There was a significant difference in Creatinine, Uric acid, AST, ALT, total protein, albumin, HbA1C and Haemoglobin when comparing between Boys and Girls of age greater than 10 years p-value < 0.05.In these tribal children the distribution of biochemical and haematological parameters values considerably follows the reported reference values. Conclusions: This study highlights a puzzling situation of health status among these Hakki Pikki tribal children due to apparent change in socio cultural, lifestyle, nutrition, and urbanization. Under weight has emanated as a solemn problem unless addressed. [ABSTRACT FROM AUTHOR]

Methods: Web of Science, Cochrane library and PubMed were systematically searched up to January 2024 to identify studies examining the impact of financial incentives on diabetes management in patients. Studies were evaluated based on the robustness of their methodology, participant numbers, and quality scores. The Cochrane risk-of-bias tool was applied for randomized controlled trials, while the Newcastle–Ottawa Scale was used for non-randomized controlled trials to assess study quality. Due to the heterogeneity of the included studies, a narrative synthesis approach was utilized. Results: In the study, we included 12 published research studies. Five studies investigated the influence of financial incentives on patient behavior, all demonstrating a significant positive impact on behaviors such as blood glucose monitoring, medication adherence, and physical activity. 10 studies analyzed the impact of financial incentives on HbA1c levels in diabetes patients. Among them, 5 studies reported that financial incentives could improve HbA1c levels through longitudinal historical comparisons. The other 5 studies did not find significant improvements compared to the control group. Three studies explored long-term effects, two studies targeting the adolescent population had no impact, and one study targeting adults had a positive impact. Conclusions: In summary, this review found that financial incentives can positively influence patient behavior and enhance compliance, but their impact on HbA1c levels is inconsistent. Financial incentives may help adult patients maintain behavior even after the withdrawal of incentives. [ABSTRACT FROM AUTHOR]

Prevalence of heart failure (HF) and diabetes are markedly increasing globally. In a population of HF patients, approximately 40% have diabetes which is associated with a more severe HF, poorer cardiovascular outcomes and higher hospitalization rates for HF than HF patients without diabetes. Similar trends were shown in HF patients with prediabetes. In addition, the association between HF and renal function decline was demonstrated in patients with or without diabetes. However, the exact prevalence of dysglycemia in HF patients requires further investigation aiming to clarify the most accurate test to detect dysglycemia in this population. The relationship between HF and diabetes is complex and probably bidirectional. In one way, patients with diabetes have a more than two-fold risk of developing incident HF with reduced or preserved ejection fraction than those without diabetes. In the other way, patients with HF, when compared with those without HF, show an increased risk for the onset of diabetes due to several mechanisms including insulin resistance (IR), which makes HF emerging as a precursor for diabetes development. This article provides epidemiological evidence of undetected dysglycemia (prediabetes or diabetes) in HF patients and reviews the pathophysiological mechanisms which favor the development of IR and the risks associated with these disorders in HF patients. This review also offers a discussion of various strategies for the prevention of diabetes in HF patients, based first on fasting plasma glucose and HbA1c measurement and if normal on an oral glucose tolerance test as diagnostic tools for prediabetes and unknown diabetes that should be performed more extensively in those patients. It discusses the implementation of diabetes prevention measures and well-structured management programs for HF patients who are generally overweight or obese, as well as current pharmacotherapeutic options for prediabetes, including sodium–glucose cotransporter 2 inhibitors which are among the pillars of HF treatment and which recently showed a benefit in the reduction of incident diabetes in HF patients. Thus, there is an urgent need of routine screening for dysglycemia in all HF patients, which should contribute to reduce the incidence of diabetes and to treat earlier diabetes when already present. [ABSTRACT FROM AUTHOR]

Background: The early diagnosis of pancreatic cancer (ICD-10 C25) can improve the patient's prognosis. The association between pancreatic cancer and type 2 diabetes (T2D) is known, but not yet fully understood. It is, therefore, necessary to investigate the impact of hemoglobin A1c (HbA1c) serum levels on pancreatic cancer development and the potential intervention options. Methods: In the case–control study, patients from the German IQVIATM Disease Analyzer database aged ≥18 years with a diagnosis of pancreatic cancer (ICD-10 C25) and a diagnosis of T2D (ICD-10: E11) were included. The patients' propensity score matched 1:5 with individuals without pancreatic cancer. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CI). Results: An elevated serum HbA1c prior to the index date was found to be significantly associated with an increased risk of a subsequent pancreatic cancer diagnosis for the mean HbA1c values of 6.5–8.4% (OR: 1.38; 95% CI: 1.22–1.57) as well as for mean HbA1c values ≥8.5% (OR: 1.41; 95% CI: 1.16–1.73). The only antihyperglycemic agent negatively associated with the subsequent pancreatic cancer diagnosis was the sodium–glucose cotransporter-2 (SGLT-2) inhibitor, with an odds ratio of 0.80 (95% confidence interval: 0.74–0.87 per year of therapy). This correlation was observed in both age- and sex-stratified subgroups. Conclusions: The data indicate that elevated serum HbA1c levels in patients with T2D are associated with an increased risk of pancreatic cancer development. It is possible that SGLT2 therapy may prove an effective means of reducing the risk of pancreatic cancer, thereby offering a potential avenue for the future reduction in pancreatic cancer incidence in patients with T2D. [ABSTRACT FROM AUTHOR]

The article explores the effects of the GLP-1 RA efpeglenatide on HbA1c levels in individuals with type 2 diabetes mellitus. The study found that efpeglenatide significantly reduced HbA1c levels, but the nonglycaemic effects of the drug, such as weight loss, did not account for a significant portion of this reduction. The document provides additional information on the study and discusses potential mechanisms for efpeglenatide's glucose-lowering effects. It concludes that further research is needed to understand if these mechanisms apply to other similar drugs. [Extracted from the article]

Background: The purpose of the study was to determine the effect of insulin pen training using the Teach-Back method in older patients with type 2 diabetes (T2D) on their self-management of insulin treatment, quality of life (QoL), and glycated hemoglobin (HbA1c) levels. Methods: Participants included 25 patients in the intervention group, with a mean age of 80.76 ± 6.132 years, and 24 patients in the control group, with a mean age of 81.29 ± 4.920 years. All participants were older people who had previously been diagnosed with T2D, had been using insulin for at least 6 months, and lived in rural areas. Teach-Back pen training was provided to the intervention group, while general diabetes education was provided to the control group. One-way variance analysis, paired-samples t-test and independent sample t-test were used. The self-management of insulin treatment, QoL and HbA1c levels were determined before training and after 3 months. The study was conducted between December 2022 and April 2023. Results: A significant difference was found in the mean scale scores between the intervention group and control group after training. The mean self-management of insulin treatment and QoL scale scores of the intervention group were significantly higher than those of the control group after training. The post-training HbA1c levels in the intervention group were lower than the pre-training levels. Conclusions: Teach-Back training improved diabetes self-management and QoL and decreased HbA1c levels in older patients with T2D living in a rural community. [ABSTRACT FROM AUTHOR]

Background: Polycystic Ovary Syndrome (PCOS) is a hormonal disorder characterized by irregular periods, excess androgen levels, and polycystic ovaries, affecting many women of reproductive age. Methods and Results: This study employed statistical and molecular analyses to compare hormone and metabolic markers between PCOS patients and controls. Sanger sequencing identified two INSR gene variants linked to high insulin and pre-diabetic conditions. Statistically, no significant age differences were detected (p = 0.492) between the overall PCOS patient pool and controls. However, a substantial variation in Vitamin D levels was observed within PCOS patients compared to controls (p = 0.0006), suggesting an association with PCOS. Correlations between Vitamin D and insulin, as well as HbA1c levels (R2 = 0.141 and 0.143, respectively), suggest Vitamin D’s potential impact on glycemic control. Significant differences were found in HbA1c (p < 0.0001), insulin (p < 0.0001), and LDL (p = 0.0004) levels between PCOS patients and controls, highlighting marked disparities in these metabolic markers. LH levels also showed a significant contrast (p < 0.0001), while progesterone levels displayed a notable difference (p = 0.007) between the two groups. Correlation analyses within PCOS patients demonstrated associations among LDL, HbA1c, and insulin, with no such correlations observed in control cases. Additionally, Sanger sequencing identified two INSR gene variants, c.3614C > T (p.Pro1205Leu) and c.3355C > T (p.Arg1119Trp), associated with high insulin, LH, and pre-diabetic conditions. These amino acid changes may trigger metabolic imbalances and hormonal irregularities, potentially contributing to the development of PCOS. Conclusions: The findings highlight the multifaceted nature of PCOS, revealing significant metabolic, hormonal, and genetic differences compared to controls. These insights may inform tailored interventions and management strategies for the complex associations characteristic of PCOS. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare different intensities of aerobic exercise for patients with knee osteoarthritis (KOA) and type 2 diabetes mellitus (T2DM) in terms of glycemic control, pain relief, and functional outcomes. Methods: A prospective randomized open-label parallel multicenter clinical trial conducted at two hospitals in Shanghai and Sichuan that included 228 patients with type 2 diabetes mellitus (T2DM) and knee osteoarthritis (KOA). Enrollment occurred between January 2021 and February 2023, and follow-up was completed in September 2023. Participants were randomized to threshold training/high-intensive stationary cycling training (n=76), intensive endurance/moderate-intensive stationary cycling training (n=77), and regular rehabilitation programs (n=75). The primary outcome at the 6-month follow-up was the HbA1c level. Key secondary outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale of pain and quality of life. Results: Of 228 patients, 212 (93%) completed the trial. The mean adjusted (sex, baseline BMI, and baseline outcome measures) HbA1c level at the 6-month follow-up decreased significantly in the high-intensive training group compared with other groups (high-intensity group vs. control group; difference, 0.51%, 95% confidence interval, 0.05% to 1.15%). Mean KOOS subscales of pain and quality of life were statistically significantly different between the control group and moderate-intensity or high-intensity groups, but no statistical differences were noted between the different intensities of aerobic exercise. Patients in all groups achieved a greater reduction in BMI but no significant differences were observed between groups. Conclusion: In KOA and T2DM patients, high-intensity stationary cycling can significantly improve glycemic control compared with moderate-intensity and regular rehabilitation programs. However, high-intensity stationary cycling does not exert a superior effect on pain relief and functional improvement for KOA compared with moderate-intensity and regular rehabilitation programs. [ABSTRACT FROM AUTHOR]

Background: Associations between HbA1c and adverse outcomes in ischemic and hemorrhagic stroke have been confirmed. It is still unclear whether HbA1c is related to the activities of daily living (ADL) score in complex chronic patients (CCP) with and without intracerebral hemorrhage (ICH). Aim: The associations between HbA1c and ADL (Barthel score) in CCP with ICH and without ICH were evaluated, respectively. Methods: We have analyzed data from a previous cohort study involving in 3594 CCPs without a ICH history at baseline, who were followed up for 5 years to assess ICH episode. Results: One hundred sixty-one ICH case were detected in a total of 3594 patients during the period of follow up for 5 years. Our nonlinear analysis suggested positive trends on the association between HBA1c and Barthel score in ICH and non-ICH patients, respectively. The multivariate linear regression analysis showed that elevated HbA1c was positively associated with a higher Barthel score among all study population (β = 1.25, 95% CI: 0.92, 1.59; P < 0.0001) with adjusted age and sex. Among non-ICH patients, increased HbA1c was still positively associated with an increased Barthel score (β = 1.24, 95% CI: 0.90, 1.58; P < 0.001). However, HbA1c appeared to have no any relationship with Barthel score in ICH patients (β = 1.87, 95% CI: -0.07, 3.82; P = 0.0613) after adjustment for age and sex. By additionally using sensitivity analysis, we still observed that the strong relationship was still existed in non-ICH patients (β = 0.90, 95% CI: 0.56, 1.24; P < 0.001) but not in ICH patients (β = 1.88, 95% CI: -0.10, 3.86; P = 0.0649). Conclusion: We observed for the first time that elevated HbA1c is associated with better ADL in CCPs without ICH but not in those with ICH. This interesting discovery contradicts the traditional adverse effects of elevated HbA1c. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions To conduct a systematic review in order to better understand the association of glycaemic risk factors and diabetes duration with risk of heart failure (HF) in individuals with type 2 diabetes (T2D).We identified longitudinal studies investigating the association of glycaemic factors (glycated haemoglobin [HbA1c], HbA1c variability, and hypoglycaemia) and diabetes duration with HF in individuals with T2D. Hazard ratios and odds ratios were extracted and meta‐analysed using a random‐effects model where appropriate. Risk of bias assessment was carried out using a modified Newcastle–Ottawa Scale. Egger's test along with the trim‐and‐fill method were used to assess and account for publication bias.Forty studies representing 4 102 589 people met the inclusion criteria. The risk of developing HF significantly increased by 15% for each percentage point increase in HbA1c, by 2% for each additional year of diabetes duration, and by 43% for having a history of severe hypoglycaemia. Additionally, variability in HbA1c levels was associated with a 20%–26% increased risk of HF for each unit increase in the metrics of variability (HbA1c standard deviation, coefficient of variation, and average successive variability). All included studies scored high in the risk of bias assessment. Egger's test suggested publication bias, with trim‐and‐fill analyses revealing a significant 14% increased risk of HF per percentage point increase in HbA1c.Glycaemic risk factors and diabetes duration significantly contribute to the heightened risk of HF among individuals with T2D. A reduction in risk of HF is anticipated with better management of glycaemic risk factors. [ABSTRACT FROM AUTHOR]

Background: While the high haemoglobin glycation index (HGI) has been extensively investigated in diabetic populations, its impact on patients with diabetic kidney disease (DKD) remains unclear. Methods: We examined data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 1999 and 2018. HGI was determined using the formula recommended by Hempe et al., which calculates the difference between measured and predicted HbA1c. Predicted HbA1c was derived from the equation: 0.024 FPG + 3.1. National death index records up to December 31, 2019, were utilized to assess mortality outcomes. To estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for both all-cause and cardiovascular disease (CVD) mortality, we utilized Cox proportional hazard models. A restricted cubic spline analysis was performed to explore the potential nonlinear relationship between HGI levels and mortality. Results: Our cohort study comprised data from 1,057 participants with DKD (mean [SE] age, 61.61 [0.57] years; 48.24% female). The mean HGI level was 0.44 (SE 0.04). Over a median follow-up period of 6.67 years, we observed 381 deaths, including 140 due to CVD. Compared with participants in the second tertile of HGI levels (0.03–0.74), those in the lowest tertile of HGI (-5.29–0.02) exhibited an all-cause mortality hazard ratio of 1.39 (95% CI, 1.02–1.88) and a CVD mortality hazard ratio of 1.10 (95% CI, 0.67–1.81). Conversely, participants in the highest tertile (0.75–9.60) demonstrated an all-cause mortality hazard ratio of 1.48 (95% CI, 1.05–2.08) and a CVD mortality hazard ratio of 2.06 (95% CI, 1.13–3.77) after further adjusting for HbA1c and other important variables. Additionally, a restricted cubic spline analysis revealed a U-shaped relationship between HGI and all-cause mortality (P < 0.001 for nonlinearity) and a J-shaped relationship between HGI and CVD mortality (P = 0.044 for nonlinearity). Conclusions: Our cohort study suggests that HGI in DKD populations exhibits a U-shaped association with all-cause mortality and a J-shaped association with CVD mortality, independent of HbA1c levels. [ABSTRACT FROM AUTHOR]

Background: Diabetes and poor glycaemic control have been shown to negatively impact cognitive abilities, while also raising risk of both mood disorders and brain structural atrophy. Sites of atrophy include the hippocampus, which has been implicated in both memory performance and depression. The current study set out to better characterise the associations between poor glycaemic control, memory performance, and depression symptoms, and investigate whether loss of hippocampal volume could represent a neuropathological mechanism underlying these. Methods: 1331 participants (60.9% female, age range 18–88 (Mean = 44.02), 6.5% with likely diabetes) provided HbA1c data (as an index of glycaemic control), completed a word list learning task, and a validated depression scale. A subsample of 392 participants underwent structural MRI; hippocampal volumes were extracted using FreeSurfer. Results: Partial correlation analyses (controlling for age, gender, and education) showed that, in the full sample, poorer glycaemic control was related to lower word list memory performance. In the MRI sub-sample, poorer glycaemic control was related to higher depressive symptoms, and lower hippocampal volumes. Total hippocampus volume partially mediated the association between HbA1c levels and depressive symptoms. Conclusions: Results emphasise the impact of glycaemic control on memory, depression and hippocampal volume and suggest hippocampal volume loss could be a pathophysiological mechanism underlying the link between HbA1c and depression risk; inflammatory and stress-hormone related processes might have a role in this. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Discussion Hypoglycemia causes significant morbidity and mortality in patients with severe eating disorders. We measured average glycemic levels using hemoglobin A1C (HbA1C) in patients hospitalized for extreme anorexia nervosa (AN) and avoidant restrictive food intake disorder (ARFID).This was a prospective, single‐center cohort study conducted in an inpatient medical stabilization unit. Clinical outcomes were compared using paired t‐tests. Additional analysis comparing clinical variables between undetectable and detectable HbA1c used two‐sample t‐tests.The study cohort consisted of 148 individuals, 90% female, average age of 31 years, average admit body mass index of 12.5 kg/m2, and mean percentage ideal body weight of 60.1%. Diagnoses included AN‐restricting (54%), AN‐binge purge (39%), and ARFID (7%). HbA1C and fructosamine levels decreased from admission to discharge. Serum glucose levels increased significantly from admission to discharge. Mean HbA1C was 4.7% on admission and 4.3% on discharge.This study evaluated mean blood glucose levels using HbA1C in patients with extreme forms of AN and ARFID. Given the concern for morbidity and mortality from hypoglycemia in this population, which can be overlooked on a single point‐of‐care glucose measurement, HbA1C is a valuable laboratory measure of glycemic status in patients with extreme forms of eating disorders. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) and obesity are prevalent metabolic disorders in the Indian population, often linked to lifestyle changes leading to metabolic alterations. Elevated levels of circulating saccharides contribute to various metabolic disturbances, including T2DM and associated complications such as renal and retinal dysfunction. This study aimed to identify individuals at risk of T2DM through lipid profiling in Bhiwadi, Rajasthan. A total of 800 participants were enrolled, and parameters including lipid profiling levels (HDL, Cholesterol) were assessed. Among the participants, 400 males and 400 females exhibited lipid profiles indicative of T2DM risk. These findings underscore the significance of lipid profiling in identifying individuals at risk of T2DM and obesity-related complications. Lifestyle modifications and targeted interventions are crucial to mitigate the growing burden of these metabolic disorders, particularly in regions like Bhiwadi, Rajasthan, India. [ABSTRACT FROM AUTHOR]

HbA1c is a pivotal biomarker in diabetes management, reflecting long-term glycaemic control. HbA1c is often measured with capillary electrophoresis, which generally is a very precise technique, but there can be interference, especially in the case of haemoglobin diseases. Thus, in patients with underlying conditions, the accurate measurement of HbA1c can be challenging. We present a case of special interference in a 74-year-old female patient referred to a HbA1c test, in whom the measurement was thought to be significantly affected by hyperleukocytosis and led to an unexpected diagnosis of leukemic low-grade lymphoma. This case report highlights the underrecognized potential interference of leukocytosis in HbA1c measurement. It underscores the importance of clinical vigilance when interpreting HbA1c results in patients with underlying haematological conditions. [ABSTRACT FROM AUTHOR]

Background: The interplay between serum albumin levels and HbA1c-defined glycemic status in individuals with diabetes is critical for understanding the metabolic and clinical outcomes of glycemic control. This study aims to investigate the correlation between serum albumin and HbA1c levels to elucidate their relationship and potential implications for diabetic management. Methods: A retrospective study was conducted involving 100 diabetic patients attended General medicine OPD,GGH Anantapur . Serum albumin and HbA1c levels were measured using standard biochemical methods. Patients were categorized into three groups based on their HbA1c levels: good glycemic control (HbA1c < 7%), moderate glycemic control (HbA1c 7- 8%), and poor glycemic control (HbA1c > 8%). Statistical analysis was performed to evaluate the correlation between serum albumin and HbA1c levels across these groups. Results: The study revealed a significant inverse correlation between serum albumin and HbA1c levels (r = -0.45, p < 0.001). Patients with poor glycemic control exhibited significantly lower serum albumin levels compared to those with good and moderate glycemic control. The mean serum albumin levels were 4.2 ± 0.3 g/dL in the good glycemic control group, 3.8 ± 0.4 g/dL in the moderate glycemic control group, and 3.5 ± 0.5 g/dL in the poor glycemic control group. Conclusion: Our findings suggest a significant inverse correlation between serum albumin and HbA1c levels in diabetic patients, indicating that lower serum albumin levels are associated with poorer glycemic control. Monitoring serum albumin levels alongside HbA1c could provide additional insights into the metabolic status and guide more effective management strategies for individuals with diabetes. Further research is warranted to explore the underlying mechanisms and potential therapeutic implications of this relationship. [ABSTRACT FROM AUTHOR]

The impact of seven hemoglobin variants (Hb Q-Thailand, Hb G-Honolulu, Hb Ube-2, Hb New York, Hb J-Bangkok, Hb G-Coushatta, and Hb E) on the outcome of HbA1c was investigated for six methods by comparing with liquid chromatography-tandem mass spectrometry (LC/MS/MS) reference method. Twenty-nine normal and 112 variant samples were measured by LC/MS/MS, Sebia Capillarys 3 TERA, Intelligene Biosystems QuanTOF, Premier Hb9210, Arkray HA-8190V, Bio-Rad D-100, and Tosoh G11, then evaluated for correlation, consistency, and mean relative bias among six methods. The lowest biological variation bias of ±2.8 % was an acceptable standard. All methods showed poor correlation and consistency with LC/MS/MS for Hb E. The unacceptable biases were observed for Capillarys 3 TERA (−14.4 to −3.7 % for Hb Q-Thailand, Hb Ube-2, Hb New York, Hb J-Bangkok and Hb E), QuanTOF (−8.3 to −2.9 % for Hb Ube-2, Hb New York and Hb G-Coushatta), Premier Hb9210 (−18.3 to −3.6 % for Hb Q-Thailand, Hb Ube-2, Hb New York, Hb J-Bangkok and Hb E), HA-8190V variant mode (−17.3 to 6.6 % for Hb G-Honolulu, Hb Ube-2, Hb New York, Hb G-Coushatta and Hb E). All variant samples showed larger biases than ±2.8 % comparing HA-8190V fast mode, D-100, and G11 with LC/MS/MS. The accuracy of different HbA1c methods was influenced by some Hb variants, especially Hb Ube-2 and Hb New York. Thus, laboratories need to choose appropriate methods to measure HbA1c with different Hb variants. [ABSTRACT FROM AUTHOR]

Objective: The aim of this meta-analysis was to investigate the effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on blood glucose and weight in adolescents with overweight/obesity and/or type 2 diabetes mellitus (T2DM) aged <18 years. Methods: PubMed, Embase, Web of Science, and Cochrane Library were searched for all randomized controlled trials (RCTs) up to August 2023 comparing GLP-1RAs with placebo in overweight/obese and/or T2DM adolescents and extracted relevant data for meta-analysis. Results: Fourteen RCTs were included in the meta-analysis with a total of 1,262 participants. Results revealed that the GLP-1RAs group had a more significant reduction in glycosylated hemoglobin A1c (HbA1c; risk difference (RD)=-0.34%, p<0.001) than the control group. However, there was no difference in fasting plasma glucose [fasting plasma glucose (FPG); RD=-2.07 mg/dL, p=0.065] between the two groups. Nonetheless, the experimental group that received exenatide showed no significant reduction in HbA1c (p=0.253) and FPG (p=0.611) between the two groups. The GLP-1RAs group had a more significant decline in body weight (RD=-4.28 kg, p=0.002) and body mass index (BMI) (RD=-1.63 kg/m2, p=0.002) compared to the control group. The experimental group was given liraglutide (RD=-2.31 kg, p=0.038) or exenatide (RD=-2.70 kg, p<0.001). Compared to the control group, the experimental group had a more significant drop in body weight than the control group. However, for the experimental group that received liraglutide, the BMI had a no significant reduction between the two groups (RD=-0.81 kg/m2, p=0.260). For the experimental group using exenatide, BMI declined more significantly in the intervention group than in the control group (RD=-1.14 kg/m2, p<0.001). Conclusion: This study showed that GLP-1RAs reduced HbA1c, FPG, and weight loss in overweight/obese and/or T2DM adolescents. Liraglutide was better than exenatide in terms of glucose reduction. Nevertheless, in terms of weight control, exenatide was more effective than liraglutide. [ABSTRACT FROM AUTHOR]

Successful management of type 1 diabetes (T1D) requires not only optimal glycemic outcomes, but also a holistic approach that encompasses all aspects of life and recommendations to address needs. Current goals include optimal glycemic values, quality of life and life expectancy similar to peers, prevention of long-term complications, prevention of severe hypoglycemia as far as possible and facilitation of glucose management. The International Society for Pediatric and Adolescent Diabetes (ISPAD) has been updating its guidelines for diabetes care every four years since 1995, covering more and more topics. For optimal metabolic outcomes, diabetes teams need to follow these current recommendations, adapt them to their clinical practice and provide guidance to people with T1D and their families. In this review, in the light of ISPAD 2018-2022 guidelines and clinical experiences, "10 Key Recommendations", emphasizing the importance of teamwork and the use of technology, current T1D treatment is described for practical applications. [ABSTRACT FROM AUTHOR]

Objective: This study sought to quantify the link between low density lipoprotein (LDL) and cholesterol, glycemic control as measured by Hemoglobin A1c (HbA1c) level, and the impact of weight changes on subsequent risk of chronic heart disease in type-2 diabetes mellitus patients. Methods: This study was conducted at Primary Care Clinics from April to September 2023. The data were retrieved from the e-SiHi (a patient care management system). Appropriate parametric tests and non-parametric analysis were applied following the normality of the data. Results: In diabetes mellitus (DM) patients, the Pearson correlation between the cholesterol and LDL relationship was found to be strongly positive and statistically significant (r = .877, p <.001). HbA1c and cholesterol were moderately positive and statistically significant (r =.330, p =.003). Pearson correlation between DM and weight was found to be positive and statistically significant (r =.212, p =.05). Chi-square analysis showed an association of DM with Hypertension, and this association was also significant; X2 (1, n = 83; 11.877; P <.001). Conclusion: Diabetes mellitus regardless of gender, has a strong association with hypertension and weight gain. In DM patients, cholesterol and HbA1c are positively correlated. There is a strong need that primary care physicians should persistently advise for lifestyle changes in all their consultations with DM patients. [ABSTRACT FROM AUTHOR]

Objective: In the present study, we aimed to evaluate the association of glycosylated hemoglobin A1c (HbA1C) and cardiac troponin I levels (cTn1) with the 30-day mortality and severity of myocardial infarction in patients presenting with ACS. Methods: The present cross-sectional study was done over two years in the medical centers of Zabol University of Medical Sciences. All patients who were referred to the cardiovascular emergency department between 2017 and 2019 presenting with acute coronary syndrome were included. Serum cTn1 and HbA1C concentration were measured between 12 and 48 h after the onset of chest pain, and the mortality rate of these patients was studied by the census method. All statistical analysis was done using SPSS software. Results: There was a significant difference in the cTn1 level between patients with SYNTAX scores higher than 22 and the rest of patients (96 ± 11.3 versus 71 ± 17.8). The patients who were diagnosed with acute MI showed significantly higher levels of HbA1C compared to unstable angina cases (6.9 ± 1.2 versus 5.2 ± 0.8). The results of pearson correlation showed a positive correlation between HbA1C levels and cTn1 levels (correlation coefficient: 0.80, p < 0.001) (Fig. 1). In addition, there was a positive correlation between HbA1C and SYNTAX score (correlation coefficient: 0.45, p < 0.001). The HbA1C level was significantly higher among the deceasesd patients compared to the survived cases (7.8 ± 0.7 versus 6.0 ± 1.3). Conclusion: In conclusion, our study underscores the prognostic importance of HbA1C and cTnI, especially in the STEMI subset within the larger ACS cohort. The association of these markers with a heightened 30-day mortality rate in STEMI patients stands out. Yet, it is paramount to emphasize that these observations are predominantly tailored to the STEMI subset and may not universally apply to all ACS patients. The null mortality in our NSTEMI cohort punctuates the need for more refined research to discern the implications of HbA1C and cTnI across diverse ACS subgroups. [ABSTRACT FROM AUTHOR]

Background: Depression is present in individuals with type 2 diabetes mellitus. Objective : We evaluated the sociodemographic, anthropometric, and clinical features of Mexican individuals with clinical depressive symptoms in order to identify predictors for depression symptoms; finally, we evaluated if HbA1c levels could be used as a probable diagnostic of depressive symptoms in individuals with type 2 diabetes mellitus. Methods: The population studied consisted of 376 Mexicans with diabetes who were interviewed to collect information about comorbidities and habits. The evaluation of depressive symptoms was performed using the Hamilton scale. For a possible clinical association between HbA1c levels and depressive symptoms, we performed chi-square tests (χ2)/ t tests. A multivariate logistic regression model with the backward conditional method was used to identify predictors of depressive symptoms. An ROC curve was plotted to assess the possible role of HbA1c as a diagnostic predictive test of depression symptoms. Results: A total of 42.8% (n = 161) individuals showed clinical depressive symptoms. When comparing individuals with and without depression symptoms, those with depression symptoms showed higher levels of glucose and HbA1c; additionally, gender (p = 0.04), age (p = 0.006), HbA1c (p < 0.01), and complications related to diabetes were predictive factors for clinical depressive symptoms (p < 0.01). However, HbA1c showed a low diagnostic accuracy for depressive symptoms, with an area under the ROC curve of 0.59. Conclusions: Our findings provided evidence of the sex, age, HbA1c levels, and medical complications as predictors of clinical depressive symptoms in individuals with diabetes mellitus. Nevertheless, HbA1c levels are not useful as a diagnostic instrument for depressive symptom severity in these Mexican individuals. [ABSTRACT FROM AUTHOR]

Introduction: Bariatric surgery (BS) has emerged an effective intervention in achieving significant and sustained weight loss in patients with type 2 diabetes (T2D). However, comprehensive data on the long-term impact of BS on hypertension is scarce. We aimed to investigate the long-term impact of BS on blood pressure management in individuals within a T2D cohort. Methods: This retrospective cohort study was conducted on 119 patients who underwent BS between 2009 and 2012. Baseline and follow-up observations, including blood pressure, HbA1c, BMI, and antihypertensive medication use were obtained from electronic patient records at regular intervals up to and beyond 10-year follow-up. Results: The median follow-up period for the 119 patients was 11.5 years. Mean fall in BMI 4–8 weeks post-surgery was 12%. A sustained reduction in systolic BP was observed up to 10 years post-surgery (154.5 mmHg pre-op vs. 132.8 mmHg at 10 years; p < 0.0001. From 5 years onwards, there were increases in mean glycated hemoglobin (HbA1c) and body mass index (BMI). At latest follow-up (> 5 years after bariatric surgery), the number of individuals prescribed an antihypertensive agent started to increase. This is in the context of the number of the number of individuals on 2–3 antihypertensive agents declining up until 5 years post-BS. Specifically, there was a reduction in the number of prescriptions of an antihypertensive agent over time from 164 prescriptions pre-operatively to 81 at 8 weeks post-operatively, 78 at 6 months, 72 at 1 year, 66 at 5 years before rising at 10 years to 95 prescriptions. Conclusions: Our study shows an overall benefit in the years after bariatric surgery in terms of blood pressure and requirement for antihypertensive medication. However, at 5 years and beyond after surgery, the beneficial effect of bariatric surgery diminishes with respect to an increase in number of antihypertensive medication prescriptions, BMI, and HbA1c. [ABSTRACT FROM AUTHOR]

Introduction: Country-specific evidence-based research is crucial for understanding the role of nonnutritive sweeteners (NNS) in managing type 2 diabetes (T2D). The main aim of this study was to explore the effect of replacing sucrose with sucralose in coffee/tea in Asian Indians with type 2 diabetes (T2D). Methods: This 12-week, parallel-arm randomized controlled trial included 210 participants with T2D, assigned to the intervention group, where sugar/sucrose in coffee or tea was substituted with sucralose, or the control group, where sugar/sucrose was continued. Lifestyle factors remained unchanged. The primary outcome was change in HbA1c. Secondary outcomes were changes in body weight (BW), body mass index (BMI), waist circumference (WC), lipid profiles, and inflammatory markers. Results: At the end of 12 weeks, no change was observed in HbA1c, fasting plasma glucose, lipid profile, and inflammatory markers between or within groups. There was a small but significant reduction in BW (− 0.5 kg [95% CI − 1.0, − 0.1]; p = 0.02), BMI (− 0.2 kg/m2 [− 0.4, 0.0]; p = 0.03), and WC (− 0.8 cm [− 1.4, − 0.3]; p = 0.002) in the intervention group. Improvements were also observed in lipid accumulation product (p = 0.01), visceral adiposity index (p = 0.04), triglyceride/glucose index (p = 0.04), total energy intake (p = 0.04), and carbohydrate intake (p < 0.0001). Conclusions: In Asian Indians with T2D, replacing about 60 kcal of added sucrose with sucralose in coffee/ tea had no benefit on glycemia but resulted in a small reduction in body weight, body mass index, and waist circumference. Trial Registration: Clinical Trials Registry of India (CTRI/2021/04/032686). [ABSTRACT FROM AUTHOR]

Introduction: The study was designed to assess outcomes with once-daily oral semaglutide in adults with type 2 diabetes (T2D) naïve to injectable glucose-lowering agents, in Swedish clinical practice. Methods: In this non-interventional, multicentre study, participants initiated oral semaglutide and were followed for 34–44 weeks. The primary endpoint was glycated haemoglobin (HbA1c) change from baseline to end of study (EOS). Secondary endpoints included body weight (BW) change from baseline to EOS, proportion of participants achieving HbA1c < 7%, and proportion achieving both a HbA1c reduction ≥ 1% and BW reduction of ≥ 3% or ≥ 5%, at EOS. Participants completed Diabetes Treatment Satisfaction Questionnaires (DTSQ status/change) and a dosing conditions questionnaire. Results: A total of 187 participants (mean age 62.5 years) initiated oral semaglutide. Baseline mean HbA1c and BW were 7.8% (n = 177) and 96.9 kg (n = 165), respectively. Estimated mean changes in HbA1c and BW were − 0.88%-points (95% confidence interval [CI] − 1.01 to − 0.75; P < 0.0001) and − 4.72% (95% CI − 5.58 to − 3.86; P < 0.0001), respectively. At EOS, 64.6% of participants had HbA1c < 7%, and 22.9% achieved HbA1c reduction of ≥ 1% and BW reduction of ≥ 5%. DTSQ status and change scores improved by 1.44 (P = 0.0260) and 12.3 points (P < 0.0001), respectively. Oral semaglutide was easy or very easy to consume for 86.4% of participants. Most common adverse events (AEs) were gastrointestinal disorders; nine participants (4.8%) had serious AEs; one (0.5%) experienced severe hypoglycaemia. Conclusion: In this real-world study population, we observed significant reductions in HbA1c and BW in people living with T2D when prescribed semaglutide tablets as part of routine clinical practice in Sweden, with improved treatment satisfaction among participants and no new safety concerns. Trial Registration: NCT04601753. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: The gut microbiome is implicated in the disease process leading to clinical type 1 diabetes, but less is known about potential changes in the gut microbiome after the diagnosis of type 1 diabetes and implications in glucose homeostasis. We aimed to analyse potential associations between the gut microbiome composition and clinical and laboratory data during a 2 year follow-up of people with newly diagnosed type 1 diabetes, recruited to the Innovative approaches to understanding and arresting type 1 diabetes (INNODIA) study. In addition, we analysed the microbiome composition in initially unaffected family members, who progressed to clinical type 1 diabetes during or after their follow-up for 4 years. Methods: We characterised the gut microbiome composition of 98 individuals with newly diagnosed type 1 diabetes (ND cohort) and 194 autoantibody-positive unaffected family members (UFM cohort), representing a subgroup of the INNODIA Natural History Study, using metagenomic sequencing. Participants from the ND cohort attended study visits within 6 weeks from the diagnosis and 3, 6, 12 and 24 months later for stool sample collection and laboratory tests (HbA1c, C-peptide, diabetes-associated autoantibodies). Participants from the UFM cohort were assessed at baseline and 6, 12, 18, 24 and 36 months later. Results: We observed a longitudinal increase in 21 bacterial species in the ND cohort but not in the UFM cohort. The relative abundance of Faecalibacterium prausnitzii was inversely associated with the HbA1c levels at diagnosis (p=0.0019). The rate of the subsequent disease progression in the ND cohort, as assessed by change in HbA1c, C-peptide levels and insulin dose, was associated with the abundance of several bacterial species. Individuals with rapid decrease in C-peptide levels in the ND cohort had the lowest gut microbiome diversity. Nineteen individuals who were diagnosed with type 1 diabetes in the UFM cohort had increased abundance of Sutterella sp. KLE1602 compared with the undiagnosed UFM individuals (p=1.2 × 10−4). Conclusions/interpretation: Our data revealed associations between the gut microbiome composition and the disease progression in individuals with recent-onset type 1 diabetes. Future mechanistic studies as well as animal studies and human trials are needed to further validate the significance and causality of these associations. [ABSTRACT FROM AUTHOR]

Owing to differences in dietary preferences between men and women, the associations between dietary intake frequency and metabolic parameters may differ between the sexes. A retrospective observational study of the checkup findings of 3147 Japanese individuals (968 men, 2179 women) aged 20–59 years was conducted to examine differences in dietary habits and associations between food frequency and blood parameters (eGFR, HbA1c, uric acid, and lipids) by sex and age. Males were more likely to consume meat, fish, soft drinks, and alcohol, whereas women were more likely to consume soybeans, dairy products, vegetables, fruits, and snacks. Multivariate linear regression models adjusted for age and BMI revealed that meat intake frequency was positively associated with HbA1c (β = 0.007, p = 0.03) and negatively associated with eGFR (β = −0.3, p = 0.01) only in males, whereas fish intake frequency was positively associated with eGFR (β = 0.4, p = 0.005) only in females. Egg and soy intake frequencies were positively and negatively associated with non-HDL-C (egg: β = 0.6, p = 0.02; soy: β = −0.3, p = 0.03) only in females. Alcohol consumption frequency was associated with uric acid (M: β = 0.06, p < 0.001; F: β = 0.06, p < 0.001) and HDL-C (M: β = 1.0, p < 0.001; F: β = 1.3, p < 0.001) in both sexes. Future research is needed to determine whether varying the emphasis of dietary guidance by sex and age group is effective, since the effects of dietary preferences on metabolic parameters vary by age and sex. [ABSTRACT FROM AUTHOR]

Diabetes stigma is the social burden of living with diabetes. People with diabetes may experience or perceive an adverse social judgment, prejudice, or stereotype about living with diabetes at work, school, in healthcare settings, popular culture, or relationships. This review describes the methods that have been used to assess diabetes stigma, and explores the prevalence of diabetes stigma, associated sociodemographic and socioeconomic factors, cultural factors, and how diabetes stigma is associated with clinical outcomes, including HbA1c levels, diabetic ketoacidosis, severe hypoglycemia, and chronic complications, in addition to psychosocial complications in youth, adolescents, and adults with type 1 diabetes (T1D) and type 2 diabetes (T2D). The prevalence of diabetes stigma has been reported as high as 78% in adults with T1D, 70% in adults with T2D, 98% in youth and adolescents with T1D, and is unknown in youth and adolescents with T2D. Diabetes stigma has been associated with lower psychosocial functioning, decreased self-care behaviors, higher HbA1c levels, and higher frequency of diabetes complications in adults with T1D and T2D. In adolescents and young adults with T1D, diabetes stigma is associated with lower psychosocial functioning, higher HbA1c levels, and higher frequency of diabetic ketoacidosis and severe hypoglycemia episodes in addition to chronic complications. In youth and adolescents with T2D, one study demonstrated an association of diabetes stigma with lower psychosocial functioning, higher HbA1c levels, and presence of retinopathy. Gaps exist in our understanding of the mechanisms of diabetes stigma, particularly in youth and adolescents with T2D. [ABSTRACT FROM AUTHOR]

Purpose: Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) in the population. In patients with diabetes mellitus, the incidence of non-diabetic nephropathy (NDNP) has been estimated to range from 3% to 69.5%. Personal judgment is frequently employed while deciding whether or not to do a kidney biopsy (KB) on diabetic patients. NDNP alters the prognosis and course of treatment for people with DM. In our study, we examined the incidence of NDNP concurrent with the progression of diabetes mellitus, as well as the laboratory and clinical indicators that could be utilized to forecast it. Methods: A retrospective analysis of 76 diabetic patients who underwent KB was conducted. Based on the pathological diagnoses of these patients, they were categorized as DNP (diabetic nephropathy) or NDNP. The definition of HbA1c variability was determined by calculating the mean HbA1c and the average value of the HbA1c measurements, as well as the standard deviation (SD) for each participant. Results: NDNP was detected in 50% of 76 patients. Among patients with NDNP, 36.8% had focal segmental glomerulosclerosis (FSGS), 23.6% had membranous glomerulonephritis, and 7.8% had IgA nephritis. The NDNP group exhibited significantly higher rates of female gender, absence of diabetic retinopathy, shorter time to diagnosis of diabetes mellitus, chronic kidney disease, and proteinuria, less intensive medication for diabetes mellitus, presence of hematuria and leukociduria, immunological serological marker positivity, and non-HbA1C variability. Risk factors for predicting non-diabetic nephropathy, as determined by multivariate analysis, included female gender, the absence of diabetic retinopathy, non-HbA1c variability and a positive immunological serological test. Conclusion: In this study, a significant number of diabetic patients with chronic kidney disease were diagnosed with NDNP. Identifying these patients allows for treatment of the specific underlying disease. Factors such as the absence of DR, non-HbA1c variability, female gender, and immunological serological test positivity can predict NDNP and guide the clinician's decision on kidney biopsy. Further prospective studies are warranted to validate the efficacy of potential predictive factors like HbA1c variability. [ABSTRACT FROM AUTHOR]

Background: The relationship between gut microbiota and vertigo, specifically Benign Paroxysmal Vertigo (BPV) and Vertigo of Central (VC), remains underexplored. Aim and hypotheses: This study aims to investigate the causal relationships between gut microbiota and two types of vertigo, BPV and VC. Additionally, the study seeks to explore the mediation effects of metabolic, inflammatory, and psychological factors on these relationships. We hypothesize that specific taxa of gut microbiota have a causal effect on the risk of developing BPV and VC. The mediation effects of HbA1c, obesity, major depression, and interleukin-18 levels significantly influence the relationships between gut microbiota and vertigo. Method: Utilizing a bidirectional two-sample Mendelian randomization approach, this study investigated causal associations between gut microbiota and the two types of vertigo. A network MR assessed mediation effects of HbA1c, major depression, obesity, and interleukin-18 levels, with data sourced from several consortia, including MiBioGen. Results: Distinct gut microbiota displayed varying influences on BPV and VC risks. A total of ten taxa affect BPV. Among these, two taxa have an odds ratio (OR) greater than 1, including one class, one order. Conversely, eight taxa have an OR less than 1, encompassing four families, three genera, and one order. The OR for these taxa ranges from 0.693 to 0.930, with p-values between 0.006 and 0.048. For VC, eight taxa were found to have an impact. Five of these taxa exhibit an OR greater than 1, including four genera and one phylum. The OR for these taxa ranges from 1.229 to 2.179, with p-values from 0.000 to 0.046. The remaining three taxa have an OR less than 1, comprising one family and two genera, with an OR range of 0.445 to 0.792 and p-values ranging from 0.013 to 0.050. The mediation analysis for BPV shows that major depression, obesity, and HbA1c are key mediators between specific taxa and BPV. Major depression mediates 28.77% of the effect of family Rhodospirillaceae on BPV. Obesity mediates 13.90% of the effect of class Lentisphaeria/order Victivallales. HbA1c mediates 11.79% of the effect of genus Bifidobacterium, 11.36% of family Bifidobacteriaceae/order Bifidobacteriales. For VC, interleukin-18 levels and major depression are significant mediators. Interleukin-18 levels mediate 6.56% of the effect of phylum Actinobacteria. Major depression mediates 6.51% of the effect of genus Alloprevotella. Conclusion: The study highlights potential causal links between gut microbiota and vertigo, emphasizing metabolic and psychological mediators. These insights underscore the therapeutic potential of targeting gut health in vertigo management. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusions To evaluate the association of glycated haemoglobin (HbA1c) and serum glucose with intraocular pressure (IOP) in a large UK general population.Participants were selected from the UK Biobank, excluding those with eye conditions that may affect IOP. IOP was measured using an ocular response analyser. Goldmann‐correlated IOP (IOPg) and corneal‐compensated IOP (IOPcc) were outcomes of interest, and ocular hypertension was defined as left‐eye IOPg or IOPcc > 21 mmHg. HbA1c and random (non‐fasting) serum glucose were the exposures of interest. Multivariate restricted cubic spline models, as well as linear regression, were applied to explore the associations of interest.Among 68 806 participants (46.5% male), the mean age was 56.7 years. The mean (standard deviation) for IOPg was 15.7 (3.6) mmHg and 15.9 (3.6) mmHg for IOPcc. Occular hypertension was prevalent in 8055 participants (11.7%) and 4178 participants (6.1%) had diabetes. Those with diabetes had higher IOP and a higher prevalence of ocular hypertension. After adjustment for demographic and clinical variables, HbA1c was positively associated with IOP in participants with diabetes, but not in those without diabetes. For every 10‐mmol/mol increase in HbA1c, IOPg increased by 0.20 mmHg (95% confidence interval [CI] 0.12, 0.28) and IOPcc by 0.15 mmHg (95% CI 0.07, 0.23); the odds of ocular hypertension was increased by 6% (95% CI 1.00, 1.13) in participants with diabetes. A borderline positive association between serum glucose and IOP was found only in participants without diabetes.Impaired glycaemic control was associated with elevated IOP and a possible risk of ocular hypertension among participants with diabetes but of normal ocular health. [ABSTRACT FROM AUTHOR]

Background: Large-scale prospective cohort studies on diabetic foot ulcers risk factor screening in China are limited. Therefore, this prospective cohort study aimed to explore the predictive risk factors for diabetic foot ulcers to provide clinicians with concise and effective clinical indicators for identifying a high-risk diabetic foot and guiding the prevention of diabetic foot ulcers. Methods: Patients with diabetes who visited the Department of Endocrinology of Peking University First Hospital from October 2017 to December 2018 were selected as research participants by convenience sampling. A total of 968 patients were included. After enrollment, a dedicated person collected and recorded all baseline data. A dedicated telephone follow-up was conducted every 12-24 months to evaluate whether the endpoint event had occurred. All patients were followed up for an average of 61 (57-71) months, with 95% of them followed up for more than 60 months. According to the occurrence of endpoint events, they were divided into the DFU and non-DFU groups. The data between the two groups were analyzed using independent-sample t-test, Wilcoxon rank sum test, and chi square test. We used univariate and multivariate logistic regression analysis to analyze the factors that affected the occurrence of diabetic foot ulcers. Results and conclusions: After the 5-year follow-up, the incidence of diabetic foot was 25.83%. Multivariate logistic regression analysis revealed that body mass index (odds ratio: 1.046; 95% confidence interval: 1.001-1.093), abnormal pinprick sensation (odds ratio: 4.138; 95% confidence interval: 1.292-13.255), history of fungal foot infection (odds ratio: 2.287; 95% confidence interval: 1.517-3.448), abnormal 128-Hz tuning fork test (odds ratio: 2.628; 95% confidence interval: 1.098-6.294), and HbA1c= 8% (odds ratio: 1.522; 95% confidence interval: 1.014-2.284) were independent predictors of diabetic foot. Our study highlights clinically relevant indicators that may help to prevent the occurrence of diabetic foot and guide timely interventions. [ABSTRACT FROM AUTHOR]

Intermittent fasting has drawn significant interest in the clinical research community due to its potential to address metabolic complications such as obesity and type 2 diabetes mellitus. Various intermittent fasting regimens include alternate-day fasting (24 h of fasting followed by 24 h of eating), time-restricted fasting (fasting for 14 h and eating within a 10 h window), and the 5:2 diet (fasting for two days and eating normally for the other five days). Intermittent fasting is associated with a reduced risk of type 2 diabetes mellitus-related complications and can slow their progression. The increasing global prevalence of type 2 diabetes mellitus highlights the importance of early management. Since prediabetes is a precursor to type 2 diabetes mellitus, understanding its progression is essential. However, the long-term effects of intermittent fasting on prediabetes are not yet well understood. Therefore, this review aims to comprehensively compile existing knowledge on the therapeutic effects of intermittent fasting in managing type 2 diabetes mellitus and prediabetes. [ABSTRACT FROM AUTHOR]

Aims: Human recombinant insulin is currently the only therapy for children and adolescents with type 1 diabetes (T1D), although not always efficient for the glycemic control of these individuals. The interrelation between the gut microbiome and the glycemic control of apparently healthy populations, as well as various populations with diabetes, is undeniable. Probiotics are biotherapeutics that deliver active components to various targets, primarily the gastrointestinal tract. This systematic review and meta-analysis examined the effect of the administration of probiotics on the glycemic control of pediatric and adolescent individuals with T1D. Materials and Methods: Randomized controlled trials employing the administration of probiotics in children and adolescents with T1D (with ≥10 individuals per treatment arm), written in English, providing parameters of glycemic control, such as mean glucose concentrations and glycosylated hemoglobin (HbA1c), were deemed eligible. Results: The search strategy resulted in six papers with contradictory findings. Ultimately, five studies of acceptable quality, comprising 388 children and adolescents with T1D, were included in the meta-analysis. Employing a random and fixed effects model revealed statistically significant negative effect sizes of probiotics on the glycemic control of those individuals, i.e., higher concentrations of glucose and HbA1c than controls. Conclusions: Children and adolescents with T1D who received probiotics demonstrated worse glycemic control than controls after the intervention. Adequately powered studies, with extended follow-up periods, along with monitoring of compliance and employing the proper strains, are required to unravel the mechanisms of action and the relative effects of probiotics, particularly concerning diabetes-related complications and metabolic outcomes. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander peoples are disproportionately impacted by type 2 diabetes. Continuous glucose monitoring (CGM) technology (such as Abbott Freestyle Libre 2, previously referred to as Flash Glucose Monitoring) offers real-time glucose monitoring that is convenient and easy to use compared to self-monitoring of blood glucose (SMBG). However, this technology's use is neither widespread nor subsidised for Aboriginal and Torres Strait Islander peoples with type 2 diabetes. Building on existing collaborations with a national network of Aboriginal and Torres Strait Islander communities, this randomised controlled trial aims to assess the effect of CGM compared to SMBG on (i) haemoglobin A1c (HbA1c), (ii) achieving blood glucose targets, (iii) reducing hypoglycaemic episodes and (iv) cost-effective healthcare in an Aboriginal and Torres Strait Islander people health setting. Methods: This is a non-masked, parallel-group, two-arm, individually randomised, controlled trial (ACTRN12621000753853). Aboriginal and Torres Strait Islander adults with type 2 diabetes on injectable therapy and HbA1c ≥ 7.5% (n = 350) will be randomised (1:1) to CGM or SMBG for 6 months. The primary outcome is change in HbA1c level from baseline to 6 months. Secondary outcomes include (i) CGM-derived metrics, (ii) frequency of hypoglycaemic episodes, (iii) health-related quality of life and (iv) incremental cost per quality-adjusted life year gained associated with the CGM compared to SMBG. Clinical trial sites include Aboriginal Community Controlled Organisations, Aboriginal Medical Services, primary care centres and tertiary hospitals across urban, rural, regional and remote Australia. Discussion: The trial will assess the effect of CGM compared to SMBG on HbA1c for Aboriginal and Torres Strait Islander people with type 2 diabetes in Australia. This trial could have long-term benefits in improving diabetes management and providing evidence for funding of CGM in this population. Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12621000753853. Registered on 15th June 2021. [ABSTRACT FROM AUTHOR]

Background: Uncontrolled type 2 diabetes mellitus (UT2DM) and its associated consequences nowadays have been a global health crisis, especially for adults. Iron has the property to oxidize and reduce reversibly, which is necessary for metabolic processes and excess accumulation of iron indicated by serum ferritin levels could have a significant impact on the pathophysiology of T2DM via generation of reactive oxygen species (ROS). However, no conclusive evidence existed about the association of serum ferritin with the state of glycemic control status. Therefore, this study aimed to evaluate serum ferritin levels and associated factors in uncontrolled T2DM patients and compare them with those of controlled T2DM and non-diabetic control groups. Methods: A hospital-based comparative cross-sectional study was conducted among conveniently selected 156 study participants, who were categorized into three equal groups of uncontrolled T2DM, controlled T2DM, and non-diabetic control groups from October 2 to December 29, 2023 at St. Paul's Hospital Millennium Medical College. A pre-tested structured questionnaire was used to collect socio-demographic and diabetes-related information. The laboratory tests were done using an automated chemistry analyzer and IBM-SPSS statistical software (version-27) was utilized for data entry and analysis with a significance level of p < 0.05. Result: The mean serum ferritin level was noticeably higher in uncontrolled T2DM patients as compared to controlled T2DM and control groups (p < 0.001). It was significantly correlated with HbA1c [r = 0.457, p < 0.001], fasting blood sugar (FBs) [r = 0.386, p < 0.001], serum iron [r = 0.430, p < 0.001], and systolic blood pressure (SBP) [r = 0.195, p = 0.047] in T2DM patients. A multivariate logistic regression model revealed that a rise in HbA1c (AOR = 3.67, 95% CI(1.50–8.98), serum iron (AOR = 1.02, 95% CI(1.01–1.04), male gender (AOR = 0.16, 95% CI(0.05–0.57) and being on oral hypoglycemic agent (OHA) monotherapy (AOR = 0.26, 95% CI(0.07–0.95) were key associated factors for the elevated serum ferritin among T2DM patients. Conclusion: The present study demonstrated that T2DM patients had elevated serum ferritin levels which might be related to the existence of long-term hyperglycaemia and that serum ferritin had a significant positive association with HbA1c and FBs, implying that it could be used as an additional biomarker to predict uncontrolled T2DM patients. [ABSTRACT FROM AUTHOR]

Glycated proteins are generated by binding of glucose to the proteins in blood stream through a nonenzymatic reaction. Hemoglobin A1c (HbA1c) is a glycated protein with glucose at the N‐terminal of β‐chain. HbA1c is extensively used as an indicator for assessing the blood glucose concentration in diabetes patients. There are different conventional clinical methods for the detection of HbA1c. However, enzymatic detection method has newly obtained great attention for its high precision and cost‐effectiveness. Today, fructosyl peptide oxidase (FPOX) plays a key role in the enzymatic measurement of HbA1c, and different companies have marketed HbA1c assay systems based on FPOX. Recent investigations show that FPOX could be used in assaying HbA1 without requiring HbA1c primary digestion. It could also be applied as a biosensor for HbA1c detection. In this review, we have discussed the recent improvements of FPOX properties, different methods of FPOX purification, solubility, and immobilization, and also the use of FPOX in HbA1c biosensors. [ABSTRACT FROM AUTHOR]

Optimal glucose control is crucial for maintaining brain health and preventing metabolic and cognitive disorders in the general population. Glycosylated hemoglobin (HbA1c) serves as a key marker for assessing glucose intolerance and its impact on brain structure and function in healthy individuals. However, existing literature presents conflicting findings, necessitating a systematic review to consolidate current knowledge in this domain. This systematic review examines 26 English‐language studies involving participants aged 15 years and above, investigating the relationship between HbA1c levels and brain health. Studies focusing on normal/general populations and utilizing magnetic resonance imaging (MRI) as the imaging modality were included. Exclusion criteria encompassed review articles, abstracts, letters, animal studies, and research involving neuropsychiatric or metabolic diseases. Data were gathered from PubMed, Scopus, and Web of Science databases up to November 2023. Analysis reveals significant associations between HbA1c levels and various brain metrics, including volume, cortical thickness, fractional anisotropy, mean diffusivity, activity, and connectivity. However, findings exhibit inconsistency, likely attributed to disparities in sample characteristics and study sizes. Notably, hippocampal volume, white matter hyperintensity, and ventral attention network connectivity emerge as frequently affected structures and functions, mirroring trends observed in diabetic populations. Despite inconclusive evidence, glucose intolerance appears to exert considerable influence on select brain structures and functions in individuals without diagnosed metabolic disorders. Understanding these associations is critical for mitigating the risk of cognitive decline and dementia in healthy populations. Future investigations should aim to elucidate the intricate relationship between HbA1c concentrations and brain health parameters in normoglycemic individuals. [ABSTRACT FROM AUTHOR]

Purpose: Glycosylated hemoglobin (HbA1c) is commonly used as a monitoring tool in diabetes. Due to the potential influence of insulin resistance (IR), HbA1c level may fluctuate over a person's lifetime. This study explores the long-term tracking of HbA1c level in individuals diagnosed with type 1 diabetes mellitus (T1DM) from infancy to early adulthood. Methods: The HbA1c levels in 275 individuals (121 males, 43.8%) diagnosed with T1DM were tracked for an average of 9.4 years. The distribution of HbA1c levels was evaluated according to age with subgroups divided by gender, use of continuous glucose monitoring (CGM), and the presence of complications. Results: HbA1c levels were highest at the age of 1 year and then declined until age 4, followed by a significant increase, reaching a maximum at ages 15–16 years. The levels subsequently gradually decreased until early adulthood. This pattern was observed in both sexes, but it was more pronounced in females. Additionally, HbA1c levels were higher in CGM nonusers compared with CGM users; however, regardless of CGM usage, an age-dependent pattern was observed. Furthermore, diabetic complications occurred in 26.8% of individuals, and the age-dependent pattern was observed irrespective of diabetic complications, although HbA1c levels were higher in individuals with diabetic complications. Conclusion: HbA1c levels vary throughout the lifespan, with higher levels during adolescence. This trend is observed regardless of sex and CGM usage, potentially due to physiological IR observed during adolescence. Hence, physiological IR should be considered when interpretating HbA1c levels during adolescence. [ABSTRACT FROM AUTHOR]

Background: Diabetes Mellitus is a prevalent metabolic disorder influenced by genetic and environmental factors, with India facing a substantial rise in its diabetic population. Recent research has highlighted the association between elevated body iron levels and the onset of diabetes and its complications. This study aimed to explore the relationship between Serum Ferritin, HbA1c%, and Blood Glucose in patients with Type 2 Diabetes Mellitus. To evaluate the association between Serum Ferritin, HbA1c%, and Blood Glucose in patients with Type 2 Diabetes Mellitus. Material & Method: This cross-sectional study was conducted among patients with Type 2 Diabetes Mellitus attending the outpatient and inpatient departments of MNR Medical College & Hospital from June 2023 to January 2024. Patients meeting the inclusion criteria were enrolled, while those with specific exclusions were excluded. Detailed demographic and medical history data were collected, and blood samples were obtained for various biochemical analyses. Statistical analysis was performed using SPSS version 20. Results: The study included 100 patients, with no significant demographic differences between groups. Participants with diabetes exhibited significantly higher fasting and postprandial blood glucose levels, glycemic control, and LDL cholesterol compared to controls (p<0.05). Serum ferritin showed significant correlations with blood glucose (FBS=0.59, PPBS=0.69) and HbA1c (r=0.62). Conclusion: Elevated Serum Ferritin levels correlated significantly with higher Blood Glucose and HbA1c levels in patients with Type 2 Diabetes Mellitus, suggesting a potential role of iron metabolism in glycemic control. These findings underscore the importance of further investigation into the link between iron status and diabetes management. [ABSTRACT FROM AUTHOR]

Background: In type 2 diabetes mellitus, lipid abnormalities that are all recognized as major risk factors for coronary artery disease and other macro vascular complications. Present study was aimed to study HbA1c as a biomarker of dyslipidemia in type 2 diabetes patients. Material and Methods: Present study was hospital-based case control study, conducted in 100 subjects of age group of 20-85 years, newly diagnosed diabetic cases not on statins and compared with 100 healthy age and gender matched non diabetic individuals. Results: Present study included 100 type 2 diabetic cases and an equal number of age and gender matched controls. Mean glycated haemoglobin levels were significantly higher among diabetics as compared to controls (8.56% vs 5.64%; p<0.01). Mean lipid parameters like triglycerides (142.4 vs 126.74 mg%), total cholesterol (168.48 vs 155.67 mg%) and LDL levels (112.37 vs 78.22 mg%) were significantly higher among diabetics as compared to non-diabetics (p<0.05). While mean HDL levels were significantly lower (39.99 vs 52.68 mg%; p<0.01). Prevalence of dyslipidaemia was observed in 89% cases as compared to 37% controls. The difference was statistically significant (p<0.01). On Pearson correlation analysis, significant correlation was observed between all lipid parameters i.e. triglycerides, total cholesterol, LDL levels with glycated haemoglobin levels while inverse correlation was observed with HDL (p<0.01). Poor glycemic control was significantly associated with prevalence of dyslipidaemia. Prevalence was 88.4% in subjects with poor glycemic control as compared to 52.8% in subjects with good control (p- 0.03). On regression analysis, raised glycated haemoglobin levels were observed as a significant predictor of development of dyslipidaemia among type 2 diabetic cases. Conclusion: A high prevalence of dyslipidemia was observed among cases of diabetes. We also observed a significant correlation between HbA1c and lipid profile parameters. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes mellitus (DM) is rapidly increasing, affecting approximately 350 million people globally. The World Health Organization projects that diabetes-related deaths will double between 2005 and 2030. Type 2 diabetes mellitus (T2DM), which accounts for over 90% of all diabetes cases, significantly impacts cardiovascular health, often leading to left ventricular (LV) diastolic dysfunction, a hallmark of diabetic cardiomyopathy. Aim: To assess the incidence of LV diastolic dysfunction in normotensive T2DM patients and to evaluate the correlation between diastolic dysfunction and HbA1c levels. Methods: This cross-sectional study included normotensive T2DM patients with a minimum of 5 years of disease duration. Echocardiography was used to assess diastolic function, and HbA1c levels were measured. Statistical analysis was conducted to determine the correlation between HbA1c levels and diastolic dysfunction. Results: Diastolic dysfunction is prevalent in asymptomatic T2DM patients, even in the absence of overt cardiovascular complications. Higher HbA1c levels were significantly associated with increased incidence of diastolic dysfunction. Conclusion: Early detection and management of LV diastolic dysfunction in T2DM patients through regular monitoring of HbA1c levels can help mitigate the adverse cardiovascular outcomes associated with diabetes. Doppler echocardiography proves to be an effective non-invasive method for this purpose. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted for evaluating the efficacy of Intrathecal levobupivacaine and bupivacaine among patients undergoing inguinal hernia surgery under spinal anesthesia. Materials & methods: A total of 50 patients were enrolled and were randomized into two study groups as follows: Group 1- intrathecal isobaric levobupivacaine, and Group 2- intrathecal hyperbaric racemic bupivacaine. Complete demographic and clinical details of all the patients was obtained. Anthropometric examination of all the patients was done. Patients having history of any systemic illness, or any known drug allergy were excluded. Complete baseline hemodynamic and biochemical profile at baseline was evaluated. All the patients underwent type of spinal according to their respective study groups. Quality of anesthesia was assessed. Motor and sensory block characteristics were also evaluated. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean age of the patients of the group 1 and group 2 was 43.8 years and 45.1 years respectively. Majority proportion of patients of both the study groups were males. Among patients of group 1, excellent and satisfactory anesthesia was seen in 84 percent and 16 percent of the patients respectively. Among patients of group 2, excellent and satisfactory anesthesia was seen in 88 percent and 12 percent of the patients respectively. Mean onset of sensory and motor block were similar for both the study groups. However; mean duration of motor block was significantly lower in group 1 (176.3 mins) in comparison to group 2 (191.7 mins). Conclusion: Levobupivacaine offered high quality of anesthesia among patients having spinal anesthesia with shorter duration of motor block, allowing quicker recovery. [ABSTRACT FROM AUTHOR]